Eur Heart J:持续气道正压通气治疗在预防OSA患者心血管事件中的作用!

2017-10-26 xing.T MedSci原创

在夜间CPAP使用超过4小时的患者中CPAP治疗可能会降低MACE和卒中的风险。需要额外的随机试验强制要求CPAP治疗时间来证实这一效果。

近日,心血管领域权威杂志Eur Heart J上发表了一篇荟萃分析文章,评估持续气道正压通气(CPAP)治疗是否减少中重度阻塞性睡眠呼吸暂停(OSA)患者的主要不良心血管事件(MACE)。

研究人员检索了MEDLINE、EMBASE和Cochrane图书馆(检索时间从成立之日到2016年12月)收集了235篇文献。研究人员选择了7项随机对照试验(RCT)进行最终分析。


对4268名患者进行分析显示CPAP治疗导致了MACE相对风险非显著性地降低了26%(风险比为0.74; 95%可信区间为0.47-1.17; P=0.19,I2=48%]。一系列敏感性分析表明,增加CPAP使用时间可以显著降低MACE和卒中风险。亚组分析显示夜间CPAP依从时间≥4小时(h)可使MACE风险降低57%(风险比为0.43; 95%可信区间为0.23-0.80; P=0.01,I2=0%)。 CPAP治疗对心肌梗死(MI)、全因死亡率、房颤/房扑(AF)或心力衰竭(HF)无显著影响(P>0.05)。 CPAP对心情和降低白天嗜睡[Epworth睡眠量表(ESS):平均差异(MD)为-2.50,95%可信区间为-3.62至-1.39; P<0.001,I2=81%]有积极效应。

在夜间CPAP使用超过4小时的患者中CPAP治疗可能会降低MACE和卒中的风险。需要额外的随机试验强制要求CPAP治疗时间来证实这一效果。

原始出处:


Safi U Khan;,et al. A meta-analysis of continuous positive airway pressure therapy in prevention of cardiovascular events in patients with obstructive sleep apnoea. Eur Heart J.2017. https://doi.org/10.1093/eurheartj/ehx597

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objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Oct 28 03:13:00 CST 2017, time=2017-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256234, encodeId=9bf225623456, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Fri Oct 27 00:17:43 CST 2017, time=2017-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256121, encodeId=970125612140, content=学习了.涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Oct 26 13:08:53 CST 2017, time=2017-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256110, encodeId=5b9f25611077, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 26 12:23:13 CST 2017, time=2017-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256109, encodeId=c6bd2561090e, content=好知识.值得拥有!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Oct 26 12:17:07 CST 2017, time=2017-10-26, status=1, ipAttribution=)]
    2017-10-28 bioon3
  5. [GetPortalCommentsPageByObjectIdResponse(id=2070293, encodeId=b01f20e0293f9, content=<a href='/topic/show?id=9a27631888f' target=_blank style='color:#2F92EE;'>#正压通气#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63188, encryptionId=9a27631888f, topicName=正压通气)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=afa4194, createdName=cenghis, createdTime=Wed Feb 28 12:13:00 CST 2018, time=2018-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1948200, encodeId=a13e194820059, content=<a href='/topic/show?id=ca7856346b7' target=_blank style='color:#2F92EE;'>#持续气道正压通气#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56346, encryptionId=ca7856346b7, topicName=持续气道正压通气)], attachment=null, authenticateStatus=null, createdAvatar=, 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content=学习了.涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Oct 26 13:08:53 CST 2017, time=2017-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256110, encodeId=5b9f25611077, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 26 12:23:13 CST 2017, time=2017-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256109, encodeId=c6bd2561090e, content=好知识.值得拥有!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Oct 26 12:17:07 CST 2017, time=2017-10-26, status=1, ipAttribution=)]
    2017-10-28 zhaojie88
  6. 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content=学习了.涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Oct 26 13:08:53 CST 2017, time=2017-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256110, encodeId=5b9f25611077, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 26 12:23:13 CST 2017, time=2017-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256109, encodeId=c6bd2561090e, content=好知识.值得拥有!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Oct 26 12:17:07 CST 2017, time=2017-10-26, status=1, ipAttribution=)]
    2017-10-28 slcumt
  7. 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content=学习了.涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Oct 26 13:08:53 CST 2017, time=2017-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256110, encodeId=5b9f25611077, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 26 12:23:13 CST 2017, time=2017-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256109, encodeId=c6bd2561090e, content=好知识.值得拥有!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Oct 26 12:17:07 CST 2017, time=2017-10-26, status=1, ipAttribution=)]
    2017-10-27 jihuaijun1112

