[口腔矫治器治疗对轻至中度阻塞性睡眠呼吸暂停低通气综合征患者血压的影响]

[Effects of oral appliance treatment upon blood pressure in mild to moderate obstructive sleep apnea-hypopnea syndrome].

作者信息

Zhang Li-Qiang, Zheng Xu, Wang Jian-Li, Wang Yu-Zhu, Ren Bin, He Bei

机构信息

Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2009 Jul 14;89(26):1807-10.

PMID:19953922

Abstract

OBJECTIVE

To evaluate the effects of oral appliance (OA) treatment upon systemic blood pressure (BP) in mild to moderate patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODS

Forty-six consecutive patients diagnosed with OSAHS on polysomnography were divided into OA treatment group (OA group, 25 patients, 15 patients with hypertension) and non-tolerated OA treatment group (N-OA group, 21 patients, 13 patients with hypertension). Polysomnography and 24-hour ambulatory blood pressure monitoring (ABPM) were performed at baseline in two groups. Polysomnography and ABPM were repeated after a completion of 12 weeks of treatment in OA group and after a cessation of treatment for 12 weeks in N-OA group. Hypertensive patients in two groups continued taking the same kind and the same dose of antihypertensive agents during the period of study.

RESULTS

There was no significant difference between the two groups in age, body mass index, Epworth sleepiness score (ESS), apnoea-hypopnoea index (AHI), arousal index (AI) and minimum arterial oxygen saturation (MSaO2) at baseline. After a 12-week treatment, OA group showed significant improvement in AHI [(7.0 +/- 3.8) vs (21.0 +/- 6.5) per hour, P < 0.01], AI [(22.9 +/- 6.3) vs (32.2 +/- 9.3) per hour, P < 0.01] and MSaO2 (86.8% +/- 3.5% vs 80.0% +/- 5.2%, P < 0.01), while nocturnal mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), 24-hour and diurnal SBP, and nocturnal mean artery pressure (MAP) were significantly reduced [(121.3 +/- 7.0) vs (125.3 +/- 9.3), (76.1 +/- 6.1) vs (78.8 +/- 6.8), (127.2 +/- 7.5) vs (129.4 +/- 8.8), (131.5 +/- 6.9) vs (133.6 +/- 8.1), and (91.2 +/- 6.4) vs (94.3 +/- 7.6) mm Hg respectively, all P < 0.01]. The reduction in nocturnal MAP was significantly correlated to improvement in AI(r = 0.37, P = 0.005) and AHI (r = 0.32, P = 0.011), to baseline nocturnal mean blood pressure (SBP: r = 0.39, P = 0.015; DBP: r = 0.30, P = 0.024). The N-OA group showed no differences in blood pressure variables between baseline and after a cessation of treatment for 12 weeks.

CONCLUSION

Oral appliance treatment for mild to moderate OSAHS may lead to a reduction in systemic blood pressure.

摘要

目的

评估口腔矫治器（OA）治疗对轻至中度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者全身血压（BP）的影响。

方法

46例经多导睡眠图诊断为OSAHS的连续患者被分为OA治疗组（OA组，25例患者，15例高血压患者）和不耐受OA治疗组（N - OA组，21例患者，13例高血压患者）。两组在基线时均进行多导睡眠图和24小时动态血压监测（ABPM）。OA组在完成12周治疗后以及N - OA组在停止治疗12周后重复进行多导睡眠图和ABPM。两组高血压患者在研究期间继续服用相同种类和相同剂量的抗高血压药物。

结果

两组在基线时的年龄、体重指数、爱泼沃斯嗜睡量表（ESS）评分、呼吸暂停低通气指数（AHI）、觉醒指数（AI）和最低动脉血氧饱和度（MSaO2）方面无显著差异。经过12周治疗后，OA组的AHI[每小时（7.0±3.8）次 vs （21.0±6.5）次，P < 0.01]、AI[每小时（22.9±6.3）次 vs （32.2±9.3）次，P < 0.01]和MSaO2（86.8%±3.5% vs 80.0%±5.2%，P < 0.01）有显著改善，而夜间平均收缩压（SBP）和舒张压（DBP）、24小时和日间SBP以及夜间平均动脉压（MAP）显著降低[分别为（121.3±7.0）mmHg vs （125.3±9.3）mmHg，（76.1±6.1）mmHg vs （78.8±6.8）mmHg，（127.2±7.5）mmHg vs （129.4±8.8）mmHg，（131.5±6.9）mmHg vs （133.6±8.1）mmHg，以及（91.2±6.4）mmHg vs （94.3±7.6）mmHg，均P < 0.01]。夜间MAP的降低与AI（r = 0.37，P = 0.005）和AHI（r = 0.32，P = 0.011）的改善以及基线夜间平均血压（SBP：r = 0.39，P = 0.015；DBP：r = 0.30，P = 0.024）显著相关。N - OA组在基线和停止治疗12周后的血压变量无差异。