定制式口腔矫治器治疗OSAHS对相关性高血压的影响  

Effect of customised oral appliances on hypertension associated with obstructive sleep apnea hypopnea syndrome

作　　者：马婷 周玮 高雪梅[3] 陈建霖 弓煦[3] 陈斯[3] 郭峰 刘霖[5] 高莹卉 樊永杰 杨喆 张佐[8] 王少 路健 杨乐 Ma Ting;Zhou Wei;Gao Xuemei;Chen Jianlin;Gong Xu;Chen Si;Guo Feng;Liu Lin;Gao Yinghui;Fan Yongjie;Yang Zhe;Zhang Zuo;Wang Shao;Lu Jian;Yang Le(School of Stomatology,Ningxia Medical University,Yinchuan 750003,China;Department of Respiratory,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Department of Orthodontics,Peking University Sohool and Hospital of Stomatological,Beijing 100081,China;Department of Stomatology,Ningxia Lingwu People's Hospital,Yinchuan 750499,China;Department of Respiratory and Critical Care Medicine,The Second Medical Centre of PLA General Hospital,Beijing 100853,China;Sleep Centre,Peking University International Hospital,Beijing 102206,China;Department of Orthodontics,Inner Mongolia First Machine Hospital,Baotou 014030,China;Department of Stomatology,Ningxia Hui Autonomous Region People's Hospital,Yinchuan 750002,China;Department of Stomatology,Nanliangtaizi Health Centre,Helan County,Yinchuan City,Yinchuan 750200,China)

机构地区：[1]宁夏医科大学口腔医学院,银川750003 [2]宁夏回族自治区人民医院呼吸科,银川750002 [3]北京大学口腔医学院·口腔医院正畸科,北京100081 [4]宁夏灵武市人民医院口腔科,银川750499 [5]解放军总医院第二医学中心呼吸与危重症医学科,北京100853 [6]北京大学国际医院睡眠中心,北京102206 [7]内蒙古一机医院口腔正畸科,包头014030 [8]宁夏回族自治区人民医院口腔科,银川750002 [9]宁夏银川市贺兰县南梁台子卫生院口腔科,银川750200

出　　处：《中华口腔正畸学杂志》2025年第1期13-18,共6页Chinese Journal of Orthodontics

基　　金：宁夏重点研发基金项目(2022BEG02031)。

摘　　要：目的观察分析定制式口腔矫治器治疗前后阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)相关性高血压患者的临床指标,探讨定制式口腔矫治器治疗OSAHS对相关性高血压的影响。方法采用前瞻性研究,选取研究对象120例,然后依据随机数表法随机分配两组,分别为实验组和对照组。实验组60例受试者在原有降压药物治疗基础上,同时使用定制式口腔矫治器进行治疗;对照组60例只持续使用原有的降压药物治疗,未应用其他辅助治疗措施。治疗6个月后,通过非接触式睡眠呼吸监测仪监测、动态血压监测、血清学检查、Epworth嗜睡评分量表(epworth sleepiness scale,ESS),对所得数据进行组内及组间差异分析对比,观察定制式口腔矫治器治疗OSAHS对相关性高血压的影响。结果在治疗完成后,实验组的睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)、ESS这两项睡眠监测指标都比治疗前降低[AHI治疗前(31.33±6.07)次/h,治疗后(15.53±5.34)次/h,(P<0.001);ESS治疗前7.20±2.43,治疗后4.00±1.69,(P<0.001)],同时最低脉搏血氧饱和度(lowest pulse oxygen saturation,LSpO_(2))和平均脉搏血氧饱和度(mean pulse oxygen saturation,MSpO_(2))比治疗前有提升[最低脉搏血氧饱和度治疗前(68.60±10.35)%,治疗后(80.13±7.44)%,(P=0.004);平均脉搏血氧饱和度治疗前(84.60±3.04)%,治疗后(89.80±3.65)%,(P=0.001)]。两组间治疗前后的血压相关指标差异在统计学上没有显著意义。对两组血压、心率相关指标治疗前后数据差值进行变化率比较,实验组全部血压相关指标下降率大于对照组,夜间平均收缩压、夜间平均舒张压两项数据下降率较对照组差异有统计学意义[实验组夜间平均收缩压下降率为(13.15±3.99)%,对照组夜间平均收缩压下降率为(7.44±4.74)%(P=0.001);实验组夜间平均舒张压下降率为(16.40±2.51)%,对照组夜间平均舒张压下降率为(4Objective To observe and analyze the clinical indicators of patients with obstructive sleep apnea hypopnea syndrome(OSAHS)-related hypertension before and after treatment with a customized oral appliance,and to explore the effects of this treatment on OSAHS-related hypertension.Methods A prospective study was conducted with 120 participants,who were randomly assigned into two groups according to a random number table:an experimental group and a control group.The 60 participants in the experimental group received a customized oral appliance treatment in addition to their existing antihypertensive medication,while the remaining 60 participants in the control group continued using only their antihypertensive medication without any additional interventions.After 6 months of treatment,data from non-contact sleep monitoring,ambulatory blood pressure monitoring,serological tests,and the Epworth Sleepiness Scale(ESS)were analyzed for intra-group and inter-group differences to observe the effects of the custom-made oral appliance on OSAHS-related hypertension.Results After treatment,the apnea-hypopnea index(AHI)and ESS scores in the experimental group decreased significantly compared to before treatment[AHI before treatment(31.33±6.07)episodes/h,after treatment(15.53±5.34)episodes/h,(P<0.001);ESS before treatment 7.20±2.43,after treatment 4.00±1.69,(P<0.001)],while the lowest pulse oxygen saturation(LSpO_(2))and mean pulse oxygen saturation(MSpO_(2))increased compared to before treatment[LSpO_(2) before treatment(68.60±10.35)%,after treatment(80.13±7.44)%,(P=0.004);MSpO_(2) before treatment(84.60±3.04)%,after treatment(89.80±3.65)%,(P=0.001)].There were no statistically significant differences in blood pressure-related indicators between the two groups before and after treatment.When comparing the rate of change in blood pressure and heart rate(HR)between the two groups,the experimental group showed a greater reduction in all blood pressure-related indicators compared to the control group.The reduction rates for n

关 键 词：睡眠呼吸暂停低通气综合征 高血压 

分 类 号：R54[医药卫生—心血管疾病]