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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
其他题名Effects of oral appliance treatment upon blood pressure in mild to moderate obstructive sleep apnea hypopnea syndrome
张立强; 郑旭; 王建丽; 王玉柱; 任斌; 贺蓓
关键词睡眠呼吸暂停,阻塞性 高血压 口腔矫治器 Sleep apnea,obstructive Hypertension Oral appliance
刊名中华医学杂志
2009
DOI10.3760/cma.j.issn.0376-2491.2009.26.005
89期:26页:1807-1810
收录类别中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型Journal Article
摘要目的 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(AJ)、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)、AJ(次/h)明显降低(7.0±3.8比21.0±6.5,22.9±6.3比32.2±9.3,均P<0.01),平均SaO2和最低SaO2明显升高(95.2%±0.6%比94.1%±1.0%,86.8%±43.5%比80.O%±5.2%,均P<0.01),同时24 h收缩压、日间收缩压和夜间收缩压、舒张压、MAP(nun Hg,1mmHg=0.133 kPa)均明显降低(127.2±7.5比129.4 4±8.8,131.5±6.9比133.6±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 polysonmography 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 24hour 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 antihypertersive 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 (AI) and minimum arterial oxygen saturation (MSaO2) atv 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 [(22.94±6.3) vs (32.2±9.3) per hour, P<0.01] and MSaO2(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 (133.64±8.1), and (91.2±6.4) vs (94.3±7.6) mmHg respectively, 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.
语种中文
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文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/71211
专题北京大学第三临床医学院_呼吸科
作者单位1.北京大学第三医院呼吸科,100191
2.北京大学第三医院口腔科,100191
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张立强,郑旭,王建丽,等. 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[J]. 中华医学杂志,2009,89(26):1807-1810.
APA 张立强,郑旭,王建丽,王玉柱,任斌,&贺蓓.(2009).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.中华医学杂志,89(26),1807-1810.
MLA 张立强,et al."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".中华医学杂志 89.26(2009):1807-1810.
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