Effect of continuous positive airway pressure on blood pressure and related inflammatory factors in patients with obstructive sleep apnea hypopnea syndrome complicated with refractory hypertension_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

XU Yanfei ^1,2 , LIU Lu ^1,2 , ZHOU Zhou ² ,  CHEN Yanwei ^1,2,3

1. Shenzhen Nanshan People’s Hospital, Shenzhen, Guangdong 518000, P. R. China;
2. The 6^th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong 518000, P. R. China;
3. Shenzhen Nanshan District Shekou People’s Hospital, Shenzhen, Guangdong 518000, P. R. China;

Corresponding?author：

CHEN Yanwei, Email: chenyw@szu.edu.cn

Keywords：

Obstructive sleep apnea hypopnea syndrome; Continuous positive airway pressure; Refractory hypertension; Inflammatory factors

DOI：

10.7507/1671-6205.201810039

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Objective To investigate the effects of continuous positive airway pressure (CPAP) ventilation on blood pressure and related inflammatory factors in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and refractory hypertension, and explore the correlation between respiratory function and related inflammatory factors.Methods Patients with OSAHS and refractory hypertension who visited Shenzhen Nanshan People’s Hospital between January 2014 and September 2018 were randomly divided into a CPAP group and a control group. The control group received routine treatment. The CPAP group received CPAP on the basis of conventional treatment. Each intervention lasted for 7 days. The changes of systolic and diastolic blood pressure were measured before and after 1, 3, 5, and 7 days, respectively. The respiratory function and related inflammatory factors were measured after 7 days of intervention.Results After 7 days of treatment in the CPAP group, the levels of apnea hyperpnoea index (AHI), lowest oxygen saturation and oxygen desaturation index were significantly better than those before intervention, with the improvement of respiratory function significantly higher than that of the control group after 7 days. Meanwhile the systolic and diastolic blood pressure levels were significantly lower in the CPAP group than those of the control group at 1, 3, 5, and 7 days, and lower than the pre-intervention after 7 days of intervention. After 7 days of intervention, the inflammatory factors in both groups were significantly improved (all P<0.05). However, the serum levels of high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and endothelin-1 (ET-1) in the CPAP group were significantly lower than those of the control group after 7 days of treatment (P<0.05). There was a significant positive correlation between AHI level and hs-CRP, IL-6, TNF-α and ET-1 in the CPAP group after intervention (P<0.001).Conclusions CPAP can significantly improve the blood pressure of patients with OSAHS and refractory hypertension. CPAP may improve the related inflammatory factors by improving the respiratory function of patients, thus reduce the patient’s blood pressure.

Citation： XU Yanfei, LIU Lu, ZHOU Zhou, CHEN Yanwei. Effect of continuous positive airway pressure on blood pressure and related inflammatory factors in patients with obstructive sleep apnea hypopnea syndrome complicated with refractory hypertension. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(4): 322-326. doi: 10.7507/1671-6205.201810039 Copy

