高血压合并睡眠呼吸暂停低通气综合征的治疗进(3)

2.4.3 中医治疗

从调节体质的角度探索OSAHS的防止目前更多存在于理论层面，缺乏大样本、多中心的随机对照试验证实[27]。现有的采用中医药方法治疗OSAHS的研究显示出一定疗效，杨珺超等[28]采用二陈解鼾颗粒治疗痰湿型OSAHS患者可降低腹围、BMI、血脂，还可改善夜间低通气和缺氧情况。温凤霞等[29]采用益平调脉方治疗OSAHS合并高血压的患者，可显著改善患者症状及夜间通气情况，降低血压，疗效显著。包君丽等学者认为治疗OSAHS应以祛痰化湿和活血化瘀药物为主，能够改善体质、减少病理损害[30]。

3 小结

OSAHS可通过氧化应激、增加交感神经系统兴奋性等多种途径升高血压，影响血压昼夜节律和增大血压变异性。对于高血压合并睡眠呼吸暂停低通气综合征的患者，应在治疗OSAHS的同时加强血压的监管，对符合条件的患者首选CPAP进行规范化治疗。此外，中医药方面的治疗没有很大进展，未来可加强采用传统医药治疗OSAHS相关性高血压的探索。

[1]盛红宇, 李南方, 孔剑琼.阻塞性睡眠呼吸暂停低通气综合征合并高血压的诊治进展[J].中华高血压杂志,2015,23(06):589-593.

[2]Cai A, Wang L, Zhou Y. Hypertension and obstructive sleep apnea[J]. Hypertens Res,2016,39(6):391-395.

[3]Zhang XB, Lin QC, Zeng HQ, et al. Erectile dysfunction and sexual hormone levels in men with obstructive sleep apnea: efficacy of continuous positive airway pressure[J]. Arch Sex Behav,2016,45(1):235-240.

[4]Lee WH, Wee JH, Rhee CS, et al. Erythrocyte sedimentation rate may help predict severity of obstructive sleep apnea[J]. Sleep Breath,2016,20(1):419-424.

[5]Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea[J]. Lancet,2014,383(9918):736-747.

[6]Dominguez JE, Krystal AD, Habib AS. Obstructive sleep apnea in pregnant women: a review of pregnancy outcomes and an approach to management[J]. AnesthAnalg,2018,127(5):1167-1177.

[7]Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015[J]. J Clin Sleep Med,2015,11(7):773-827.

[8]中国高血压防治指南修订委员会,高血压联盟(中国,中华医学会心血管病学分会中国医师协会高血压专业委员会, 等). 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志,2019,24(1):24-56.

[9]Donovan LM, Boeder S, Malhotra A, et al. New developments in the use of positive airway pressure for obstructive sleep apnea[J]. J Thorac Dis,2015,7(8):1323-1342.

[10]Lei Q, Lv Y, Li K, et al. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a systematic review and meta-analysis of six randomized controlled trials[J]. J Bras Pneumol,2017,43(5):373-379.

[11]孙睿. CPAP治疗阻塞性睡眠呼吸暂停低通气综合征合并难治性高血压的疗效观察[J]. 中国实用医药,2018,13(22):57-58.

[12]徐彦飞, 刘露, 周舟, 等. 持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征合并难治性高血压患者血压及相关炎性因子的影响[J]. 中国呼吸与危重监护杂志,2019,18(04):322-326.

[13]陈婷, 陆建芳. 持续正压通气对青年阻塞性睡眠呼吸暂停低通气综合征合并高血压患者疗效探讨[J]. 当代医学,2018,24(36):24-26.

[14]Sánchez-de-la-Torre M, Khalyfa A, Sánchez-de-la-Torre A, et al. Precision medicine in patients with resistant hypertension and obstructive sleep apnea: blood pressure response to continuous positive airway pressure treatment[J]. J Am Coll Cardiol,2015,66(9):1023-1032.

[15]Askland K, Wright L, Wozniak DR, et al. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea[J]. Cochrane Database Syst Rev,2020,4(4): CD007736.

[16]Hefny, MR, Samy D, Mohamed T, et al. Hypoglossal nerve conduction studies in patients with obstructive sleep apnea[J]. Egypt J Otolaryng,2013,29(2):176-181.

[17]Tokunou T, Ando SI. Recent advances in the management of secondary hypertension-obstructive sleep apnea[EB/OL]. Hypertens Res,2020,17.

[18]Walia HK, Harneet T, Nicolas S, et al. Upper airway stimulation versus positive airway pressure impact on blood pressure and sleepiness symptoms in obstructive sleep apnea[J]. Chest,2019,157(1):1-11.

[19]Witkowski A, Prejbisz A, Florczak E, et al. Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea[J]. Hypertension,2011,58(4):559-565.

[20]Linz D, Mancia G, Mahfoud F, et al. Renal artery denervation for treatment of patients with self-reported obstructive sleep apnea and resistant hypertension: results from the Global Symplicity Registry[J]. J Hypertens,2017,35(1):148-153.

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