Yu Liangcai, Shu Lan, Gao Simin, Li Lin
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Zigong Fourth People's Hospital, Zigong, China.
Front Neurol. 2025 Jul 7;16:1587127. doi: 10.3389/fneur.2025.1587127. eCollection 2025.
To investigate the effects of continuous positive airway pressure (CPAP) therapy on sleep architecture, particularly the microarousal index (MAI), and the frequency of nocturnal acute blood pressure surge events (NBPF) in patients with obstructive sleep apnea (OSA), and to analyze the association between improvements in sleep architecture (especially reduced MAI) and decreased NBPF.
A retrospective analysis was conducted on 477 patients diagnosed with OSA at the Sleep Medicine Center of West China Fourth Hospital, Sichuan University, between January 2021 and January 2023, who received CPAP therapy (mean age 42.70 ± 10.90 years; mild: 92, moderate: 108, severe: 277). Comparisons were made of polysomnography (PSG)-monitored sleep architecture parameters (N1%, N2%, N3%, R%, MAI) and nocturnal blood pressure indices (SBP, DBP, NBPF) before and after CPAP treatment. NBPF was defined as the number of events per hour where nocturnal systolic blood pressure (SBP) increased by >12 mmHg.
(1) Baseline characteristics: N1%, N2%, SBP, DBP, and NBPF significantly increased, while R% and N3% significantly decreased with increasing severity of OSA ( < 0.05). (2) Overall efficacy: After CPAP treatment, N1% significantly decreased, N3% significantly increased, and DBP and NBPF significantly decreased ( < 0.05). (3) Subgroup analysis: All patients experienced significant reductions in MAI, N1%, N2%, and NBPF, and significant increases in R% after CPAP treatment ( < 0.05); N3% significantly increased in moderate and severe patients ( < 0.05); SBP and DBP improvements were most significant in severe patients ( < 0.05). (4) Correlation and linear regression analysis: NBPF was significantly correlated with sleep structure parameters, showing an independent positive correlation with MAI ( = 0.375, < 0.001) and an independent negative correlation with N3% ( = -0.143, = 0.001).
The first night of positive airway pressure (PAP) therapy significantly improves sleep architecture and effectively reduces nocturnal blood pressure while suppressing acute systolic blood pressure (NBPF) elevations in OSA patients, especially those with severe disease.
探讨持续气道正压通气（CPAP）治疗对阻塞性睡眠呼吸暂停（OSA）患者睡眠结构的影响，尤其是微觉醒指数（MAI），以及夜间急性血压激增事件（NBPF）的发生频率，并分析睡眠结构改善（尤其是MAI降低）与NBPF降低之间的关联。
对2021年1月至2023年1月在四川大学华西第四医院睡眠医学中心确诊为OSA并接受CPAP治疗的477例患者进行回顾性分析（平均年龄42.70±10.90岁；轻度：92例，中度：108例，重度：277例）。比较了CPAP治疗前后多导睡眠图（PSG）监测的睡眠结构参数（N1%、N2%、N3%、R%、MAI）和夜间血压指标（收缩压、舒张压、NBPF）。NBPF定义为夜间收缩压（SBP）升高>12 mmHg时每小时的事件数。
（1）基线特征：随着OSA严重程度增加，N1%、N2%、收缩压、舒张压和NBPF显著升高，而R%和N3%显著降低（<0.05）。（2）总体疗效：CPAP治疗后，N1%显著降低，N3%显著升高，舒张压和NBPF显著降低（<0.05）。（3）亚组分析：所有患者在CPAP治疗后MAI、N1%、N2%和NBPF均显著降低，R%显著升高（<0.05）；中度和重度患者N3%显著升高（<0.05）；重度患者收缩压和舒张压改善最为显著（<0.05）。（4）相关性和线性回归分析：NBPF与睡眠结构参数显著相关，与MAI呈独立正相关（=0.375，<0.001），与N3%呈独立负相关（=-0.143，=0.001）。
气道正压通气（PAP）治疗的第一晚可显著改善睡眠结构，并有效降低夜间血压，同时抑制OSA患者尤其是重症患者的急性收缩压（NBPF）升高。
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