[Effects of CPAP therapy on blood pressure and vascular endothelial function in hypertensive patients with moderate-to-severe obstructive sleep apnea].

摘要

Objective: To investigate the effect of continuous positive airway pressure (CPAP) therapy on blood pressure and vascular endothelial function in patients with hypertension and moderate-to-severe obstructive sleep apnea (OSA). Methods: This was a retrospective study. Patients diagnosed with hypertension and moderate-to-severe OSA in the Department of Hypertension, Tianjin Kanghui Hospital, from October 2023 to December 2024 were enrolled. Patients were divided into the observation group (received standard CPAP therapy ≥4 hours per night and ≥5 nights per week) and the control group (did not receive CPAP therapy). Both groups received standard antihypertensive medication and were observed continuously for 24 weeks. Vascular endothelial function was assessed by flow-mediated dilation (FMD) of the brachial artery, and blood pressure fluctuations were evaluated by ambulatory blood pressure monitoring. Spearman rank correlation analysis was used to evaluate the correlation between changes in endothelial function and changes in blood pressure parameters. Antihypertensive medication load was assessed using the defined daily dose of antihypertensive drugs. Results: A total of 109 patients with hypertension and moderate-to-severe OSA were enrolled, with an age of (47.13±11.21) years, including 15 females (14%). There were 54 patients in the observation group and 55 in the control group. After 24 weeks of treatment, FMD was higher in the observation group than in the control group ((7.15±1.15)% vs. (4.08±1.46)%, P0.001). Ambulatory blood pressure monitoring showed that the mean 24-hour systolic blood pressure ((120.96±5.27) mmHg vs. (124.71±3.15) mmHg) and mean 24-hour diastolic blood pressure ((77.36±6.99) mmHg vs. (81.60±3.67) mmHg) were lower in the observation group than in the control group (both P0.05). Specifically, the mean daytime systolic blood pressure ((123.86±5.83) mmHg vs. (126.73±4.65) mmHg), mean daytime diastolic blood pressure ((80.12±7.16) mmHg vs. (82.75±4.61) mmHg), mean nighttime systolic blood pressure ((116.40±5.37) mmHg vs. (123.12±5.99) mmHg), and mean nighttime diastolic blood pressure ((72.57±7.54) mmHg vs. (80.29±5.67) mmHg) were all lower in the observation group than control group (all P0.05). The nighttime systolic blood pressure dipping ratio ((5.88±2.73)% vs. (3.13±4.45)%) and nighttime diastolic blood pressure dipping ratio ((9.37±5.65)% vs. (2.89±5.92)%) were higher in the observation group than the control group (both P0.05). In addition, the defined daily dose of antihypertensive drugs was lower in the observation group than in the control group ((1.60±0.86) vs. (2.26±0.87), P0.001]. Spearman rank correlation analysis showed that changes in FMD were negatively correlated with the reduction in mean nighttime diastolic blood pressure only in the observation group (r=-0.441, P=0.001). Conclusion: CPAP therapy is associated with improved vascular endothelial function, reduced blood pressure and reversal of non-dipper blood pressure rhythm in hypertensive patients with moderate to severe OSA. 目的： 探讨持续气道正压通气（CPAP）治疗对高血压合并中重度阻塞性睡眠呼吸暂停（OSA）患者血压及血管内皮功能的影响。 方法： 本研究为回顾性研究，纳入2023年10月至2024年12月在天津康汇医院高血压科诊断的高血压合并中重度OSA患者。依据是否接受规范CPAP治疗，将患者分为观察组（每晚CPAP治疗时长≥4 h，且每周治疗天数≥5 d）和对照组（未接受CPAP治疗）。2组患者均予规范降压药物治疗，持续观察24周。采用肱动脉血流介导的血管扩张功能（FMD）评估患者血管内皮功能，通过动态血压监测明确患者血压波动情况。采用Spearman秩相关分析评估内皮功能变化量与血压参数变化量的相关性。以降压药物日定义剂量评估患者的降压药物负荷。 结果： 共纳入109例高血压合并中重度OSA患者。年龄（47.13±11.21）岁，女性15例（14%）。观察组54例，对照组55例。治疗后24周，观察组FMD高于对照组［（7.15±1.15）%比（4.08±1.46）%，P0.001］。动态血压监测结果显示，观察组治疗后24周的全天平均收缩压［（120.96±5.27）mmHg比（124.71±3.15）mmHg］和全天平均舒张压［（77.36±6.99）mmHg比（81.60±3.67）mmHg］均低于对照组（P均0.05）（1 mmHg=0.133 kPa）；其中，观察组日间平均收缩压［（123.86±5.83）mmHg比（126.73±4.65）mmHg］、日间平均舒张压［（80.12±7.16）mmHg比（82.75±4.61）mmHg］、夜间平均收缩压［（116.40±5.37）mmHg比（123.12±5.99）mmHg］、夜间平均舒张压［（72.57±7.54）mmHg比（80.29±5.67）mmHg］均低于对照组（P均0.05）。同时，观察组患者夜间收缩压下降率［（5.88±2.73）%比（3.13±4.45）%］和舒张压下降率［（9.37±5.65）%比（2.89±5.92）%］均较对照组高（P均0.05）。此外，治疗24周后，观察组降压药物日定义剂量低于对照组［（1.60±0.86）比（2.26±0.87），P0.001］。Spearman秩相关分析结果显示，仅观察组患者的FMD变化与夜间平均舒张压下降呈负相关（r=-0.441，P=0.001）。 结论： CPAP 治疗与高血压合并中重度 OSA 患者血管内皮功能改善、血压降低及非杓型血压节律逆转相关。.