口腔矫治器治疗阻塞性睡眠呼吸暂停综合征合并高血压的原因探讨

The effect of oral appliance therapy on obstructive sleep apnea syndrome with hypertension

目的探讨下颌前移式口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征(OSAS)合并难治性高血压的疗效及其可能机制。方法经多导睡眠监测(PSG)确诊为轻、中度OSAS合并原发性高血压、规范口服降压药物治疗3个月以上,血压控制欠佳、同时适合配合戴用下颌前移式的口腔矫治器(OA)的患者21例为试验对象,年龄范围、体质量指数、血压相匹配的未带23例患者作为对照组。经过13周的治疗比较2组患者呼吸暂停和低通气指数(AHI)、夜间最低血氧饱和度(LSaO2)及睡前、晨起舒张压(SBP)和收缩压(DBP)。结果 OSAS患者晨起血压较睡前血压增高(P<0.05),并与LSaO2呈负相关(P<0.05)。经OA治疗、纠正睡眠呼吸暂停13周后,晨起舒张压较治疗前明显下降(P<0.05)。结论 OSAS患者反复睡眠呼吸暂停引起的低氧血症与其高血压具有相关性,OA通过对这种高血压患者低氧血症的纠正达到治疗的目的。

Objective To explore the relationship of obstructive sleep apnea syndrome （OSAS）with hyper-tension.Methods Forty-four patients diagnosed with OSAS were divided into oral appliance （OA）treatment group（OA group,21 patients）,and non-tolerated OA treatment group （N-OA group,23 patients）.Polysomnog-raphy and self-test blood pressure were performed at baseline in two groups.Results After a 13-week treatment, OA group showed significant improvement in apnea hypopnea index （AHI）and the lowest oxygen saturation （LSaO2 ）（P ＆lt;0.05）.While blood pressure significantly reduced （all P ＆lt;0.05）between before and after treat-ment.The reduction in blood pressure was significantly correlated to AHI and SaO2 .The N-OA group showed no differences in blood pressure variables between baseline and after the treatment for 13 weeks.Conclusion The nocturnal hypoxemia may be one of the causes of some OSAS with hypertension.Oral appliance treatment was ef-fective for such kind of hypertension.