Effectiveness of continuous positive airway pressure in lowering blood pressure in patients with obstructive sleep apnea: a critical review of the literature

IF 1.5 Q3 PERIPHERAL VASCULAR DISEASE
Fernanda Fatureto-Borges, G. Lorenzi-Filho, L. Drager
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引用次数: 39

Abstract

Obstructive sleep apnea (OSA) is an extremely common comorbid condition in patients with hypertension, with a prevalence of ~50%. There is growing evidence suggesting that OSA is a secondary cause of hypertension, associated with both poor blood pressure (BP) control and target organ damage in patients with hypertension. The application of continuous positive airway pressure (CPAP) during sleep is the gold standard treatment of moderate- to-severe OSA and very effective in abolishing obstructive respiratory events. However, several meta-analyses showed that the overall impact of CPAP on BP is modest (~2 mmHg). There are several potential reasons for this disappointing finding, including the heterogeneity of patients studied (normotensive patients, controlled, and uncontrolled patients with hypertension), non-ideal CPAP compliance, clinical presentation (there is some evidence that the positive impact of CPAP on lowering BP is more evident in sleepy patients), and the multifactorial nature of hypertension. In this review, we performed a critical analysis of the literature evaluating the impact of CPAP on BP in several subgroups of patients. We finally discussed perspectives in this important research area, including the urgent need to identify predictors of BP response to CPAP and the importance of precision medicine in this scenario.
持续气道正压对降低阻塞性睡眠呼吸暂停患者血压的有效性:文献综述
阻塞性睡眠呼吸暂停(OSA)是高血压患者极为常见的合并症,患病率约为50%。越来越多的证据表明,OSA是高血压的继发原因,与高血压患者血压控制不佳和靶器官损害有关。睡眠期间应用持续气道正压通气(CPAP)是中重度OSA的金标准治疗方法,对消除阻塞性呼吸事件非常有效。然而,一些荟萃分析显示,CPAP对血压的总体影响是适度的(~2 mmHg)。这一令人失望的发现有几个潜在的原因,包括研究患者的异质性(血压正常的患者,控制和不控制的高血压患者),不理想的CPAP依从性,临床表现(有证据表明CPAP对降低血压的积极影响在困倦的患者中更为明显),以及高血压的多因素性质。在这篇综述中,我们对评估CPAP对几个亚组患者血压影响的文献进行了批判性分析。我们最后讨论了这一重要研究领域的观点,包括迫切需要确定CPAP对BP反应的预测因素以及精准医学在这一情况下的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Integrated Blood Pressure Control
Integrated Blood Pressure Control PERIPHERAL VASCULAR DISEASE-
CiteScore
4.60
自引率
0.00%
发文量
13
审稿时长
16 weeks
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