持续气道正压通气对合并阻塞性睡眠呼吸暂停的难治性高血压疗效的Meta分析

方明亮+李松桃+刘家勉

[摘要] 目的 评价持续正压通气对合并阻塞性睡眠呼吸暂停的难治性高血压的疗效。 方法 利用计算机检索PubMed数据库、Medline数据库、Cochrane图书馆以及中文生物医学期刊数据库、万方数据库、维普数据库、CNKI系列数据库有关在联合药物基础上应用持续正压通气治疗阻塞性睡眠呼吸暂停合并难治性高血压（CPAP组）对比单纯联合降压药物治疗（对照组）疗效的中英文文献，发表年限为1980年1月～2016年6月。按照纳入标准、排除标准纳入合格文献并进行质量评价。采用Rev Man 5.3统计软件进行Meta分析。 结果 共纳入7项随机对照研究，共648例患者，其中有CPAP组328例，对照组320例。荟萃分析结果显示CPAP组与对照组日间平均收缩压、舒张压及夜间平均收缩压比较差异有统计学意义（P < 0.05），合并均数差（MD）及95%置信区间（CI）依次为：-4.26（-8.14，-0.38），-4.93（-9.18，-0.67），-2.60（-4.45，-0.75）；两组24 h平均收缩压、24 h平均舒张压、夜间平均舒张压比较差异无统计学意义（P > 0.05）。 结论 药物联合CPAP治疗难治性高血压合并阻塞性睡眠呼吸暂停较单纯药物治疗能更好地降低患者日间血压及夜间收缩压，但药物联合CPAP对24 h平均收缩压、舒张压及夜间平均舒张压的疗效与单纯药物治疗相当。

[关键词] 持续正压通气；睡眠呼吸暂停；难治性高血压；Meta分析

[中图分类号] R544.1 [文献标识码] A [文章编号] 1674-4721（2016）10（c）-0175-05

[Abstract] Objective To investigate the effect of continuous positive airway pressure （CPAP） on blood pressure in patients with obstructive sleep apnea （OSA） and resistant hypertension （RH）. Methods Randomized controlled trials about the patients with obstructive sleep apnea and resistant hypertension treated by CPAP， which published from January 1980 to June 2016， were searched from PubMed， Medline， Cochrane Library， Chinese Medical Current Contents， Wanfang database， Vip database and CNKI database. Meta-analysis was performed by Rev Man 5.3 software after the data of qualified studies were included in consistence with the criteria of inclusion and exclusion. Results There were 7 studies including 648 cases （CPAP group was 328 cases， control group was 320 cases） met the inclusion criteria. Results of Meta-analysis showed that there were significant difference （P < 0.05） between the CPAP group and control group in daytime systolic BP （SBP）， daytime diastolic BP （DBP） and nocturnal SBP. MD and 95% CI were -4.26（-8.14， -0.38）， -4.93（-9.18， -0.67）， -2.60（-4.45， -0.75）. However， there were no significant difference in the 24-hour ambulatory SBP， 24-hour ambulatory DBP and nocturnal DBP （P > 0.5）. Conclusion Patients with OSA and RH received drugs combined with CPAP therapy have lower daytime SBP， daytime DBP and nocturnal SBP than pure drugs therapy. Effects of drugs combined with CPAP therapy and pure drugs therapy on 24-hour average systolic pressure， diastolic pressure and mean diastolic pressure at night are the same.

[Key words] Continuous positive airway pressure； Obstructive sleep apnea； Resistant hypertension； Meta-analysis

随着人口老龄化、肥胖、糖尿病、睡眠呼吸暂停低通气综合征等的增多，难治性高血压（resistant hypertension，RH）成为越来越常见的临床问题。有研究表明阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）与RH明显相关，在RH中睡眠呼吸暂停的发生率达71%～88%[1-3]。持续气道正压通气（continuous positive airway pressure，CPAP）是目前治疗睡眠呼吸暂停的有效方法。本研究旨在全面收集并严格筛选国内外针对OSA合并RH的患者采用CPAP的临床研究，采用Meta分析的方法得到相关结论，以期指导临床工作。……