Blood Pressure And Cardiac Rhythm Response To Short Term Continuous Positive Airway Pressure In Obstructive Sleep Apnea Hypopnea Syndrome

BackgroundSeveral lines of evidence suggest multiple systems injury in obstructive sleep apnea hypopnea syndrome(OSAHS)patients.Obstructive sleep apnea hypopnea syndrome(OSAHS)is common in people with hypertension.Only treatment with an antihypertensive agent alone is often insufficient to control hypertension in patients with OSAHS.Arrhythmia is also often associated with obstructive sleep apnea hypopnea syndrome(OSAHS).ObjectivesHence,we sought to evaluate the effect of short-term continuous positive airway pressure(CPAP)treatment on inflammation,immune system derangement,metabolic dysregulation and abnormal cardiac rhythm.We also examine the short-term effects of continuous positive airway pressure(CPAP)therapy on blood pressure(BP)in patients with OSAHS and hypertension.Methods1.After whole night polysomnography,venous blood was collected from 292 subjects referred for suspected OSAHS.Serum levels of inflammation,immune,metabolism were investigated.In addition,the effects of 1 month of CPAP also were studied in patients with moderate to severe OSAHS.2.Eligible patients in the two hospitals were consecutive enrolled into the prospective study.Ambulatory blood pressure was performed for 24h in 214 subjects with previously encountered a full night polysomnography(PSG).Ambulatory blood pressure was measured again in 59 follow-up OSAHS patients who were underwent home CPAP 30 days.3.Holter monitoring was performed for 24h in 214 subjects with previously encountered a full night polysomnography(PSG).In 15 follow-up OSAHS patients,Holter was repeated within 2 to 3 days after institution of CPAP therapy in the hospital.Results1.Levels of C3(complement C3),CH50(total complement activity),superoxide dismutase(SOD),uric acid(UA)were significantly higher in patients with moderate to severe OSAHS than in no to mild OSAHS(C3 P=0.009,CH50 P=0.046,SOD P=0.040,UA P=0.037).In contrast,IGF-1 level in the moderate-severe OSAHS was lower than in the no-mild OSAHS(P=0.022),which was negative correlated with apnea-hypopnea index(AHI)and oxygen desaturation index(ODI).Moreover,CPAP significantly decreased levels of C3(P=0.018),meanwhile elevated levels of IGF-1(P=0.041).2.51 OSAHS patients with hypertension who used CPAP at least 4 hours per night received 30 days CPAP treatment.Added CPAP on usual antihypertension,systolic,diastolic,and mean arterial BP were significantly reduced at night(5.08,3.05,and 3.73 mmHg),in the morning(6.31,4.83,and 5.32 mmHg)and in the whole a day(3.09,2.60,and 2.76 mmHg).There were no significant changes in daytime BP values but did reduce daytime BP by 2.09,2.37 and 2.28 mmHg,respectively.3.CPAP therapy resulted in abolition of most sinus pauses and atrioventricular block in the 15 OSAHS patients coexisting pathologically rhythm disturbances,while the effect to other types of arrhythmia is not effective enough.Conclusion1.Levels of complement C3 raise and IGF-1 simultaneously reduce in moderate/severe OSAHS patients.CPAP may be useful for decreasing C3 and elevating IGF-1 in moderate to severe OSAHS patients.2.One month short-term CPAP reduced BP modestly in OSAHS with hypertension,especially in the morning and at nighttime.3.Some types of arrhythmia in moderate to severe OSAHS patients can be successfully controlled by 2-3 days CPAP.