北京生物医学工程

基于Meta分析的CPAP联合常规降压药物对OSAHS合并高血压患者的综合疗效分析

Comprehensive curative effect of CPAP combined with conventionalantihypertensive drugs on OSAHS patients with hypertensionbased on Meta-analysis

作者：雷强吕云辉李凯孙睿黄代金相艳马磊苗志斌

单位：昆明理工大学信息工程与自动化学院   云南省第一人民医院呼吸科

关键词： Meta分析;持续气道正压通气；阻塞性睡眠呼吸暂停低通气综合征；高血压；治疗效果

分类号：

出版年·卷·期（页码）：2017·36·2（192-201）

摘要：

目的利用Meta分析评价持续气道正压通气(continuous positive airway pressure，CPAP）联合常规降压药物对阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）合并高血压患者的综合疗效，为临床治疗提供参考。方法计算机检索中国生物医学文献数据库（Chinese BioMedical Literature Database，CBM）、Cochrane Library、PubMed、中国学术期刊全文数据库（China National Knowledge Infrastructure，CNKI）、万方数据知识服务平台，维普中文期刊服务平台等电子数据库并手工检索相关期刊，查找CPAP治疗对OSAHS合并高血压患者综合疗效影响的临床随机对照试验（randomized controlled trial，RCT），对符合条件的RCT，逐一评价纳入研究的质量，提取入选文献资料，采用RevMan5.3软件进行Meta分析，以Meta分析中的合并效应统计参数探讨CPAP联合常规降压药物的治疗效果。结果共纳入13篇文献。Meta分析数据显示：各项指标差异均具有统计学意义［AHI：WMD=-25.19，95%CI（-34.05，-16.33），P<0.00001；LSaO2：WMD=17.57，95%CI（11.16，23.98），P<0.00001。白天平均收缩压：WMD=-8.26，95%CI（-11.18，-5.34），P<0.00001；白天平均舒张压：WMD=-6.42，95%CI（-8.25，-4.60），P<0.00001；夜间平均收缩压：WMD=-12.92，95%CI（-19.65，-6.19），P<0.0002；夜间平均舒张压：WMD=-6.31，95%CI（-8.53，-4.09），P<0.00001；24h平均收缩压：WMD=-10.28，95%CI（-14.08，-6.48），P<0.00001；24h平均舒张压：WMD=-6.99，95%CI（-8.88，-5.09），P<0.00001］。分析数据提示CPAP联合常规降压药物治疗后OSAHS合并高血压患者各项指标改善程度较对照组（常规药物治疗）均有明显提升。漏斗图基本对称，存在发表偏倚可能性小。结论 CPAP联合常规降压药物治疗对我国OSAHS合并高血压患者有确切的疗效。

Objective To evaluate the comprehensive curative effect of continuous positive airway pressure (CPAP) combinated with conventional antihypertensive drugs on the obstructive sleep apnea-hypopnea syndrome (OSAHS) patients with hypertension by using meta-analysis method in order to provide a reference for the clinical treatment. Methods The related randomized controlled trial (RCT) literatures of comprehensive curative effects of CPAP on the OSAHS patients with hypertension were searched by computer from Chinese BioMedical Literature Database (CBM)，Cochrane Library，PubMed，China National Knowledge Infrastructure，Wanfang Data Knowledge Service Platform，and the relevant journals retrieved manually.Each eligible RCT was evaluated the quality and the literature was extracted.RevMan5.3 software was applied to carry out meta-analysis，and with the pooled meta-analysis we explored the curative effects of CPAP combined conventional antihypertensive drugs.Results A total of 13 articles were identified to meet the inclusion criteria.Meta-analysis showed that the differences of the indicators were statistically significant {Apnea hypopnea index ［WMD=-25.19，95%CI(-34.05,-16.33)，P<0.00001］，the lowest oxygen saturation at night［WMD=17.57，95%CI(11.16,23.98)，P<0.00001］，average systolic blood pressure and diastolic blood pressure during the day［WMD=-8.26，95%CI(-11.18,-5.34)，P<0.00001 and WMD=-6.42，95%CI(-8.25,-4.60)，P<0.00001，respectively］，night average systolic blood pressure and diastolic blood pressure［WMD=-12.92，95%CI(-19.65,-6.19)，P<0.0002 and WMD=-6.31，95%CI(-8.53,-4.09)，P<0.00001，respectively］，24 h average systolic blood pressure and diastolic blood pressure ［WMD=-10.28，95%CI (-14.08,-6.48)，P<0.00001 and WMD=-6.99，95% CI(-8.88,-5.09)，P<0.00001,respectively］}.The indicators of the CPAP group for OSAHS patients with hypertension improved significantly comparied with the control group (conventional drug treatment).The funnel schema was nearly symmetry with little bias.Conclusions The curative effect of CPAP combined with conventional antihypertensive drugs on OSAHS patients with hypertension is definite.

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