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背景阻塞性睡眠呼吸暂停综合征(OSAS)与高血压相关,持续气道正压通气(CPAP)可有效改善OSAS患者的睡眠情况,但在血压控制方面的效果尚存争议。目的探究CPAP在中重度OSAS合并高血压患者血压控制中的作用。方法选取阜外心血管病医院高血压诊治中心2010年9月至2014年9月诊断为中重度OSAS合并高血压患者117例进行回顾性分析(失访31例),其中对照组65例,只给予常规降压药物治疗;CPAP治疗组52例,除常规药物治疗外加用CPAP治疗。每3月随访1次,2014年10月1日截止,对照组随访(41.95±22.18)月,CPAP组随访(39.43±24.74)月(P>0.05)。比较两组患者血压变化情况,分析CPAP对OSAS合并高血压患者血压的影响。结果除糖尿病比例外,两组患者基本情况的差异无统计学意义,CPAP组呼吸暂停低通气指数、氧减饱和度指数更高。经过治疗后,CPAP组收缩压下降较对照组更明显[(12.6±18.1)比(4.5±16.8)mm Hg,P=0.02],但两组舒张压下降的差异无统计学意义[(10.0±12.4)比(6.9±15.0)mm Hg,P=0.23],并且治疗组增加降压药种类的患者明显少于对照组(2.0%比20.3%,P<0.01)。结论 CPAP可在药物治疗基础上进一步降低中重度OSAS合并高血压患者的收缩压。
Background Obstructive sleep apnea syndrome (OSAS) is associated with hypertension, and continuous positive airway pressure (CPAP) can effectively improve sleep in OSAS patients, but the effect of blood pressure control is still controversial. Objective To investigate the role of CPAP in blood pressure control in patients with moderate-severe OSAS and hypertension. Methods A total of 117 patients diagnosed as moderate-to-severe OSAS complicated with hypertension from September 2010 to September 2014 in Fuwai Cardiovascular Hospital Hypertension Diagnostic Center were retrospectively analyzed (31 patients were lost to follow-up), including 65 in the control group Given conventional antihypertensive drug treatment; CPAP treatment group of 52 patients, in addition to conventional drug therapy plus CPAP treatment. The patients were followed up once every 3 months and ended on October 1, 2014. The control group was followed up for 41.95 ± 22.18 months and the CPAP group was followed up for 39.43 ± 24.74 months (P> 0.05). The changes of blood pressure in two groups were compared, and the effect of CPAP on blood pressure in patients with OSAS complicated with hypertension was analyzed. Results In addition to the proportion of diabetes, the difference between the two groups was not statistically significant, CPAP group, apnea-hypopnea index, oxygen desaturation index higher. After treatment, the systolic blood pressure in CPAP group was significantly lower than that in control group [(12.6 ± 18.1) vs (4.5 ± 16.8) mm Hg, P = 0.02], but there was no significant difference in diastolic blood pressure between the two groups (6.9 ± 15.0) mmHg, P = 0.23], and the number of antihypertensive drugs in the treatment group was significantly less than that in the control group (2.0% vs 20.3%, P <0.01). Conclusions CPAP can further reduce the systolic blood pressure in patients with moderate-severe OSAS complicated with hypertension on the basis of medical treatment.