1.	陳雄, 陳威娜, 葉建華, 等. 持續氣道正壓通氣對阻塞性睡眠呼吸暫停低通氣綜合征并高血壓患者血壓及血脂代謝的影響. 實用心腦肺血管病雜志, 2017, 25(6): 140-142.
2.	Bixler EO, Vgontzas AN, Lin HM, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med, 2000, 160(15): 2289-2295.
3.	盛紅宇, 汪迎春, 姚曉光, 等. 短期持續正壓通氣治療對阻塞性睡眠呼吸暫停低通氣綜合征合并高血壓患者清晨和睡前血壓水平的影響. 中華高血壓雜志, 2015, 23(6): 574-578.
4.	牛保松. 經鼻持續氣道正壓通氣對難治性高血壓合并 OSAHS 清晨血壓的影響. 黑龍江醫藥, 2017, 30(2): 392-393.
5.	中國醫師協會高血壓專業委員會, 中華醫學會呼吸病學分會睡眠呼吸障礙學組. 阻塞性睡眠呼吸暫停相關性高血壓臨床診斷和治療專家共識. 中華高血壓雜志, 2012, 20(12): 1119-1124.
6.	孫寧玲, 霍勇, 王繼光, 等. 難治性高血壓診斷治療中國專家共識. 中華高血壓雜志, 2013, 21(4): 321-326.
7.	Thomas G, Xie D, Chen H Y, et al. Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease: report from the chronic renal insufficiency cohort study. Hypertension, 2016, 67(2): 387-396.
8.	嵇友林, 姜永前, 陳富剛, 等. 持續氣道正壓通氣對阻塞性睡眠呼吸暫停低通氣綜合征患者 AGEs 和 ox-LDL 水平的影響. 南京醫科大學學報(自然科學版), 2017, 37(1): 85-87.
9.	王海威, 劉會苗, 鄭振宇. 持續氣道正壓通氣對阻塞性睡眠呼吸暫停低通氣綜合征患者難治性高血壓的影響. 中國耳鼻咽喉頭頸外科, 2017, 24(10): 533-535.
10.	Li J, Chen X, Sun J. Is the grading system of the severity of the OSAHS used presently rational or not? From the view of incidence of hypertension in different severity groups. Eur Arch Otorhinolaryngol, 2014, 271(9): 2561-2564.
11.	Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med, 2000, 342(19): 1378-1384.
12.	潘瑞春, 劉國榮, 王寶軍, 等. nCPAP 治療對合并心腦血管疾病的中重度 OSAHS 患者超敏 C-反應蛋白的影響. 臨床醫藥文獻電子雜志, 2017, 4(37): 7212-7213.
13.	Lloberes P, Sampol G, Espinel E, et al. A randomized controlled study of CPAP effect on plasma aldosterone concentration in patients with resistant hypertension and obstructive sleep apnea. J Hypertens, 2014, 32(8): 1650-1657.
14.	De Oliveira AC, Martinez D, Massierer D, et al. The antihypertensive effect of positive airway pressure on resistant hypertension of patients with obstructive sleep apnea: a randomized, double-blind, clinical trial. Am J Respir Crit Care Med, 2014, 190(3): 345-347.
15.	Martínez-García MA, Capote F, Campos-Rodríguez F, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA, 2013, 310(22): 2407-2415.
16.	胡競, 黃慧, 郝華, 等. 持續氣道正壓通氣治療對阻塞性睡眠呼吸暫停低通氣綜合征患者體脂率和血脂的影響. 中華老年心腦血管病雜志, 2017, 19(10): 1052-1054.
17.	Li F, Huang H, Song L, et al. Effects of obstructive sleep apnea hypopnea syndrome on blood pressure and C-reactive protein in male hypertension patients. J Clin Med Res, 2014, 8(3): 220-224.
18.	劉志宏, 任壽安, 任筱璐, 等. CPAP 治療對 OSAHS 及其合并高血壓患者 CRP 和 IL-6 的影響. 中西醫結合心腦血管病雜志, 2010, 8(11): 1287-1289.
19.	李霞. 阻塞性睡眠呼吸暫停低通氣綜合征合并高血壓患者持續氣道正壓通氣治療前后血漿 ET-1、NPY 水平的變化及意義[D]. 山西醫科大學, 2011.

