The Treatment Of Obstructive Sleep Apnea-hypopneasyndrome(OSAHS) With Hypertension By NCPAP

Objective:This study analysed the efficacy of antihypertensive therapy in hypertensive patients with obstructive sleep7 apnea-hypopnea syndrome through the 24h ambulatory blood pressure and polysomn-ography.It would be helpful to explore the efficient treatment of OSAHS with hypertension.Methods:1 Object:The 82 cases were diagnosed OSAHS with hypertension by polysomnograhy(PSG)and 24h ambulatory blood pressure(exclusive of heart failure, renal inadequacy,renal arterial stenosis,primary aldosteronism, hyperadreno-corticism syndrome,asthma as well as cerebrovascular disease) 82 patients were divided randomly into twogroughs:control grough(n=38) when low dosage of single drug treat bad,combining two or more than two kinds of drugs to improve the effect of treatment;and treat grough(n=44)basing on using the same drugs in treated group as control group,use nCPAP.2 Method:All of patients were monitored over 7 hours during sleep by PSG24h ambulatory blood pressure was monitored every 30 minutes in day and 60 minutes during night.Treatment of nCPAP:Basing on using the same drugs in treated group as control group.During the treatment checking the blood pressure at eight clock everybody every 3 days,cut down or plus the kinds of drugs and dosage according to the level of blood pressure until blood pressure was controlled satisfactorily.In the treated group 4 cases were given up during the experience because of cannot obey the nCPAP treatment.The other 78 cases were monitored by PSG, 24hABP after 12 weeks about AHI,the lowest SaO2(LSaO2),meanSaO2(MSaO2),the oxygen desaturation index(ODI),the longest apnea time;24h mean systolic blood pressure(24hSBP),mean diurnal systolic blood pressure(dSBP)(6:00-22:00),mean nocturnal systolic blood pressure(nSBP)(22:00-6:00),24h mean diastolic blood pressure(dDBP),mean diurnal diastolic blood pressure,(dDBP)(6:00-22:00),mean nocturnal diastolic blood pressure(nDBP)(22:00-6:00),24h pulse pressure(24hPP),and the blood pressure day-nocturnal rhythm.Compare the results of general state of health,medication,AHI,LSaO2,MSaO2, ODI and the details of blood pressure before and after the treatment of nCPAP between two groups.The effect of nCPAP-treated was estimated in OSAHS with hypertension.The compare of values of two groups was managed based on Analysis of SAS statistical software,and p＜0.05 was defined as statistically significantly.Results:1.12 weeks later in the control group the rate of blood pressure get to the object (＜140/90mmHg) is 52.6%(20/38),while in the treated group it is 82.5%(33/40).There is significantly difference between two groups(P＜0.01).2.In the control group the change of 24hSBP,24hDBP,dSBP,dDBP and nDBP was significantly different before and after the antihypertensive treatment at the end of 12 weeks after treated only by antihypertensive drugs,but the change of nSBP,24hPP was not significantly different.3.The change of 24hSBP,24hDBP,dSBP,dDBP,nDBP,nSBP,24hPP was significantly different before and after treated by nCPAP in treated group(P＜0.05),and there is also significantly difference(P＜0.05)except 24hPP(P＞0.05) between control group and treated group at the end of 12 weeks.4.The kinds of antihypertensive drugs were cut down along with the degrading of blood pressure in treated group.Among them8 cases even stop antihypertensive drugs completely,the blood pressure can be controlled in normal range only relying on nCPAP treatment,the number of cases that need three or more kinds of drugs is only 9while in control group it is 23,there was significantly different between control group and treated group(P＜0.01).5.The improvement of day nocturnal rhythm of blood pressure in control and treated group are all significantly different before and after the treatment and also between them(P＜0.05).6.There is significantly different about AHI,LSaO2,MSaO2,ODI in treated group before and after treatment(P＜0.01),but in control group there is no difference.Conelusions:1.The hypertension that relate to OSAHS is caused by hypoxemia and hypercaponia.The therapeutic efficacy of antihypertensive drugs was poor.The blood pressure can't be controlled satisfactorily even using many kinds of antihypertensive drugs.2.The treatment of nCPAP could eliminate the obstruction of upper airway and effectively relieve hypoxemia and hypercaponia,so high sympathetic activity could be inhibited,the disorder of nerve-body liquid can be corrected.The abnormal day-nocturnal rhythm can also be improved.The blood pressure could be controlled effectively and the kinds of antihypertensive drugs could be3.The nCPAP treatment can be used as an effective method of treating hypertension related to OSAHS.