Objective To observe the impact of nasal continuous positive airway pressure ( nCPAP ) on blood pressure and brain natriuretic peptide ( BNP ) among hypertension patients with complicated obstructive sleep apnea - hypopnea syndrome ( OSAHS ) and morning blood pressure surge ( EMBPS ).Methods Polysomnography ( PSC ) and 24 - hour ambulatory hlood pressure monitoring ( ABPM ) were carried out in 34 hypertension patients with complicated moderate to severe OSAHS and EMBPS.These patients were divided into treatment group ( 20 cases ) and control group ( 14 cases ).The average systolic pressure ( AvSP ), average diastolic pressure ( AvDP ) , and mean arterial blood pressure ( MABP ) of morning blood pressure, the lowest sleep hlood pressure and EMBPS were recorded.Morning BNP levels were detected.Then the treatment group received a 5 day treatment of nCPAP.Both groups were examined for the above indices on the fifth day.Differences hetween the treatment group and the control group were analyzed.Results The AvSP [( 30.03 ±7.77 ) mm Hg]and MABP [( 24.61 ±8.19 ) mm Hg]of EMBPS, and the AvSP [( 150.47 ±14.08 ) mm Hg], AvDP [( 98.82 ±12.29 ) mm Hg]and MABP [( 115.40 ±11.98 ) mm Hg]of morning blood pressure declined remarkably after treatment [( 35.96 ±5.18 ), ( 29.18 ±6.76 ).( 159.59 ±11.53 ), ( 104.7 ± 10.48 ), ( 123.34 ± 9.76 ) mm Hg]in the treatment group ( P ＜ 0.05 ).Serum levels of BNP [( 721.025 ±99.382 ) pg/ml]in the treatment group declined remarkably after treatment in comparison with hefore [( 807.253 ± 110.537 ) pg/ml]( P ＜ 0.05 ).A positive correlation was noted between the decline of BNP and the decline of morning AvSP after treatment ( r = 0.540 , P ＜ 0.05 ).Conclusion These data suggest that OSAHS may contrihute to EMBPS.It is of significance to carry out nCPAP treatment in hypertension patients with complicated moderate or severe OSAHS.When blood pressure can not be controlled by medicine.it is better for PSG examination to be carried out for OSAHS screening.Moreover, BNP may participate in the regulation of EMBPS , which can be used in evaluating the severity and the therapeutic efficacy of EMBPS.%目的 观察经鼻持续气道正压通气(nCPAP)治疗对中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并血压晨峰(EMBPS)的高血压患者EMBPS及脑钠肽(BNP)水平的影响.方法 对中重度OSAHS合并EMBPS的高血压患者34例(其中治疗组20例,对照组14例)行多导睡眠图(PSG)和24 h动态血压监测(ABPM).记录清晨血压、夜间最低血压及EMBPS的平均收缩压(AvSP)、平均舒张压(AvDP)、平均动脉压(MABP),并于晨醒时抽血检测血清BNP水平.治疗组连续5晚使用nCPAP治疗.所有研究对象均于实验第5天再次检测以上指标.比较两组观察前后血压和BNP水平的差别、nCPAP治疗对血压和BNP水平的影响,分析EMBPS程度与BNP水平的相关性.结果 (1)治疗组治疗后血压晨峰AvSP、血压晨峰MABP、清晨血压AvSP、清晨血压AvDP、清晨血压MABP[(30.03±7.77)、(24.61±8.19)、(150.47±14.08)及(98.82±12.29)、(115.40±11.98)mm Hg]均较治疗前[(35.96±5.18)、(29.18±6.76)、(159.59±11.53)、(104.7±10.48)、(123.34±9.76)mm Hg]明显下降,差异有统计学意义(P＜0.05).(2)治疗组治疗后BNP水平[(721.025±99.382)pg/ml]较治疗前[(807.253±110.537 )pg/ml]明显下降,差异有统计学意义(P＜0.05);且治疗前后清晨血压AvSP差值与BNP差值呈正相关(r=0.540,P＜0.05).结论 OSAHS可能是高血压EMBPS的促成因素之一.提示对合并高血压的中重度OSAHS患者进行nCPAP治疗的重要性,对于药物控制不理想的此类临床患者,可进行PSG检查筛查OSAHS,并对中重度患者进行nCPAP治疗.BNP可能参与了EMBPS的调节,可以作为观察EMBPS程度及治疗效果的参考指标.
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