1. 陳雄, 陳威娜, 葉建華, 等. 持續氣道正壓通氣對阻塞性睡眠呼吸暫停低通氣綜合征并高血壓患者血壓及血脂代謝的影響. 實用心腦肺血管病雜志, 2017, 25(6): 140-142.
2. Bixler EO, Vgontzas AN, Lin HM, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med, 2000, 160(15): 2289-2295.
3. 盛紅宇, 汪迎春, 姚曉光, 等. 短期持續正壓通氣治療對阻塞性睡眠呼吸暫停低通氣綜合征合并高血壓患者清晨和睡前血壓水平的影響. 中華高血壓雜志, 2015, 23(6): 574-578.
4. 牛保松. 經鼻持續氣道正壓通氣對難治性高血壓合并 OSAHS 清晨血壓的影響. 黑龍江醫藥, 2017, 30(2): 392-393.
5. 中國醫師協會高血壓專業委員會, 中華醫學會呼吸病學分會睡眠呼吸障礙學組. 阻塞性睡眠呼吸暫停相關性高血壓臨床診斷和治療專家共識. 中華高血壓雜志, 2012, 20(12): 1119-1124.
6. 孫寧玲, 霍勇, 王繼光, 等. 難治性高血壓診斷治療中國專家共識. 中華高血壓雜志, 2013, 21(4): 321-326.
7. Thomas G, Xie D, Chen H Y, et al. Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease: report from the chronic renal insufficiency cohort study. Hypertension, 2016, 67(2): 387-396.
8. 嵇友林, 姜永前, 陳富剛, 等. 持續氣道正壓通氣對阻塞性睡眠呼吸暫停低通氣綜合征患者 AGEs 和 ox-LDL 水平的影響. 南京醫科大學學報(自然科學版), 2017, 37(1): 85-87.
9. 王海威, 劉會苗, 鄭振宇. 持續氣道正壓通氣對阻塞性睡眠呼吸暫停低通氣綜合征患者難治性高血壓的影響. 中國耳鼻咽喉頭頸外科, 2017, 24(10): 533-535.
10. Li J, Chen X, Sun J. Is the grading system of the severity of the OSAHS used presently rational or not? From the view of incidence of hypertension in different severity groups. Eur Arch Otorhinolaryngol, 2014, 271(9): 2561-2564.
11. Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med, 2000, 342(19): 1378-1384.
12. 潘瑞春, 劉國榮, 王寶軍, 等. nCPAP 治療對合并心腦血管疾病的中重度 OSAHS 患者超敏 C-反應蛋白的影響. 臨床醫藥文獻電子雜志, 2017, 4(37): 7212-7213.
13. Lloberes P, Sampol G, Espinel E, et al. A randomized controlled study of CPAP effect on plasma aldosterone concentration in patients with resistant hypertension and obstructive sleep apnea. J Hypertens, 2014, 32(8): 1650-1657.
14. De Oliveira AC, Martinez D, Massierer D, et al. The antihypertensive effect of positive airway pressure on resistant hypertension of patients with obstructive sleep apnea: a randomized, double-blind, clinical trial. Am J Respir Crit Care Med, 2014, 190(3): 345-347.
15. Martínez-García MA, Capote F, Campos-Rodríguez F, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA, 2013, 310(22): 2407-2415.
16. 胡競, 黃慧, 郝華, 等. 持續氣道正壓通氣治療對阻塞性睡眠呼吸暫停低通氣綜合征患者體脂率和血脂的影響. 中華老年心腦血管病雜志, 2017, 19(10): 1052-1054.
17. Li F, Huang H, Song L, et al. Effects of obstructive sleep apnea hypopnea syndrome on blood pressure and C-reactive protein in male hypertension patients. J Clin Med Res, 2014, 8(3): 220-224.
18. 劉志宏, 任壽安, 任筱璐, 等. CPAP 治療對 OSAHS 及其合并高血壓患者 CRP 和 IL-6 的影響. 中西醫結合心腦血管病雜志, 2010, 8(11): 1287-1289.
19. 李霞. 阻塞性睡眠呼吸暫停低通氣綜合征合并高血壓患者持續氣道正壓通氣治療前后血漿 ET-1、NPY 水平的變化及意義[D]. 山西醫科大學, 2011.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of continuous positive airway pressure on blood pressure and related inflammatory factors in patients with obstructive sleep apnea hypopnea syndrome complicated with refractory hypertension

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