阻塞性睡眠呼吸暂停对夜间血压的影响：机制与治疗反应——一篇叙述性综述

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中文摘要

背景： 夜间血压（BP）是心血管风险的主要决定因素。在阻塞性睡眠呼吸暂停（OSA）中，异常的夜间血压模式，尤其是非杓型和夜间高血压，很常见，并导致额外的心血管风险。然而，这种关联尚未充分整合到常规临床实践中，因为血压评估仍主要依赖诊室或家庭测量，动态血压监测使用不足。本叙述性综述总结了当前关于夜间血压生理调节、OSA破坏夜间血压控制的机制、OSA中异常夜间血压模式的流行病学和预后相关性以及可用治疗效果的证据。持续气道正压通气（CPAP）拥有最强的证据基础，平均可适度降低夜间血压，在未控制或难治性高血压患者以及治疗依从性更好的患者中效果更大。相比之下，非CPAP疗法的证据，包括下颌前移装置、补充氧气、舌下神经刺激和上气道手术，仍然有限且不太一致。总之，夜间血压异常在OSA中常见、具有临床重要性且常被忽视。更广泛地使用动态血压监测以及更精确地识别最可能从靶向治疗中获益的患者，可能改善OSA的心血管风险分层和管理。

英文摘要

Nocturnal blood pressure (BP) is a major determinant of cardiovascular risk. In obstructive sleep apnoea (OSA), abnormal nocturnal BP patterns, particularly nondipping and nocturnal hypertension, are common and contribute to excess cardiovascular risk. However, this association remains insufficiently integrated into routine clinical practice, as BP assessment still relies largely on office or home measurements and ambulatory BP monitoring is underused. This narrative review summarises current evidence on the physiological regulation of nocturnal BP, the mechanisms by which OSA disrupts nocturnal BP control, the epidemiology and prognostic relevance of abnormal nocturnal BP patterns in OSA, and the effects of available therapies. Continuous positive airway pressure (CPAP) has the strongest evidence base and lowers nocturnal BP modestly on average, with greater effects in patients with uncontrolled or resistant hypertension and with better treatment adherence. By contrast, evidence for non-CPAP therapies, including mandibular advancement devices, supplemental oxygen, hypoglossal nerve stimulation and upper-airway surgery, remains limited and less consistent. In summary, nocturnal BP abnormalities are common, clinically important and frequently overlooked in OSA. Greater use of ambulatory BP monitoring and more precise identification of patients most likely to benefit from targeted treatment may improve cardiovascular risk stratification and management in OSA.