Zhonghua Yi Xue Za Zhi. 2025 Apr 8;105(14):1075-1080. doi: 10.3760/cma.j.cn112137-20241220-02901.
ABSTRACT
Objective: To explore the immediate antihypertensive efficacy of continuous positive airway pressure (CPAP) overnight manual pressure titration (OMPT) in patients with obstructive sleep apnea (OSA) complicated with hypertension, and the influencing factors related to antihypertensive efficacy. Methods: A total of 88 patients diagnosed with OSA complicated with hypertension who were admitted to the Third Hospital of Hebei Medical University from September 2022 to October 2023 due to nocturnal sleep snoring and breath-holding were retrospectively enrolled. All patients were treated with CPAP OMPT during polysomnography (PSG). Based on the immediate antihypertensive effect after CPAP OMPT treatment (changes in blood pressure within 15 minutes before and after treatment), patients were divided into the significant decrease group [group A, systolic blood pressure (SBP) decreased by ≥5 mmHg (1 mmHg=0.133 kPa) and diastolic blood pressure (DBP) decreased by ≥3 mmHg] and the non-decrease group (group N, SBP decreased by <5 mmHg or DBP decreased by <3 mmHg). The demographic characteristics of the two groups was compared, as well as the differences in apnea-hypopnea index (AHI), time for pulse oxygen saturation<90% [T (SpO2<90%)], oxygen desaturation index (ODI), lowest SpO2 during sleep (LSpO2), mean SpO2 during sleep (MSpO2). A multivariate logistic regression model was used to analyze the factors associated with the improvement of blood pressure by CPAP OMPT. Results: A total of 88 patients with OSA complicated with hypertension were included, with 77 males and 11 females, and aged (46.5±13.2) years. There were 33 cases in group A and 55 cases in group N. CPAP OMPT had a significant effect on immediate blood pressure reduction in 37.5% of patients with OSA complicated with hypertension; there were no significant differences in age, gender composition, neck circumference, history of diabetes mellitus, history of coronary heart disease, and history of hyperlipidemia between the two groups (all P>0.05). After CPAP OMPT treatment, the change values of LSpO2 and MSpO2 [M (Q1, Q3)] in group A were higher than those in group N [17.0% (9.0%, 22.0%) vs 8.0%(5.0%, 15.0%), 4.0%(1.0%, 7.0%) vs 2.0%(1.0%, 4.0%), both P<0.05]. The change values of AHI, ODI and T (SpO2<90%) in group A were lower than those in group N [(-59.5±26.2) vs (-43.7±25.3) episodes/h, -52.7(-64.1, -31.0) vs -32.0(-54.0, -12.8) episodes/h, -75.8(-148.6, -9.8) vs -12.0(-82.9, -2.6) min, all P<0.05]. The results of multivariate logistic regression model analysis indicated that the change of LSpO2 was positively associated with the improvement of blood pressure by CPAP OMPT, with an OR value (95%CI) of 1.086 (1.010-1.167). Conclusions: CPAP OMPT has a significant immediate antihypertensive effect on 37.5% of patients with OSA complicated with hypertension. The change values in LSpO2 before and after CPAP OMPT treatment is positively associated with blood pressure improvement.
PMID:40176653 | DOI:10.3760/cma.j.cn112137-20241220-02901