中重度阻塞性睡眠呼吸暂停患者 CPAP 与下颌前移矫治器治疗对血压变异性的比较影响。
Comparative effects of CPAP and mandibular advancement splint therapy on blood pressure variability in moderate to severe obstructive sleep apnoea.
机构信息
Sleep Research Group, D 17 - Charles Perkins Centre, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, Northern Clinical School, The University of Sydney, Australia.
Sleep Research Group, D 17 - Charles Perkins Centre, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, Northern Clinical School, The University of Sydney, Australia; Centre for Sleep Health & Research, Department of Respiratory Medicine, Royal North Shore Hospital, Australia.
出版信息
Sleep Med. 2021 Apr;80:294-300. doi: 10.1016/j.sleep.2021.01.059. Epub 2021 Feb 3.
BACKGROUND
Obstructive sleep apnoea (OSA) is associated with increased blood pressure variability (BPV) and are risk factors for cardiovascular disease. We aimed to assess the comparative effects of two OSA therapies, continuous positive airway pressure (CPAP) and mandibular advancement splint (MAS), on BPV.
METHODS
This is a secondary analysis of data collected as part of a previously published randomised crossover trial of one month each of CPAP and MAS therapy. BPV was determined from 24-h-ambulatory blood pressure recordings in 92 patients with moderate to severe OSA at baseline and after one month of optimised treatment with each modality. BPV was assessed by three measures: Standard deviation of the mean (SD), Coefficient of variation (CoV), and the Average Real Variability (ARV) index.
RESULTS
Neither CPAP nor MAS therapy improved BPV, with no difference between treatments. BPV did not change in hypertensive OSA patients, however, there was a reduction in ARV of diastolic blood pressure in the effectively treated compared to ineffectively treated CPAP patients, Δ ARV 24-h-DBP (mmHg), -0.72 ± 2.14, 0.34 ± 1.52, P = 0.02, respectively. There was no difference between effective versus ineffective MAS treatment, Δ ARV 24-h-DBP (mmHg), -0.04 ± 2.4, 0.02 ± 1.9, P = 1.00, respectively.
CONCLUSIONS
One month of optimised CPAP or MAS therapy did not improve short term BPV in patients with moderate to severe OSA. The subgroup of patients on effective CPAP showed some improvement in BPV with CPAP but not MAS. Further work on the effect of OSA therapy on BPV following long-term therapy is needed.
背景
阻塞性睡眠呼吸暂停（OSA）与血压变异性（BPV）增加有关，是心血管疾病的危险因素。我们旨在评估两种 OSA 治疗方法，持续气道正压通气（CPAP）和下颌前伸矫治器（MAS），对 BPV 的比较效果。
方法
这是对先前发表的一项随机交叉试验数据的二次分析，该试验每个月分别接受 CPAP 和 MAS 治疗一个月。在基线和每种模式优化治疗一个月后，通过 24 小时动态血压记录评估 92 例中重度 OSA 患者的 BPV。BPV 通过三种方法评估：均数标准差（SD）、变异系数（CoV）和平均真实变异性（ARV）指数。
结果
CPAP 或 MAS 治疗均未改善 BPV，两种治疗方法之间无差异。高血压 OSA 患者的 BPV 没有变化，然而，与 CPAP 治疗无效的患者相比，有效治疗的患者舒张压 ARV 降低，Δ ARV 24-h-DBP（mmHg），-0.72±2.14，0.34±1.52，P=0.02，分别。有效与无效 MAS 治疗之间无差异，Δ ARV 24-h-DBP（mmHg），-0.04±2.4，0.02±1.9，P=1.00，分别。
结论
中重度 OSA 患者接受优化 CPAP 或 MAS 治疗一个月，短期 BPV 无改善。接受有效 CPAP 治疗的患者亚组在 CPAP 治疗下，BPV 有所改善，但 MAS 治疗无效。需要进一步研究长期治疗后 OSA 治疗对 BPV 的影响。
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