持续气道正压通气治疗老年人阻塞性睡眠呼吸暂停低通气综合征合并高血压的疗效

目的探讨老年人阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与高血压之间的关系,以及经鼻持续气道正压通气(nCPAP)治疗老年人OSAHS合并高血压的远期效果。方法104例确诊为OSAHS合并高血压的门诊或住院患者,其中52例患者经过6个月的nCPAP治疗作为治疗组,于行nCPAP治疗前及治疗后6个月,进行多导睡眠图(PSG)及24h动态血压测定,另52例患者未行nCPAP治疗或治疗失败作为对照组,6个月后对两组重复上述各项指标的监测并进行统计学处理。结果治疗组治疗前最长呼吸暂停时间、睡眠呼吸暂停低通气指数(AHI)、最低氧分压(SpO2)、收缩压/舒张压分别为(63.5±22.4)s、(46.8±19.2)次/h、(62.4±18.5)%、(146.2±9.5/90.4±8.5)mmHg,经过nCPAP治疗6个月后,上述各项指标分别为(10.5±11.4)s(、4.6±4.0)次/h(、89.81±8.2)%、(134.7±8.3/82.6±9.1)mmHg,均有显著改善(P<0.01),平均血压明显好转,治疗组降压有效率为96%,与对照组比较差异有统计学意义(P<0.01),部分患者停用降压药。结论反复低氧血症、呼吸暂停可能是部分老年OSAHS伴发高血压的发病原因,nCPAP治疗有助于此类患者血压的恢复。

The therapeutic effect of nasal continuous positive airway pressure (nCPAP) in the elderly hypertensive patients with obstructive sleep apnea/hypopnea syndrome

ObjectiveTo explore the relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) and hypertension in elderly patients, and the long-term effect of nCPAP in old patients with OSAHS and hypertension. MethodsOne hundred and four patients with snoring were randomized into a treatment group (n=52) and a control group (n=52) and monitored by Autoset diagnosis-treatment system during nocturnal sleep. Blood pressure over 24 hours and polysomnogram were measured before and 6 months after nCPAP treatment. Data of Apnea index, SpO2 and arterial pressure were chosen for statistical analysis. ResultsThe longest apnea time, apnea hyponea index, lowest SpO_2 and systolic/diastolic pressure were (63.522.4) s, (46.819.2) times/h, (62.418.5)% and (14610/909) mm Hg separately before treatment and (10.511.4)s, (4.64.0) time/h, (89.88.2)% and (1358)/(839)mm Hg separately 6 months after nCPAP treatment. All the indexes improved significantly. (all P<0.05). ConclusionsThe nocturnal hypoxemia and sleep apnea may be considered as one of the cause of some OSAHS patients with hypertension. nCPAP is an effective therapy to control hypertension caused by OSAHS.