短期持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征患者外周动脉硬度的影响

目的 观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠前后外周动脉硬度的变化及短期持续气道正压通气(CPAP)治疗对其的影响.方法 以60例OSAHS患者为试验组,正常人60名为对照组,两组间年龄、性别构成比匹配,分别于入睡前及第二天清晨醒来后按相同方法测定四肢血压及心脏一踝血管指数(CAVI).试验组中的22例重度SAHS患者接受CPAP治疗,并在治疗第1天睡前及醒后、治疗第3天醒后重复测定上述指标.结果 试验组一夜睡眠后CAVI值(8.0±1.2)m/s]、舒张压(87±12)mm Hg]及平均压(101±12)mm Hg]均高于睡前分别为(7.3±1.0)m/s、(83±13)mm Hg及(98±14)mm Hg](均P<0.05),收缩压无明显改变;对照组相关参数在醒后均呈下降趋势,但差异无统计学意义.试验组经CPAP治疗1晚后,晨起的CAVI值(7.8±1.0)m/s]、收缩压(129±19)mm Hg]、舒张压(84±11)mm Hg]及平均压(99±13)mmHg]均低于治疗前晨起的相应数值分别为(8.6±1.1)m/s、(137±23)mm Hg、(89±13)mm Hg、(105±16)mm Hg](均P<0.05);治疗第3天与治疗后第1天相比,晨起后的CAVI值仍继续明显下降,而收缩压、舒张压、平均压虽呈下降趋势,但差异无统计学意义.结论 睡眠可以引起OSAHS患者动脉硬度急性增高,经CPAP治疗可降低,并在3 d的治疗中持续改善.

Effects of short-term continuous positive airway pressure treatment on arterial stiffness in patients with obstructive sleep apnea hypopnea syndrome

OBJECTIVE: To investigate the effect of short-term continuous positive airway pressure (CPAP) treatment on the arterial stiffness in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Cardio ankle vascular index (CAVI) and blood pressure (BP) were measured before and after sleep in 60 non-hypertensive patients with OSAHS and gender and 60 age-matched healthy controls. CPAP was administrated in 22 of the 60 OSAHS patients. And on the first and third days of the CPAP treatment CAVI and BP were measured in the morning, i. e., after sleep. RESULTS: In the morning, the CAVI of the OSAHS patients was 8.0 +/- 1.2 m/s, significantly higher than that before sleep (7.3 +/- 1.0, P = 0.000), the diastolic BP (DBP) was (86 +/- 12) mm Hg, significantly higher than that before sleep (83 +/- 13 mmHg, P = 0.001), and the mean BP (MBP) was (101 +/- 12) mm Hg, significantly higher than that before sleep (98 +/- 14, P = 0.00116). However, there were no significant differences in these parameters among the controls The systolic BP (SBP) of the OSAHS patients did not changed significantly after sleep, however, there was a tendency to decrease in the controls (123 +/- 14) vs (121 +/- 13) mm Hg, P = 0.074). After the first night treatment, the CAVI, SBP, DBP, and mean BP of the 22 severe OSAHS patients decreased significantly (all P < 0.05), and after three nights treatment, only the CAVI showed further significant decrease (P < 0.05). CONCLUSION: Sleep induces increase of artery stiffness in OSAHS patients, but not in the normal controls. Short-term CPAP may decrease CAVI without affecting the blood pressures. Early atherosclerosis in the patients with OSAHS may be reversed by CPAP therapy.