通气负荷与CPAP的血压反应：APPLES试验的二次分析
Ventilatory burden and blood pressure response to CPAP: A secondary analysis of the APPLES trial.
文献信息
| PMID | 42849377 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Wentao Wu |
| 作者单位 | Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, 610041, China; Department of Respiratory Care, West China School of Medicine and West China Hospital, Sichuan University, 610041, China. Electronic address: wuwentaort@163.com. |
| 期刊 | Sleep medicine |
| SCI 分区 | Q1 |
| IF | 4.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 持续气道正压通气（CPAP）是阻塞性睡眠呼吸暂停（OSA）的标准治疗，但其降压效果存在异质性。我们假设通气负荷（VB）——一种更能反映病理性气流总体负担的指标——可能预测CPAP引起的血压下降。
方法： 我们对呼吸暂停正压长期疗效研究（APPLES）队列进行了二次分析。参与者根据基线VB（>20%的呼吸幅度<50%）和OSA严重程度（AHI ≥ 30）进行分层。采用线性回归模型评估这些亚组、CPAP依从性与2个月和6个月时晨间/晚间血压变化之间的关系。亚组分析为探索性，报告的p值为名义值。
结果： 最初共纳入962名具有完整基线评估的参与者，其中749名完成了2个月随访，649名完成了6个月随访。在2个月时，在高VB且依从性良好的参与者中，与假CPAP相比，活性CPAP与晨间收缩压降低相关（β = 1.73 mmHg，p = 0.037）。这种关联在6个月时未观察到。在按OSA严重程度分层的分析中，在非重度OSA亚组且依从性良好的参与者中，活性CPAP在两次随访中均与晨间收缩压降低相关。
结论： 在高VB且CPAP依从性良好的参与者中，与假CPAP相比，活性CPAP与晨间收缩压的早期降低相关。这种关联在2个月时观察到，但在6个月时未观察到。需要纳入预先指定治疗交互分析的前瞻性研究，以确定VB能否识别CPAP的血压应答者。
英文摘要
BACKGROUND: Continuous Positive Airway Pressure (CPAP) is the standard treatment of obstructive sleep apnea (OSA), but has a heterogeneous blood pressure (BP) lowering effect. We hypothesized that Ventilatory Burden (VB), a metric better reflecting the entire burden of pathological airflow, may predict CPAP-induced BP reduction.
METHODS: We conducted a secondary analysis of the Apnea Positive Pressure Long-term Efficacy Study (APPLES) cohort. Participants were stratified by baseline VB (>20% breaths with < 50% amplitude) and OSA severity (AHI ≥ 30). Linear regression models were used to assess the relationship between these subgroups, CPAP adherence, and morning/evening BP changes at 2 and 6 months. The subgroup analyses were exploratory, and reported p values were nominal.
RESULTS: A total of 962 participants were initially enrolled with complete baseline assessments, of whom 749 completed the 2-month follow-up and 649 completed the 6-month follow-up. At 2 months, active CPAP was associated with a reduction in morning SBP relative to sham CPAP among participants with High VB and good adherence (β = 1.73 mmHg, p = 0.037). This association was not observed at 6 months. In the OSA severity-stratified analysis, active CPAP was associated with morning SBP reduction in the non-severe OSA subgroup with good adherence at both follow-ups.
CONCLUSION: Among participants with High VB and good CPAP adherence, active CPAP was associated with an early reduction in morning SBP relative to sham CPAP. This association was observed at 2 months but not at 6 months. Prospective studies incorporating prespecified treatment-interaction analyses are required to determine whether VB can identify blood pressure responders to CPAP.