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目的探讨持续气道正压通气(Continuous positive airway pressure,CPAP)干预对有阻塞性睡眠呼吸暂停综合征(Obstructive sleep apnea syndrome,OSAS)的高血压伴代谢综合征患者的血压及异常代谢组分的影响。方法采用双盲、安慰剂对照设计,将患者随机分配接受5个月CPAP治疗或者5个月假性CPAP。在每种干预之前和之后,检测受试者的血压、空腹血糖、胰岛素抵抗指数、空腹血脂谱、糖化血红蛋白及人体测量学参数等指标。结果共128例完成研究。CPAP治疗与下列指标平均值的显著降低相关:收缩压(6.1mmHg;95%可信区间[CI]:1.3～6.2,P=0.001),舒张压(4.5mmHg;95%CI:0.8～4.2,P<0.001),血清总胆固醇(16.5mg/dl;95%CI:5.2～21.4,P=0.005),非高密度脂蛋白胆固醇(16.1mg/dl;95%CI:4.7～21.9,P=0.008),低密度脂蛋白胆固醇(12.8mg/dl;95%CI:2.4～16.9,P=0.007),甘油三酯(21.9mg/dl;95%CI:4.2～42.1,P=0.03)和糖化血红蛋白(0.4%;95%CI:0.1～0.5,P=0.004)。CPAP治疗后代谢综合征显著好转(128例患者中23例逆转[18%]vs.假性CPAP治疗后仅3例逆转[2%])。结论在有中重度OSAS的高血压伴代谢综合征患者中,CPAP治疗5个月可降低血压并改善伴随的代谢异常。
Objective To investigate the effects of continuous positive airway pressure (CPAP) on blood pressure and abnormal metabolic components in patients with metabolic syndrome complicated with obstructive sleep apnea syndrome (OSAS) influences. Methods A double-blind, placebo-controlled design was used to randomize patients to either 5-month CPAP treatment or 5-month false CPAP. Subjects were tested for blood pressure, fasting blood glucose, insulin resistance index, fasting lipid profile, glycosylated hemoglobin, and anthropometric parameters before and after each intervention. Results A total of 128 cases completed the study. CPAP treatment was associated with a significant reduction of the mean of systolic (6.1 mmHg; 95% confidence interval [CI]: 1.3-6.2, P = 0.001), diastolic (4.5 mmHg; 95% CI: 0.8-4.2, (P <0.001), serum total cholesterol (16.5mg / dl; 95% CI: 5.2-21.4, P = 0.005) and non-HDL cholesterol (16.1mg / dl; 95% CI: 4.7-21.9, P = 0.008 (12.8 mg / dl; 95% CI: 2.4-16.9, P = 0.007), triglycerides (21.9 mg / dl; 95% CI: 4.2-42.1, P = 0.03) and HbA1c (0.4%; 95% CI: 0.1-0.5, P = 0.004). Metabolic syndrome was significantly improved after CPAP (23 of 128 reversed [18%] vs only 3 of 2 reversed [2%] after CPAP treatment). Conclusion In patients with moderate-severe OSAS complicated with metabolic syndrome, CPAP treatment for 5 months can lower blood pressure and improve the accompanying metabolic abnormalities.