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持续气道正压通气治疗阻塞性睡眠呼吸暂停合并高血压的有效性:一项传统综述。

Effectiveness of Continuous Positive Airway Pressure in Treating Hypertension in Obstructive Sleep Apnea: A Traditional Review.

作者信息

Modi Naisargi Shrikant, Bajoria Parth S, Dave Prathma Anandbhai, Rohit Ralph Kingsford, Tibrewal Charu, Patel Priyansh, Gandhi Siddharth Kamal, Gutlapalli Sai Dheeraj, Diaz Keith, Nfonoyim Jay

机构信息

Department of Internal Medicine, Civil Hospital Ahmedabad, Ahmedabad, IND.

Department of Internal Medicine, GMERS (Gujarat Medical Education and Research Society) Medical College Gandhinagar, Gandhinagar, IND.

出版信息

Cureus. 2023 Jul 19;15(7):e42111. doi: 10.7759/cureus.42111. eCollection 2023 Jul.

Abstract

Almost one billion individuals worldwide suffer from obstructive sleep apnea (OSA). The most widely used treatment for OSA has been continuous positive airway pressure (CPAP), but its effect on blood pressure (BP) has been challenged. Our review aims to evaluate the effects of treating OSA with CPAP on BP and BP-related morbidities in adult hypertensive patients. Medical subject headings (MeSH) terminology was used to search the PubMed Central, MEDLINE, and PubMed databases for articles on the use of CPAP in OSA patients with hypertension. We selected various forms of academic writing, encompassing complete texts that were published in the English language. The study included a total of 21 papers. OSA is a serious health concern associated with a higher risk of cardiovascular disease, kidney disease, pulmonary hypertension, and aortic stiffness, which is brought on by the periodic hypoxia caused by nocturnal respiratory episodes. For individuals with moderate-to-severe OSA, CPAP therapy has been shown to have a considerable long-term benefit with a median drop of 11 mm Hg, and high adherence results in a decrease in diastolic BP. CPAP therapy directly lowers BP in OSA patients with a body mass index (BMI) of more than 30 kg/m2 and has also demonstrated improvement in early signs of atherosclerosis with lower nocturnal systolic BP levels. OSA patients with resistant hypertension also experienced lower BP after using CPAP for a year. Therefore, our findings suggest that obesity, hypersomnolence, high nocturnal BP, prolonged CPAP usage, and resistant hypertension may all have a major impact on the BP response to CPAP therapy in individuals with severe OSA.

摘要

全球近10亿人患有阻塞性睡眠呼吸暂停(OSA)。OSA最广泛使用的治疗方法是持续气道正压通气(CPAP),但其对血压(BP)的影响一直受到质疑。我们的综述旨在评估成人高血压患者使用CPAP治疗OSA对血压及与血压相关疾病的影响。使用医学主题词(MeSH)术语在PubMed Central、MEDLINE和PubMed数据库中搜索关于CPAP在OSA合并高血压患者中应用的文章。我们选择了各种形式的学术著作,包括以英文发表的完整文本。该研究共纳入21篇论文。OSA是一个严重的健康问题,与心血管疾病、肾脏疾病、肺动脉高压和主动脉僵硬度增加的风险相关,这是由夜间呼吸事件导致的周期性缺氧引起的。对于中重度OSA患者,CPAP治疗已显示出相当大的长期益处,平均降幅为11毫米汞柱,高依从性会导致舒张压降低。CPAP治疗可直接降低体重指数(BMI)超过30kg/m²的OSA患者的血压,还显示出随着夜间收缩压水平降低,动脉粥样硬化早期迹象有所改善。难治性高血压的OSA患者在使用CPAP一年后血压也有所降低。因此,我们的研究结果表明,肥胖、嗜睡、夜间高血压、长期使用CPAP以及难治性高血压可能都会对重度OSA患者对CPAP治疗的血压反应产生重大影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/da11/10436127/66026e245f9f/cureus-0015-00000042111-i01.jpg

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