口腔矫治器治疗对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 apneahypopnea syndrome

目的研究口腔矫治器（OA）对轻中度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血压的影响。方法46例轻中度OSAHS患者在继续使用原降压药（种类和剂量不变）的基础上分为睡眠时配戴OA治疗组（OA组，25例，合并高血压者15例）和非OA治疗组（N—OA组，21例，合并高血压者13例），OA组于OA治疗前和治疗12周末、N—OA组于入组时和12周末行多导睡眠图监测[记录呼吸暂停低通气指数（AHI）、微觉醒指数（AI）、平均血氧饱和度（SaO2）和最低SaO2]和动态血压监测，记录OA组患者每夜使用OA的平均时间，并应用Pearson检验分析OA治疗所致夜间平均动脉压（MAP）变化与其他参数的关系。结果OA组患者每夜使用OA时间平均（6．8±1．0）h，治疗12周末AHI（次／h）、AI（次／h）明显降低（7．04-3．8比21．0±6．5，22．9±6．3比32．2±9．3，均P〈0．01），平均Sa02和最低Sa02明显升高（95．2％±0．6％比94．1％±1．0％，86．8％±3．5％比80．0％±5．2％，均P〈0．01），同时24h收缩压、日间收缩压和夜间收缩压、舒张压、MAP（mmHg，1mmHg=0．133kPa）均明显降低（127．2±7．5比129．4±8．8，131．5±6．9比153．6±8．1，121．3±7．0比125．3±9．3，76．1±6．1比78．8±6．8，94．3±7．6比91．2±6．4，均P〈0．01）；夜间MAP下降与AI下降（r=0．37，P=0．005）、AHI下降（r=0．32，P=0．011）、治疗前夜间收缩压（r=0．39，P=0．015）、舒张压（r=0．30，P=0．024）相关。N—OA组12周末各项指标均无明显变化。结论OA治疗可降低OSAHS患者血压，血压降低程度与睡眠呼吸暂停低通气纠正程度和治疗前血压水平相关。

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 （A/） 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] andMSaO2 （ 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 Hgrespectively, 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.