Obstructive sleep apnea (OSA) is a chronic disease that affects more than 15% of the adult population and becomes more prevalent with age.1 Although multiple observational studies show that OSA is an independent risk factor for cardiovascular disease (CVD), the treatment of OSA with continuous positive airway pressure (CPAP) does not uniformly prevent CVD. Recent randomised clinical trials failed to demonstrate a role for CPAP treatment in secondary CVD prevention.2 3 Nevertheless, CPAP treatment affects cardiovascular outcomes positively in specific groups of OSA patients. For example, patients with resistant hypertension experience a significant reduction in 24-hour blood pressure with CPAP treatment.4 Notably, a secondary analysis of this study showed that CPAP treatment did not decrease blood pressure in at least 30% of patients with resistant hypertension, demonstrating that a more precise approach to patient selection is needed to improve the effectiveness of OSA treatment(s) in CVD prevention. Previous studies have explored novel approaches to identify OSA patients where CPAP treatment has significant antihypertensive effects. These studies have demonstrated a combination of specific biomarkers together with the clinical characterisation of circadian blood pressure patterns to be informative.5–7 In this context, the identification of new clinical variables that go beyond the apnea-hypopnea index (AHI), which fails to capture the complexity of OSA pathophysiology, may allow precise CVD risk stratification. The results of a cross-sectional analysis of the Multi-Ethnic …

中文翻译：

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睡眠障碍测量与血压的关联：是时候探索新的测量了吗？

阻塞性睡眠呼吸暂停 (OSA) 是一种慢性疾病，影响超过 15% 的成年人口，并且随着年龄的增长变得更加普遍。 1 尽管多项观察性研究表明 OSA 是心血管疾病 (CVD) 的独立危险因素，但治疗具有持续气道正压通气 (CPAP) 的 OSA 并不能统一预防 CVD。最近的随机临床试验未能证明 CPAP 治疗在二级 CVD 预防中的作用。2 3 然而，CPAP 治疗对特定 OSA 患者组的心血管结局有积极影响。例如，顽固性高血压患者在接受 CPAP 治疗后 24 小时血压显着降低。 4 值得注意的是，这项研究的二次分析表明，CPAP 治疗不会降低至少 30% 顽固性高血压患者的血压，这表明需要更精确的患者选择方法来提高 OSA 治疗在 CVD 预防中的有效性. 以前的研究探索了新的方法来识别 CPAP 治疗具有显着降压作用的 OSA 患者。这些研究表明，将特定的生物标志物与昼夜节律血压模式的临床特征相结合，可以提供信息。 5-7 在这种情况下，识别超出呼吸暂停低通气指数 (AHI) 的新临床变量，该方法失败了捕捉 OSA 病理生理学的复杂性，可能允许精确的 CVD 风险分层。