阻塞性睡眠呼吸暂停与血压难控制相关

巴尔的摩——根据一项随机对照试验的数据，尽管成人重度阻塞性睡眠呼吸暂停(OSA)患者往往使用多种抗高血压药物，但其难治性高血压患病率仍显著高于中度OSA患者。

克利夫兰医院的Harneet Walia医生及其同事回顾了参与HeartBEAT(呼吸暂停治疗中的心脏生物学标记物评估)研究的4个中心318例患者的基线数据。该试验将患者随访分配到接受关于健康生活方式和睡眠规划的教育项目组或教育项目加夜间持续气道内正压通气或夜间辅助供氧治疗组。所有患者接受血压监测，并使用Ⅲ型便携式监测仪完成睡眠分析。患者平均年龄为65岁，大约70%为男性，平均呼吸暂停低通气指数(AHI)为27。难治性高血压定义为尽管使用降压药仍无法将血压降至140/90 mmHg(对于糖尿病或慢性肾病患者为130/80 mmHg)以下。约半数难治性高血压患者达到重度OSA标准(AHI≥30)。

结果显示，在318例受试者中，73例接受至少3种处方降压药治疗，包括1种利尿剂。在这73例患者中，重度OSA患者中有58%为难治性高血压，中度OSA患者中有28%为难治性高血压，重度OSA患者的经校正难治性高血压比值比(OR)为3.3。研究中排除了血压高于170/110 mmHg的个体，“因此我们可能还低估了睡眠呼吸暂停的影响”。

研究者总结认为，重度OSA患者较之中度OSA患者更难控制血压。

该研究由国立心肺血液研究所资助。Walia医生披露无相关利益冲突。

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By: KAREN BLUM, Internal Medicine News Digital Network

BALTIMORE – Resistant hypertension was significantly more prevalent in adults with severe obstructive sleep apnea than in those with moderate OSA, despite the use of multiple antihypertensive medications, based on data from a randomized, controlled trial.

"Strategies to treat sleep apnea in this subgroup should be strongly considered, as improvements in blood pressure could potentially lead to improvements in cardiovascular morbidity and mortality," said Dr. Harneet Walia of the Cleveland Clinic, reporting results of her study at the annual meeting of the Associated Professional Sleep Societies.

Dr. Walia and her colleagues reviewed baseline data from 318 individuals at four sites participating in the HeartBEAT (Heart Biomarker Evaluation in Apnea Treatment) study. The trial randomized patients to receive an educational program about healthy lifestyle and sleep schedules, or the educational program plus either nighttime continuous positive airway pressure or nighttime supplemental oxygen. All patients underwent blood pressure monitoring and completed sleep studies with type III portable monitors.

Of the 318 participants, 73 were taking at least three prescribed antihypertensive medications, including a diuretic. Among these 73 patients, resistant hypertension was noted in 58% of those with severe obstructive sleep apnea and 28% of those with moderate OSA. The adjusted odds ratio for resistant blood pressure in severe OSA was 3.3.

Individuals with blood pressure greater than 170/110 mm Hg were excluded from the study, "so we may have underestimated the effects of sleep apnea," Dr. Walia said.

The average age of the patients was 65 years, approximately 70% were men, and the average apnea-hypopnea index (AHI) was 27. Resistant blood pressure was defined as failure to reach a target below 140/90 mmHg (or 130/80 mmHg for patients with diabetes or chronic kidney disease), despite the use of medication. Approximately half of patients with resistant hypertension met the criteria for severe OSA (AHI of 30 or higher).

"Rigorous trials are needed to assess the effects of sleep apnea treatment on blood pressure control in individuals on intensive antihypertensive regimens," Dr. Walia noted.

The study was funded by the National Heart, Lung, and Blood Institute. Dr. Walia said she had no relevant financial disclosures.