Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown.
Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
J Hypertens. 2021 Nov 1;39(11):2272-2280. doi: 10.1097/HJH.0000000000002914.
Oral appliance therapy for obstructive sleep apnoea (OSA) reduces blood pressure (BP) but there is little information on relationship to circadian BP pattern (nocturnal BP dipping or non-dipping). The aims of this study were to determine whether nocturnal dipping pattern influences BP changes following oral appliance therapy, and to determine the effect of oral appliance therapy on circadian BP pattern.
Participants in two randomized trials of oral appliance therapy (1-2 months) with 24-h ambulatory BP monitoring (ABPM) data were included (N = 152). Nocturnal BP Dippers (nocturnal/diurnal SBP ratio <0.9) and non-dippers were compared for BP changes following oral appliance therapy and the effect of oral appliance therapy on nocturnal BP dipping was assessed.
Of 152 participants, 64.5% were dippers. Dippers were on average younger and less likely to be hypertensive (42 vs. 82.7%, P < 0.001). Nondippers showed greater reduction in nocturnal BP measures, related to higher BP measures at baseline. There was no difference in the relationship between treatment effectiveness and BP changes between groups. Oral appliance therapy converted only 23% of baseline non-dippers to a nocturnal dipping profile.
Baseline circadian BP profile influenced the BP response to oral appliance therapy, largely because of higher baseline BP in the non-dipper subgroup. Oral appliance therapy did not convert OSA patients to a more favourable circadian BP profile. Further work is required to understand the effect of oral appliance therapy on circadian BP profile and of the individuals who will receive cardiovascular benefit from oral appliance therapy.
口腔矫治器治疗阻塞性睡眠呼吸暂停（OSA）可降低血压（BP），但关于其与昼夜 BP 模式（夜间 BP 下降或非下降）关系的信息较少。本研究旨在确定夜间下降模式是否会影响口腔矫治器治疗后的 BP 变化，并确定口腔矫治器治疗对昼夜 BP 模式的影响。
纳入了两项关于口腔矫治器治疗（1-2 个月）的随机试验（均有 24 小时动态血压监测[ABPM]数据）的参与者（N=152）。比较了夜间 BP 下降者（夜间/日间 SBP 比值<0.9）和非下降者在口腔矫治器治疗后的 BP 变化，并评估了口腔矫治器治疗对夜间 BP 下降的影响。
在 152 名参与者中，64.5%为夜间 BP 下降者。夜间 BP 下降者的平均年龄更小，且更不可能患有高血压（42% vs. 82.7%，P<0.001）。非下降者夜间 BP 指标的下降幅度更大，与基线时更高的 BP 指标相关。两组之间，治疗效果与 BP 变化之间的关系没有差异。口腔矫治器治疗仅将 23%的基线非下降者转变为夜间下降模式。
基线昼夜 BP 模式影响了口腔矫治器治疗的 BP 反应，主要是因为非下降亚组的基线 BP 更高。口腔矫治器治疗并不能使 OSA 患者的昼夜 BP 模式更有利。需要进一步研究来了解口腔矫治器治疗对昼夜 BP 模式的影响，以及哪些个体将从口腔矫治器治疗中获益。