    学习学习学习

    0

  8. 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content=学习了.涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Oct 26 13:08:53 CST 2017, time=2017-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256110, encodeId=5b9f25611077, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 26 12:23:13 CST 2017, time=2017-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256109, encodeId=c6bd2561090e, content=好知识.值得拥有!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Oct 26 12:17:07 CST 2017, time=2017-10-26, status=1, ipAttribution=)]
    2017-10-26 1ddf0692m34(暂无匿称)

    学习了.涨知识

    0

  9. 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content=学习了.涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Oct 26 13:08:53 CST 2017, time=2017-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256110, encodeId=5b9f25611077, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 26 12:23:13 CST 2017, time=2017-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256109, encodeId=c6bd2561090e, content=好知识.值得拥有!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Oct 26 12:17:07 CST 2017, time=2017-10-26, status=1, ipAttribution=)]
    2017-10-26 清风拂面

    谢谢分享.学习了

    0

  10. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256109, encodeId=c6bd2561090e, content=好知识.值得拥有!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Oct 26 12:17:07 CST 2017, time=2017-10-26, status=1, ipAttribution=)]
    2017-10-26 zb1235672

    好知识.值得拥有!

    0

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因为阻塞性睡眠呼吸暂停而晚上呼吸困难,长期被认为是心血管风险增加的原因。  然而,有篇最新研究让这个关联性产生困惑,当以持续正压通气(CPAP)治疗确实降低睡眠呼吸暂停的症状时,它确实无法降低使用者长期的心脏病发作、中风、或心脏相关死亡的几率。  CPAP是使用者在晚上睡觉时戴上它,让他们呼吸较顺。  然而,CPAP疗法最常见问题的就是难以坚持,这篇最新研究法应这一点,人们平均一个晚上只使用这个设

NEJM:持续气道正压通气并不能预防阻塞性睡眠呼吸暂停患者心血管事件的发生

阻塞性睡眠呼吸暂停与心血管事件的发生风险增加有关;持续气道正压通气(CPAP)治疗是否可预防重达心血管事件的发生则尚未确定。 研究共纳入了2717名合格的成年人,年龄在45岁到75岁之间,患有中度至重度阻塞性睡眠呼吸暂停及冠状动脉或脑血管疾病。将其随机分配分别接受CPAP治疗加常规治疗(CPAP组)或常规治疗(常规护理组)。 主要的复合终点是因心血管疾病死亡,心肌梗死,中风,或住院治疗

AJRCCM:CPAP不改变OSA,CVD共存的肾功能

根据7月25日发表在《美国呼吸与危重病医学杂志》上的一项研究,对于患有阻塞性睡眠呼吸暂停综合症(OSA)和心血管疾病的人来说,持续的正气道压力(CPAP)不会改变肾功能。阻塞性睡眠呼吸暂停(OSA)与肾功能受损有关,但OSA治疗是否会影响肾功能存在不确定性。为了探讨持续正气道压力(CPAP)对共同存在的OSA和心血管疾病患者肾功能的影响。澳大利亚弗林德斯大学的Kelly A. Loffler博士及

Eur Respir J:持续气道正压通气对睡眠呼吸暂停的女性患者血压和代谢的影响!

由此可见,在中重度女性OSA患者中,与保守治疗相比,12 周CPAP治疗可以改善血压,尤其是舒张压,但是不改变代谢指标。

Eur Respir J:24h动态血压监测对接受CPAP治疗的OSA患者有何价值?

该研究的结果表明,夜间高血压、血压昼夜模式和夜间心率可能是CPAP治疗血压反应的预测因子,这些结果支持对OSA患者在CPAP治疗开始前进行24小时动态血压监测。