Lin Ruihan, Zhang Yuan, Yan Wenjie, Hu Wenru, Chen Yuwei, Yi Minhan
Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
J Sleep Res. 2024 Apr;33(2):e13965. doi: 10.1111/jsr.13965. Epub 2023 Jul 5.
Obstructive sleep apnea (OSA) and cardiovascular co-morbidities have a mutually reinforcing effect, but existing studies have focussed only on the improvement of the associated co-morbidities by treatment for OSA. To provide fresh guidelines for the treatment of OSA from a co-morbidity standpoint, we conducted a systematic search of Web of Science, PubMed, EMBASE, and the Cochrane Library for articles published from inception up to 2 May 2023. Fourteen original studies of patients with OSA with cardiovascular co-morbidities and who received related treatment were included in the analysis. We found that diuretic treatment can reduce the apnea-hypopnea index in patients with OSA and hypertension (-19.41/h, p = 1.0 × 10 ), aldosterone-angiotensin inhibitors also have a 9.19/h reduction (p = 0.003), while the effect of renal sympathetic denervation is insignificant (-2.32/h, p = 0.19). The short-term treatment (<4 weeks) did not show an improvement (-2.72/h, p = 0.16), while long-term treatment (>4 weeks) produced surprising outcomes (-12.78/h, p = 0.002). Patients with milder disease (baseline AHI < 35/h) had insignificant improvements (-1.05/h, p = 0.46), whereas those with more severe disease (baseline AHI > 35/h) could achieve satisfactory outcomes (-14.74/h, p < 0.00001). In addition, it also showed some improvement in the oxygen desaturation index and blood oxygen. Our results support the additional benefit of antihypertensive treatment for OSA symptoms, and the efficacy can be affected by different therapy, treatment duration, and severity levels. It could be useful in developing clinical therapy, educating patients, and exploring interaction mechanisms. The proposal was registered with PROSPERO (CRD42022351206).
阻塞性睡眠呼吸暂停（OSA）与心血管合并症具有相互促进的作用，但现有研究仅关注通过治疗OSA来改善相关合并症。为了从合并症角度为OSA治疗提供新的指导方针，我们对科学网、PubMed、EMBASE和考克兰图书馆进行了系统检索，以查找从创刊至2023年5月2日发表的文章。分析纳入了14项关于患有心血管合并症且接受相关治疗的OSA患者的原始研究。我们发现，利尿剂治疗可降低OSA合并高血压患者的呼吸暂停低通气指数（-19.41次/小时，p = 1.0×10），醛固酮 - 血管紧张素抑制剂也可使其降低9.19次/小时（p = 0.003），而肾交感神经去传入术的效果不显著（-2.32次/小时，p = 0.19）。短期治疗（<4周）未显示出改善（-2.72次/小时，p = 0.16），而长期治疗（>4周）产生了令人惊讶的结果（-12.78次/小时，p = 0.002）。病情较轻（基线呼吸暂停低通气指数<35次/小时）的患者改善不显著（-1.05次/小时，p = 0.46），而病情较重（基线呼吸暂停低通气指数>35次/小时）的患者可取得满意的结果（-14.74次/小时，p < 0.00001）。此外，它在氧饱和度指数和血氧方面也有一定改善。我们的结果支持抗高血压治疗对OSA症状的额外益处，且疗效可能受不同治疗方法、治疗持续时间和严重程度水平的影响。这对于制定临床治疗方案、教育患者以及探索相互作用机制可能有用。该提议已在国际前瞻性注册系统（PROSPERO）注册（CRD42022351206）。
