下颌前伸装置治疗阻塞性睡眠呼吸暂停患者并逆转左心室肥厚重构。
Mandibular advancement device treatment and reverse left ventricular hypertrophic remodeling in patients with obstructive sleep apnea.
机构信息
Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.
出版信息
J Clin Sleep Med. 2022 Mar 1;18(3):903-909. doi: 10.5664/jcsm.9766.
STUDY OBJECTIVES
Obstructive sleep apnea (OSA) is associated with cardiovascular comorbidities such as left ventricular (LV) hypertrophy. Whether OSA is an independent etiological factor for this hypertrophic remodeling is yet unknown. Continuous positive airway pressure partially reverses this hypertrophy, but data regarding the effect of mandibular advancement devices on LV remodeling are scarce. The aim of this prospective trial is to evaluate the effect of mandibular advancement device therapy on LV geometry and function in patients with OSA.
METHODS
At baseline and 6-month follow-up, participants underwent a home sleep apnea test, 24-hour ambulatory blood pressure monitoring and a 2-dimensional Doppler and tissue Doppler echocardiography.
RESULTS
Sixty-three patients (age: 49 ± 11 years; body mass index: 27.0 ± 3.4 kg/m; baseline apnea-hypopnea index home sleep apnea test: 11.7 [8.2; 24.9] events/h) completed the 6-month follow-up visit. Overall, blood pressure values and parameters of LV function were within normal ranges at baseline and did not change under mandibular advancement device therapy. In contrast, the interventricular septum thickness was at the upper limits of normal at baseline and showed a significant decrease at 6-month follow-up (11.1 ± 2.1 mm vs 10.6 ± 2.0 mm, = .03). This significant improvement is only found in responders but not in nonresponders. There was no correlation between the decrease of interventricular septum thickness and the change in blood pressure.
CONCLUSIONS
In mildly obese, normotensive patients with OSA we observed significant reverse hypertrophic remodeling after 6 months of successful mandibular advancement device therapy, with maintained normotensive systemic blood pressure. This suggests that OSA is an independent factor in the pathophysiology of LV hypertrophy in these patients.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Name: Evaluation of the Cardiovascular Effects of the MAS in the Treatment of Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT02320877; Identifier: NCT02320877.
CITATION
Dieltjens M, Vanderveken OM, Shivalkar B, et al. Mandibular advancement device treatment and reverse left ventricular hypertrophic remodeling in patients with obstructive sleep apnea. . 2022;18(3):903-909.
研究目的
阻塞性睡眠呼吸暂停（OSA）与左心室（LV）肥大等心血管合并症相关。OSA 是否是这种肥厚重塑的独立病因尚不清楚。持续气道正压通气可部分逆转这种肥大，但关于下颌前伸装置对 LV 重塑影响的数据却很少。本前瞻性试验旨在评估下颌前伸装置治疗对 OSA 患者 LV 几何形状和功能的影响。
方法
在基线和 6 个月随访时，参与者接受家庭睡眠呼吸暂停试验、24 小时动态血压监测以及二维多普勒和组织多普勒超声心动图检查。
结果
63 例患者（年龄：49±11 岁；体重指数：27.0±3.4kg/m；基线家庭睡眠呼吸暂停试验呼吸暂停低通气指数：11.7[8.2；24.9]次/h）完成了 6 个月的随访。总的来说，血压值和 LV 功能参数在基线时均在正常范围内，并且在使用下颌前伸装置治疗期间没有变化。相反，室间隔厚度在基线时处于正常上限，在 6 个月随访时显著下降（11.1±2.1mm 比 10.6±2.0mm， =.03）。这种显著改善仅见于反应者，而不在无反应者中。室间隔厚度的降低与血压的变化之间没有相关性。
结论
在轻度肥胖、血压正常的 OSA 患者中，我们观察到成功的下颌前伸装置治疗 6 个月后，存在明显的反向肥厚重塑，同时保持正常的系统性血压。这表明 OSA 是这些患者 LV 肥厚病理生理学中的一个独立因素。
临床试验注册
注册处：ClinicalTrials.gov；名称：评估 MAS 在治疗阻塞性睡眠呼吸暂停中的心血管影响；网址：https://clinicaltrials.gov/ct2/show/NCT02320877；标识符：NCT02320877。
引用
Dieltjens M、Vanderveken OM、Shivalkar B 等人。下颌前伸装置治疗阻塞性睡眠呼吸暂停患者和逆转左心室肥厚重塑。睡眠医学。2022；18(3):903-909。
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