The Effects Of CPAP Treatmen On The Vascular Endothelial Function And Blood Pressure Variability In Hypertensive Patients With Obstructive Sleep Apnea Hyponea Syndrome

Objective:By observing levels of nitricoxide (nitrogen monoxide, NO), endothelin-1(endothelin-1, ET-1) and blood pressure variability (Blood Pressure Variability, BPV) in patient with HP and OSAHS. To investigate:①the relationship between HP and OSAHS;②The changing of NO,and ET-1in patients of HP, and HP with OSAHS③the changing of BPV in patients of HP, and HP with OSAHS and observing the relationship between OSAHS’s severity and BPV;④the relationship between NO, ET-1and BPV;④the changing of NO, ET-1level and BPV before and after CPAP treatment in patients of HP with OSAHS.Methods:A case-control study was adopted,the data of110cases were analysed retrospectively, who hospitalized continuously to the department of our hospital healthy subjects and Geriatrics, Department of Respiratory Medicine, ENT-patients from May2011to October2012, Selected cases are older men, aged65to84years, mean (73.2±5.3) years.According to the24-hour ambulatory blood pressure monitoring (Ambulatory Blood Pressure Monitoring, ABPM), polysomnography (Polysomnogroply PSG) diagnosis,they are divided into five groups:control group, HP without OSAHS group, HP with mild OSAHS group, HP with moderate OSAHS group, HP with severe OSAHS group.The admission week were detected concentration of NO, ET-1and with24hour Ambulatory Blood Pressure Monitoring, selecting the sleep apnea-hypopnea index (APNEA-hypopnea index, AHI), lowest oxygen saturation (Minimum oxygen saturation, SaO2min), mean oxygen saturation the (Mean oxygen saturation, MSaO2), and BPV long time variability indicators as indicators. Giving the HP with OSAHS in group CPAP treatment, reviewing the indicators respectively, at one month and two months treatment.Results:①The level of ET-1、AHI、BPV in HP with OSAHS group were higher than Control group and HP with OSAHS group, the concentration of NO is lower than the control group and HP with OSAHS group, the concentration of ET-1increased with severity of OSAHS,the difference was statistically significant (P<0.01).②Non-dipper blood pressure accounted for50.9%of all monitoring patients, the control group was15.0%, HP without OSAHS group was33.3%, hypertension with OSAHS group was72.3%. HP with OSAHS group, the increase in the proportion of non-dipper with the increase in the value of AHI, Comparisoning with HP with OSAHS groups,we found that:increasing with the the OSAHS severity of the composition of non-dipper blood pressure, BPV larger than increasing, the difference was statistically significant (P<0.05).③CPAP treatment after1month in HP with OSAHS group, The concentration of ET-1decreased, NO concentration, non-dipper blood pressure ratio, BPV indicators were decreased, the difference was not statistically significant (P>0.05)④CPAP treatment after2months, the HP with OSAHS in each group, The concentration of ET-1, blood pressure non-dipper proportion of BPV index to decline further, the difference was statistically significant (P<0.05).And with the severity of OSAHS increased, the indicators change significantly (P<0.01)⑤The linear correlation analysis showed that:The concentration of ET-1is positively correlated with AHI, lowest SaO2average SaO2nSBPR, nDBPR significant negative phase; the AHI and24hDBPSD, nSBPSD, nDBPSD significant positive correlation. Multiple stepwise regression analysis showed:CPAP treatment after2months, the The concentration of ET-1decreased with AHI, followed by nDBPSD.Conclusion:①here are the changes of vascular endothelial function and BPV in HP patients with or without OSAHS②HP with OSAHS in patients, the level of NO is lower than HP with or without OSAHS patients, the level of ET-1is higher than that HP with OSAHS group, OSAHS may increase HP, inhibition of NO production, and promote the ET-1secretion, thereby increasing the vessels, resulting in a further increase in blood pressure. With the severity of OSAHS increased, this effect is more obvious.③The concentration of ET-1, nSBPRand nDBPR negative correlation prompt OSAHS patients with hypertension and blood pressure circadian rhythm changes may be mainly associated with ET-1, NO relationship is not obvious.④There is an obvious correlation between the changes of circadian rhythm disorders、BPV and severity of OSAHS.⑤CPAP therapy can improve the endothelial dysfunction and blood pressure variability of HP with OSAHS patients. AHI might play a role in CPAP treatment.