经 CPAP 或下颌前伸装置治疗轻度阻塞性睡眠呼吸暂停以及治疗一年后对血压和血管内皮功能的影响。
The treatment of mild OSA with CPAP or mandibular advancement device and the effect on blood pressure and endothelial function after one year of treatment.
机构信息
Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil.
Departamento de Pneumologia, Universidade Federal de Sao Paulo, São Paulo, Brasil.
出版信息
J Clin Sleep Med. 2021 Feb 1;17(2):149-158. doi: 10.5664/jcsm.8822.
STUDY OBJECTIVES
To evaluate and compare the effects of continuous positive airway pressure (CPAP), use of a mandibular advancement device (MAD), and no treatment on 24-hour ambulatory blood pressure monitoring and peripheral arterial tonometry at 6 and 12 months follow-up in individuals with mild obstructive sleep apnea (OSA), and in a subgroup who had an apnea-hypopnea index of < 5 events/h and adherence of ≥ 4 hours per night (effective-treatment subgroups).
METHODS
The inclusion criteria were individuals with mild obstructive sleep apnea, any sex, age between 18 and 65 years, and a body mass index of ≤ 35 kg/m². Patients were randomized into CPAP, MAD, and no-treatment groups. The evaluations included physical examination, full polysomnography, 24-hour ambulatory blood pressure monitoring, and peripheral arterial tonometry at baseline and after 6 and 12 months. A generalized linear mixed model was used for comparisons.
RESULTS
The CPAP and MAD groups had lower apnea-hypopnea indexes than the control group at 6 and 12 months, and the CPAP group had higher blood oxygen levels (SpO₂) than the MAD group. The MAD group had more hours of treatment per night and better adaptation to treatment than the CPAP group (MAD: 5.7 ± 2.7 h/night; CPAP: 3.8 ± 3.4 h/night; MAD: 16% did not adapt; CPAP: 42% did not adapt). No differences were found in the total sample and effective treatment in relation to peripheral arterial tonometry or 24-hour ambulatory blood pressure monitoring outcomes.
CONCLUSIONS
Treatment of mild obstructive sleep apnea with CPAP or MAD did not improve blood pressure or endothelial function after 1 year, even in patients with effective treatment.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Name: Continuous Positive Airway Pressure and Oral Appliances Treatments in Mild Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT01461486; Identifier: NCT01461486.
研究目的
评估和比较持续气道正压通气（CPAP）、使用下颌前伸装置（MAD）和不治疗对轻度阻塞性睡眠呼吸暂停（OSA）患者的 24 小时动态血压监测和外周动脉张力的影响，并在亚组中比较呼吸暂停低通气指数<5 次/小时和每晚≥4 小时依从性（有效治疗亚组）的影响。
方法
纳入标准为轻度阻塞性睡眠呼吸暂停患者，任何性别，年龄 18-65 岁，体重指数≤35kg/m²。患者随机分为 CPAP、MAD 和不治疗组。评估包括体格检查、全夜多导睡眠图、24 小时动态血压监测和外周动脉张力，基线和治疗后 6 个月和 12 个月进行评估。采用广义线性混合模型进行比较。
结果
CPAP 和 MAD 组在 6 个月和 12 个月时呼吸暂停低通气指数低于对照组，CPAP 组血氧水平（SpO₂）高于 MAD 组。MAD 组每晚治疗时间更长，对治疗的适应性更好（MAD：5.7±2.7h/夜；CPAP：3.8±3.4h/夜；MAD：16%不适应；CPAP：42%不适应）。在总样本和有效治疗中，外周动脉张力或 24 小时动态血压监测结果均无差异。
结论
即使在有效治疗的患者中，CPAP 或 MAD 治疗轻度阻塞性睡眠呼吸暂停 1 年后也不能改善血压或内皮功能。
临床试验注册
注册号：ClinicalTrials.gov；名称：持续气道正压通气和口腔器具治疗轻度阻塞性睡眠呼吸暂停；网址：https://clinicaltrials.gov/ct2/show/NCT01461486；标识符：NCT01461486。
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