Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension: a randomized clinical trial
Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension: a randomized clinical trial
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DOI：
10.1007/s11325-012-0746-7
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发表时间：
2013-05-01
影响因子：
2.5
通讯作者：
Tegelberg, Ake
中科院分区：
文献类型：
--
作者：
Andren, Ann;Hedberg, Par;Tegelberg, Ake
持续气道正压治疗可以降低阻塞性睡眠呼吸暂停(OSA)患者的血压。本研究的目的是评估口腔矫治器(OA)治疗对血压的潜在影响，评估不同的血压测量结果，并提供样本量计算的信息。72名OSA合并高血压的患者被随机分配到有下颌前移的口腔矫治器(主动组)和没有下颌前移的口腔矫治器(对照组)进行干预。在治疗前和治疗3个月后，患者进行夜间睡眠监测和24小时动态血压监测，在各种血压措施中，治疗组24小时平均收缩压变化趋势最大，与对照组相比降压幅度为1.8 mm Hg。在基线日间平均收缩压为135/85毫米汞柱的亚组中，平均收缩压下降了2.6毫米汞柱，出现了更强的效应趋势。另外，排除基线呼吸暂停低通气指数为千分之15的患者，活动组的平均收缩压较对照组显著降低4.4毫米汞柱(P=0.044)。在阻塞性睡眠呼吸暂停伴高血压的患者中，OA治疗对降低血压的效果不大。排除基线动态血压正常的患者后，治疗效果有更强的趋势。附加排除基线AHI为千分之一货币标志15的患者显示出显着的治疗效果。提供了为充分有效的随机研究提供样本量的数据。
Continuous positive airway pressure treatment has been shown to lower blood pressure (BP) in patients with obstructive sleep apnea (OSA). The aims of the present pilot study were to evaluate the potential effects of oral appliance (OA) therapy on BP, to assess various outcome BP measures, and to inform sample size calculation.Seventy-two patients with OSA and hypertension were randomly assigned to intervention with either an OA with mandibular advancement (active group) or an OA without advancement (control group). Before and after 3 months of treatment, the patients underwent nocturnal somnographic registration and 24-h ambulatory BP monitoring.Among the various BP measures, the largest trend toward effect of OA treatment was seen in 24-h mean systolic BP with a 1.8 mmHg stronger BP reduction in the active group compared with controls. A stronger trend toward effect was seen in a subgroup with baseline ambulatory daytime mean systolic BP > 135/85 mmHg where the mean systolic BP fell, on average, 2.6 mmHg. Additional exclusion of patients with baseline apnea hypopnea index (AHI) a parts per thousand currency sign15 gave a significant reduction in mean systolic BP of 4.4 mmHg (P = 0.044) in the active group compared with controls.In patients with OSA and hypertension, OA treatment had a modest trend toward effect on reducing BP. A stronger trend toward treatment effect was seen after excluding patients with normal baseline ambulatory BP. Additional exclusion of patients with baseline AHI a parts per thousand currency sign15 showed a significant treatment effect. Data to inform sample size for an adequately powered randomized study are provided.