短期持续正压通气对老年与非老年阻塞性睡眠呼吸暂停低通气综合征合并高血压患者降压疗效比较

Efficiency of short-term continuous positive airway pressure therapy on obstructive sleep apnea hypopnea syndrome in senile and non-senile hypertension patients

摘要:

目的 比较短期持续正压通气（CPAP）治疗对老年与非老年阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并高血压患者的降压疗效。方法 入选2012年11月至2013年5月在新疆维吾尔自治区人民医院高血压科住院经多导睡眠监测确诊的OSAHS合并高血压患者100例，按年龄分为老年组与非老年组。在原有降压药物治疗基础上，给予连续每日夜间CPAP治疗＞6h，持续1周。监测两组每日血压水平，对治疗前后血压、血压下降幅度及血压达标率做组内自身前后对照比较，分析短期CPAP治疗对两组患者降压疗效差异。结果 （1）非老年组CPAP治疗第7天晨起收缩压[mSBP，（135.0±13.2） vs （140.6±15.0）mmHg，P＜0.05，1mmHg＝0.133kPa]、晨起舒张压[mDBP，（86.3±9.3） vs （93.3±11.5）mmHg，P＜0.05]、晨起平均动脉压[（102.6±9.8） vs （109.1±11.7）mmHg（P＜0.05）]均低于治疗前，第7天晨起平均动脉压下降幅度[（9.2±11.7） vs （5.0±10.7）mmHg，P＜0.05]大于第1天；老年组差异均无统计学意义（P＞0.05）；（2）非老年组CPAP治疗第7天mSBP达标率（80.7% vs 45.5%，P＜0.05）、mDBP达标率（80.7% vs 29.5%，P＜0.05）高于治疗前；老年组差异均无统计学意义（P＞0.05）。结论 短期CPAP治疗对非老年OSAHS合并高血压患者降压疗效优于老年患者。

Abstract:

Objective To determine the effects of short-term continuous positive airway pressure (CPAP) therapy on obstructive sleep apnea hypopnea syndrome (OSAHS) in the senile and non-senile patients with coexisting hypertension. Methods A total of 100 inpatients suffering from OSAHS determined by polysomnography and hypertension admitted in our center from November 2012 to May 2013 were subjected in this study. They were divided into 2 groups according to their age over or under 60 years old, senile (n＝12) and non-senile groups (n＝88). Besides pre-existing antihypertensive medication, they were all given nocturnal CPAP therapy for 7 consecutive days (＞6h/night). Their daily blood pressure, pre- and post-treatment blood pressure, decrease of the pressure and ratio of those achieving target blood pressure goal were measured and calculated, and the results were compared before and after treatment, and between the 2 groups for the efficiency of CPAP therapy. Results (1) In the 7th day after treatment, the morning systolic blood pressure [mSBP, (135.0±13.2) vs (140.6±15.0)mmHg, P＜0.05, 1mmHg＝0.133kPa], morning diastolic blood pressure [mDBP, (86.3±9.3) vs (93.3±11.5)mmHg, P＜0.05], and morning mean blood pressure [(102.6±9.8) vs (109.1±11.7)mmHg, P＜0.05] were significantly reduced when compared with the values before treatment in non-senile group, and the decrease of morning mean blood pressure at day 7 was greater than at day 1 after CPAP treatment [(9.2±11.7) vs (5.0±10.7)mmHg, P＜0.05]. Whereas, no such difference was seen in the senile group (P＞0.05). (2) The ratios of achieving target mSBP (80.7% vs 45.5%, P＜0.05) and mDBP (80.7% vs 29.5%, P＜0.05) were obviously higher in the non-senile group at day 7 than before the treatment. But there was no significant difference in the senile group (P＞0.05). Conclusion Short-term CPAP therapy has better efficiency in non-senile than senile patients in the treatment of OSAHS with coexisting hypertension.