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目的了解经鼻持续气道内正压通气(CPAP)治疗对阻塞性睡眠呼吸暂停(OSA)患者24h血压变异性的影响。方法采用24h动态血压(ABP)和多导睡眠(PSG)同步监测的方法,对62例患者按照呼吸紊乱指数(AHI)分为正常对照组、轻度OSA组和中重度OSA组,观察3组患者24h的血压情况。对中重度OSA患者同步进行一夜CPAP治疗和24hABP监测,观察一夜CPAP治疗对24h血压变异性的影响。结果依据AHI评分,正常组20例,轻度OSA组22例,中重度OSA组20例。中重度OSA组的24h平均压为(100.4±15.7)mmHg,明显高于对照组的(92.1±12.5)mmHg及轻度OSA组的(94.0±10.2)mmHg(P均﹤0.01);中重度OSA组经CPAP治疗一夜后,睡眠阶段的收缩压及舒张压的变异程度分别减少了7.25及9.12,但其他时间段的血压变异性无明显变化。结论OSA患者24h血压有特征性的改变,对于中重度OSA患者来说,有效的CPAP治疗在纠正呼吸障碍的同时可能对降低血压变异程度有重要的意义。
Objective To investigate the effect of nasal continuous positive airway pressure (CPAP) on blood pressure variability in patients with obstructive sleep apnea (OSA). Methods Sixty-two patients were divided into normal control group, mild OSA group and moderate-severe OSA group according to the synchronous respiratory disturbance index (AHI) by using ABP and PSG. Patients 24h blood pressure. Simultaneous overnight CPAP treatment and 24hABP monitoring were performed in patients with moderate-severe OSA. The effects of CPAP on blood pressure variability of 24h were observed. Results According to AHI, there were 20 cases in normal group, 22 cases in mild OSA group and 20 cases in moderate and severe OSA group. The average 24h pressure was (100.4 ± 15.7) mmHg in moderate and severe OSA group, which was significantly higher than that in control group (92.1 ± 12.5) mmHg and (94.0 ± 10.2) mmHg in mild OSA group (all P <0.01) After CPAP treatment for one night, the systolic and diastolic variability in sleep stage decreased by 7.25 and 9.12, respectively, but there was no significant change in blood pressure variability at other time points. Conclusions There is a characteristic change of blood pressure at 24h in patients with OSA. For patients with moderate-severe OSA, effective CPAP therapy may play an important role in reducing the degree of variability of blood pressure while correcting respiratory disorders.