外科干预对阻塞性睡眠呼吸暂停低通气综合征患者血压影响的系统评价

目的 系统评价外科干预对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴或不伴难治性高血压患者血压的影响,为临床治疗提供依据。 方法 采用计算机检索维普、中国知网和Pubmed数据库,按纳入与排除标准选择文献,按MINORS评价条目评价文献质量,最后提取数据进行定性描述,采用RevMan 5.3软件进行 Meta分析。 结果 共纳入15个研究,共989例患者。［24 h-SBP(24 h平均收缩压)WMD=15.50,95%CI(11.14,19.85); 24 h-DBP(24 h平均舒张压)WMD=8.50,95%CI(5.89,11.11); dSBP(日间收缩压)WMD=13.74,95%CI(9.10,18.39); dDBP(日间舒张压)WMD=8.42,95%CI(6.06,10.78); nSBP(夜间收缩压)WMD=15.10,95%CI(8.90,21.30); nDBP(夜间舒张压)WMD=9.95,95%CI(6.35,13.54)］。［24 h-SBP WMD=13.22,95%CI(9.59,16.84); 24 h-DBP WMD=6.30,95%CI(3.13,9.46); dSBP WMD=13.32,95%CI(8.25,18.38); dDBP WMD=5.62,95%CI(3.60,7.63); nSBP WMD=12.27,95%CI(5.55,18.98); nDBP WMD=9.20,95%CI(3.26,15.13)］。悬雍垂腭咽成形术对OSAHS患者血压的影响:［24 h-SBP WMD=13.61,95%CI(4.21,23.02); 24 h-DBP P=0.05,没有统计学意义; dSBP WMD=13.47,95%CI(1.02,25.91); dDBP WMD=4.78,95%CI(1.08,8.48); nSBP WMD=16.81,95%CI(3.68,29.95); dDBP WMD=13.66,95%CI(3.07,24.24);晨起收缩压(mSBP)WMD=9.83,95%CI(6.63,13.02);晨起舒张压(mDBP)WMD=6.40,95%CI(3.79,9.00)］。2篇文献研究表明,试验组悬雍垂腭咽成形术+常规治疗在改善24 h-SBP、24 h-DBP、mSBP、mDBP的效果上优于对照组仅常规治疗。 结论 手术干预可以降低OSAHS伴或不伴难治性高血压患者的24 h平均收缩压、24 h平均舒张压,日间收缩压、日间舒张压,夜间收缩压、夜间舒张压;悬雍垂腭咽成形术可以降低OSAHS患者的24 h平均收缩压、日间收缩压、日间舒张压,夜间收缩压、夜间舒张压,晨起收缩压、晨起舒张压。远期疗效有待进一步研究。

Meta-analysis of the effect of surgery for obstructive sleep apnea hypopnea syndrome on blood pressure

Objective Assessing the efficacy of surgery for obstructive sleep apnea hypopnea syndrome(OSAHS)with or without refractory hypertension on blood pressure to provide a reference for the clinical treatment of OSAHS. Methods An electronic search was conducted in VIP, CNKI, and Pubmed databases. Studies were included according to inclusion and exclusion criteria. Literature quality was evaluated via the Methodological index for non-randomized studies(MINORS)system. Effects of surgery for obstructive sleep apnea hypopnea syndrome(OSAHS)on blood pressure were qualitatively evaluated and meta-analyzed with RevMan 5.3. Results Fifteen self-controlled trials or randomized controlled trials(RCTs)involving 989 patients were included. Selected blood pressure outcomes: ［24-hour average systolic blood pressure WMD=15.50, 95% confidence interval(CI, 11.14, 19.85), P<0.05; 24-hour average diastolic blood pressure WMD = 8.50, 95%CI(5.89, 11.11), P<0.05; average systolic blood pressure during the day WMD=13.74, 95%CI(9.10, 18.39), P<0.05; average diastolic blood pressure during the day WMD=8.42, 95%CI(6.06, 10.78), P<0.05; average systolic blood pressure during the night WMD=15.10, 95%CI(8.90, 21.30), P<0.05; average diastolic blood pressure during the night WMD=9.95, 95%CI(6.35, 13.54), P<0.05］. Selected outcomes in patients with OSAHS with refractory hypertension: ［24-hour average systolic blood pressure WMD=13.22, 95%CI(9.59, 16.84), P<0.05; 24-hour average diastolic blood pressure WMD=6.30, 95%CI(3.13, 9.46), P<0.05; average systolic blood pressure during the day WMD=13.32, 95%CI(8.25, 18.38), P<0.05; average diastolic blood pressure during the day WMD=5.62, 95%CI(3.60, 7.63), P<0.05; average systolic blood pressure during the night WMD=12.27, 95%CI(5.55, 18.98), P<0.05; average diastolic blood pressure during the night WMD=9.20, 95%CI(3.26, 15.13), P<0.05］; Selected outcomes on blood pressure after UPPP/H-UPPP: ［24-hour average systolic blood pressure WMD=13.61, 95%CI(4.21, 23.02), P<0.05; 24-hour average diastolic blood pressure, P>0.05; average systolic blood pressure during the day WMD=13.47, 95%CI(1.02, 25.91), P<0.05; average diastolic blood pressure during the day WMD=4.78, 95%CI(1.08, 8.48), P<0.05; average systolic blood pressure during the night WMD=16.81, 95%CI(3.68, 29.95), P<0.05; average diastolic blood pressure during the night WMD=13.66, 95%CI(3.07, 24.24), P<0.05; morning systolic blood pressure WMD=9.83, 95%CI(6.63, 13.02), P<0.05; morning diastolic blood pressure WMD=6.40, 95%CI(3.79, 9.00), P<0.05］; Two articles affirm that the experimental group(with UPPP+conventional treatment)has significantly better outcomes than the control group(conventional treatment only)on 24-hour SBP, 24-hour DBP, mSBP, and mDBP. Conclusion More high-quality studies are needed. It is challenging to distinguish the effect of each surgery on blood pressure because of small sample sizes in these studies. Surgery is effective in reducing the 24-hour average systolic blood pressure, 24-hour average diastolic blood pressure, average systolic blood pressure during the day, average diastolic blood pressure during the day, average systolic blood pressure during the night, and average diastolic blood pressure during the night in OSHAS patients with or without refractory hypertension. UPPP/H-UPPP additionally reduced morning systolic blood pressure and morning diastolic blood pressure but not 24-hour average diastolic blood pressure. The long-term efficacy remains to be studied.