高血压英文ppt精品课件obstructivesleep apnoeahypopnoea

Dr C Ravindran MD,DTCD,MBA Dean Medical College, Calicut ICS-Dr CV Ramakrishnan Oration 2010 Obstructive Sleep Apnoea- Hypopnoea Syndrome OSAHS is a common but often unrecognized entity Sleep disordered breathing occur in both men (25%) and women (10%) of varying ethnic groups Prevalence of symptomatic sleep apnea has been reported to be 4% for men and 2% for women ICS-Dr CV Ramakrishnan Oration 2010 OSAHS Obstructive sleep apnea (OSA) is affecting an estimated 15 million Americans, with a prevalence that is probably also rising as a consequence of increasing obesity. Epidemiologic data support a link between obesity and hypertension as well as between OSA and hypertension. ICS-Dr CV Ramakrishnan Oration 2010 OSAHS P for trend = 0.005) compared with those with lowest AHI (5) were at significantly higher risk for nocturnal systolic (OR 3.9 (95% CI 1.4 to 10.5) and diastolic (OR 3.3 (95% CI 1.4 to 8.1) hypertension. Thorax63(9),803-809 (2008). OSA 14: 10905 OSA 131:285-301 OSA/HTN + CPAP 118 patients with ODI of 17/hr on CPAP Vs sub-therapeutic CPAP (1cm) x 4weeks Mean BP decreased by 2.4/3.4(sleep/wake) Vs an increase of 0.8 CPAP 5 hours needed Pepperell et al ICS-Dr CV Ramakrishnan Oration 2010 Changes in mean (MAP), systolic, and diastolic blood pressure with effective (closed bars) and sub- therapeutic (open bars) CPAP. ICS-Dr CV Ramakrishnan Oration 2010 OSA/HTN + CPAP 32 patients on CPAP vs sub-therapeutic CPAP (1cm) x 9 weeks SBP/DBP decreased by 10 mm vs no change AHI decreased from 65 to 3 vs 65 to 33 Becker et al ICS-Dr CV Ramakrishnan Oration 2010 Becker et al: Circulation, 2003 N=768 ICS-Dr CV Ramakrishnan Oration 2010 ICS-Dr CV Ramakrishnan Oration 2010 Long-term Effect of Continuous Positive Airway Pressure in Hypertensive Patients with Sleep Apnea In non-sleepy hypertensive patients with OSA, CPAP treatment for 1 year is associated with a small decrease in BP. This effect is evident only in patients who use CPAP for more than 5.6 hours per night. Ferran Barb1, Joaqun Durn- Cantolla, Francisco Capote et al: AJRCCM 2010;181:718-726 Comparison of Continuous Positive Airway Pressure and Valsartan in Hypertensive Patients with Sleep Apnea In an RCT, although the BP decrease was significant with CPAP treatment, valsartan induced a fourfold higher decrease in mean 24-hour BP than CPAP in untreated hypertensive patients with OSA. AJRCCM 2010; 182: 954-960 Conclusions Epidemiologic data suggest that sleep apnea is an independent risk factor for hypertension. Studies support the concept that effective CPAP therapy can have early and sustained beneficial effect on daytime and nighttime blood pressure. Obesity contributes to cardiovascular risk associated with OSA and also to hypertension. Efforts to carefully screen and treat patients with sleep apnea would