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.	陈雄, 陈威娜, 叶建华, 等. 持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征并高血压患者血压及血脂代谢的影响. 实用心脑肺血管病杂志, 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.	盛红宇, 汪迎春, 姚晓光, 等. 短期持续正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征合并高血压患者清晨和睡前血压水平的影响. 中华高血压杂志, 2015, 23(6): 574-578.
4.	牛保松. 经鼻持续气道正压通气对难治性高血压合并 OSAHS 清晨血压的影响. 黑龙江医药, 2017, 30(2): 392-393.
5.	中国医师协会高血压专业委员会, 中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停相关性高血压临床诊断和治疗专家共识. 中华高血压杂志, 2012, 20(12): 1119-1124.
6.	孙宁玲, 霍勇, 王继光, 等. 难治性高血压诊断治疗中国专家共识. 中华高血压杂志, 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, 陈富刚, 等. 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 AGEs 和 ox-LDL 水平的影响. 南京医科大学学报(自然科学版), 2017, 37(1): 85-87.
9.	王海威, 刘会苗, 郑振宇. 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难治性高血压的影响. 中国耳鼻咽喉头颈外科, 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, 刘国荣, 王宝军, 等. nCPAP 治疗对合并心脑血管疾病的中重度 OSAHS 患者超敏 C-反应蛋白的影响. 临床医药文献电子杂志, 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.	胡竞, 黄慧, 郝华, 等. 持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者体脂率和血脂的影响. 中华老年心脑血管病杂志, 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.	刘志宏, 任寿安, 任筱璐, 等. CPAP 治疗对 OSAHS 及其合并高血压患者 CRP 和 IL-6 的影响. 中西医结合心脑血管病杂志, 2010, 8(11): 1287-1289.
19.	李霞. 阻塞性睡眠呼吸暂停低通气综合征合并高血压患者持续气道正压通气治疗前后血浆 ET-1、NPY 水平的变化及意义[D]. 山西医科大学, 2011.

1. 陈雄, 陈威娜, 叶建华, 等. 持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征并高血压患者血压及血脂代谢的影响. 实用心脑肺血管病杂志, 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. 盛红宇, 汪迎春, 姚晓光, 等. 短期持续正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征合并高血压患者清晨和睡前血压水平的影响. 中华高血压杂志, 2015, 23(6): 574-578.
4. 牛保松. 经鼻持续气道正压通气对难治性高血压合并 OSAHS 清晨血压的影响. 黑龙江医药, 2017, 30(2): 392-393.
5. 中国医师协会高血压专业委员会, 中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停相关性高血压临床诊断和治疗专家共识. 中华高血压杂志, 2012, 20(12): 1119-1124.
6. 孙宁玲, 霍勇, 王继光, 等. 难治性高血压诊断治疗中国专家共识. 中华高血压杂志, 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, 陈富刚, 等. 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 AGEs 和 ox-LDL 水平的影响. 南京医科大学学报(自然科学版), 2017, 37(1): 85-87.
9. 王海威, 刘会苗, 郑振宇. 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难治性高血压的影响. 中国耳鼻咽喉头颈外科, 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, 刘国荣, 王宝军, 等. nCPAP 治疗对合并心脑血管疾病的中重度 OSAHS 患者超敏 C-反应蛋白的影响. 临床医药文献电子杂志, 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. 胡竞, 黄慧, 郝华, 等. 持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者体脂率和血脂的影响. 中华老年心脑血管病杂志, 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. 刘志宏, 任寿安, 任筱璐, 等. CPAP 治疗对 OSAHS 及其合并高血压患者 CRP 和 IL-6 的影响. 中西医结合心脑血管病杂志, 2010, 8(11): 1287-1289.
19. 李霞. 阻塞性睡眠呼吸暂停低通气综合征合并高血压患者持续气道正压通气治疗前后血浆 ET-1、NPY 水平的变化及意义[D]. 山西医科大学, 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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