下颌推进装置与CPAP在重度阻塞性睡眠呼吸暂停中的比较

IF 5.9 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Dental Research Pub Date : 2025-09-01 DOI:10.1177/00220345251361796

J.T. Colpani, Y.-H. Ou, A.M. Kosasih, F.K.F. Lee, S.-P. Chan, H.H. Tan, R.C.W. Wong, C.W. Chin, P.A. Cistulli, C.-H. Lee

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引用次数: 0

摘要

严重阻塞性睡眠呼吸暂停（OSA）与不良心血管结局有关。虽然持续气道正压通气（CPAP）是标准治疗方法，但下颌推进装置（MADs）提供了另一种选择。这是一项随机试验的亚研究，比较了MADs与CPAP在重度OSA患者24小时动态血压（BP）、睡眠相关生活质量、心肌重构、动态心律和生物标志物方面的有效性。共有144名参与者被随机分为MAD组（n = 73）或CPAP组（n = 71），持续12个月。MAD组的平均每晚使用时间为5.4（2.9-6.5）小时（≥6小时/晚：56.1%），CPAP组的平均每晚使用时间为4.9（4.0-6.0）小时（≥6小时/晚：28.3%）。基线和6个月时，MAD组呼吸暂停-低通气指数分别为44.0（37.6-59.2）和20.9（11.7-31.9）事件/h， CPAP组分别为50.7（40.7-59.8）和2.1（1.2-3.4）事件/h。MAD治疗降低了睡眠平均血压（- 4.7 mm Hg， 95%可信区间[CI]: - 8.3至- 4.0,P = 0.015）、睡眠收缩压（- 2.0 mm Hg, 95% CI: - 10.0至- 4.0,P = 0.047）和睡眠舒张压（- 4.0 mm Hg, 95% CI: - 9.0至- 3.0,P = 0.007），而CPAP治疗无显著变化。组间差异有利于睡眠期平均血压（- 3.70 mm Hg, 95% CI: - 7.40 ~ 0.00, P = 0.050）和睡眠期收缩压（- 4.78 mm Hg, 95% CI: - 9.51 ~ 0.04, P = 0.048）。两者都改善了睡眠相关的生活质量，尽管CPAP对Epworth嗜睡量表的影响略大（Δ1.63, 95% CI: 0.45至2.81,P = 0.007）。在心脏磁共振成像参数、动态心律或生物标志物方面未观察到显著变化。不良反应包括下颌疼痛（14.8%）和牙齿不适（8.2%），而CPAP使用者报告口干（50.8%）、鼻塞（23.0%）和漏气（29.5%）。综上所述，这些发现提示MAD可能是重度OSA合并高血压患者可接受且有效的治疗方法。该研究已在Clinicaltrials.gov注册（NCT04119999）。

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Mandibular Advancement Device versus CPAP in Severe Obstructive Sleep Apnea

Severe obstructive sleep apnea (OSA) is linked to adverse cardiovascular outcomes. While continuous positive airway pressure (CPAP) is the standard treatment, mandibular advancement devices (MADs) offer an alternative. This substudy of a randomized trial compared the effectiveness of MADs versus CPAP on 24-h ambulatory blood pressure (BP), sleep-related quality of life, myocardial remodeling, ambulatory heart rhythm, and biomarkers in severe OSA. A total of 144 participants were randomized to MAD ( n = 73) or CPAP ( n = 71) for 12 mo. Median nightly usage was 5.4 (2.9–6.5) h for the MAD group (≥6 h/night: 56.1%) and 4.9 (4.0–6.0) h for the CPAP group (≥6 h/night: 28.3%). The apnea-hypopnea index at baseline and 6 mo was 44.0 (37.6–59.2) and 20.9 (11.7–31.9) events/h in the MAD group and 50.7 (40.7–59.8) and 2.1 (1.2–3.4) events/h in the CPAP group, respectively. MAD treatment reduced asleep mean BP (−4.7 mm Hg, 95% confidence interval [CI]: −8.3 to −4.0, P = 0.015), asleep systolic BP (−2.0 mm Hg, 95% CI: −10.0 to −4.0, P = 0.047), and asleep diastolic BP (−4.0 mm Hg, 95% CI: −9.0 to −3.0, P = 0.007), whereas CPAP showed no significant changes. The between-group differences favored MAD in asleep mean BP (−3.70 mm Hg, 95% CI: −7.40 to 0.00, P = 0.050) and asleep systolic BP (−4.78 mm Hg, 95% CI: −9.51 to 0.04, P = 0.048). Both improved sleep-related quality of life, although CPAP had a slightly greater effect on the Epworth Sleepiness Scale (Δ1.63, 95% CI: 0.45 to 2.81, P = 0.007). No significant changes were observed in cardiac magnetic resonance imaging parameters, ambulatory heart rhythm, or biomarkers. Adverse effects included jaw pain (14.8%) and teeth discomfort (8.2%) with MAD, whereas CPAP users reported dry mouth (50.8%), nasal congestion (23.0%), and air leakage (29.5%). In conclusion, these findings suggested MAD could be an acceptable and effective treatment for patients with severe OSA and hypertension. The study was registered at Clinicaltrials.gov (NCT04119999).

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来源期刊

Journal of Dental Research 医学-牙科与口腔外科

CiteScore

15.30

自引率

3.90%

发文量

155

审稿时长

3-8 weeks

期刊介绍： The Journal of Dental Research (JDR) is a peer-reviewed scientific journal committed to sharing new knowledge and information on all sciences related to dentistry and the oral cavity, covering health and disease. With monthly publications, JDR ensures timely communication of the latest research to the oral and dental community.