Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia.
BMC Pulm Med. 2023 Nov 23;23(1):467. doi: 10.1186/s12890-023-02757-1.
In a cohort, observational prospective trial, we assessed the long-term dynamics of sleep-disordered breathing in patients with resistant hypertension after renal denervation and their association with blood pressure change at remote follow-up.
Twenty-eight patients with stable hypertension who were recruited for endovascular radiofrequency renal denervation in 2012-2019 and had valid both baseline and follow-up sleep study, were included in the analysis. All patients underwent physical examination, anthropometry, office and ambulatory blood pressure measurements, blood and urine tests, kidney visualization, and full polysomnography before and within 12-36 months after renal denervation.
The average follow-up comprised 30.1 ± 8.4 months. At long-term follow-up, no significant changes in creatinine level, estimated glomerular filtration rate, body mass index were registered. There was a significant increase in sleep apnea severity indices: the mean change in apnea-hypopnea index comprised 9.0(-21.1;25.2) episodes/h, in oxygen desaturation index 6.5(-16.8;35.9) episodes/h, in the average SpO -1.7(-5.6;1.9)%. Over 12-month follow-up, there were no significant differences in blood pressure response in patients with and without sleep apnea. The baseline apnea-hypopnea and oxygen desaturation indices and the mean SpO were associated with the circadian blood pressure profile at follow-up, but did not correlate with the blood pressure response.
Although the severity of sleep apnea worsens at > 12 months follow-up after renal denervation, this is not associated with hypertension exaggeration.
在一项队列、观察性前瞻性试验中，我们评估了肾去神经术后难治性高血压患者睡眠呼吸障碍的长期动态变化及其与远程随访时血压变化的关系。
2012 年至 2019 年，我们招募了 28 例稳定型高血压患者进行血管内射频肾去神经术，并对其进行了基线和随访睡眠研究，将这些患者纳入分析。所有患者均在肾去神经术前和术后 12-36 个月内接受体格检查、人体测量、诊室和动态血压测量、血液和尿液检查、肾脏影像学和全面多导睡眠图检查。
平均随访时间为 30.1±8.4 个月。长期随访时，肌酐水平、估算肾小球滤过率和体重指数无显著变化。睡眠呼吸暂停严重程度指数有显著增加：呼吸暂停低通气指数平均变化 9.0（-21.1；25.2）次/小时，氧减指数 6.5（-16.8；35.9）次/小时，平均 SpO2 下降 1.7（-5.6；1.9）%。在 12 个月的随访中，有睡眠呼吸暂停和无睡眠呼吸暂停患者的血压反应无显著差异。基线呼吸暂停低通气和氧减指数以及平均 SpO2 与随访时的昼夜血压谱相关，但与血压反应无关。
尽管肾去神经术后 >12 个月时睡眠呼吸暂停的严重程度恶化，但这与高血压加重无关。
