目的

探讨二维可调式口腔矫治器（OA）治疗阻塞性睡眠呼吸暂停综合征（OSAS）合并高血压患者时，对其血压的影响。

方法

106 例确诊为中度OSAS 合并原发性高血压患者，规范口服降压药物治疗3 个月以上，血压控制欠佳，采用二维可调式OA 治疗；75 例能按医嘱坚持OA 治疗6 个月以上为实验组；22 例OA 治疗时间少于三分之一作为对照组；9 例患者间歇性OA 治疗时间大于三分之一，没有纳入研究。 统计分析实验组和对照组OA治疗前后呼吸紊乱指数（RDI）、最低氧饱和度（SaO₂）以及平均收缩压（MSBP）、平均舒张压（MDBP）、脉压差（PP）。

结果

实验组RDI、SaO₂ 均比OA 治疗前明显改善，差异有统计学意义（P ＜0.05）；对照组RDI、SaO₂ 也比OA 治疗前有改善，但差异无统计学意义（P ＞0.05）。 实验组MSBP、MDBP 均比OA 治疗前显著下降，血压恢复到正常水平，差异有统计学意义（P ＜0.05）；而对照组MSBP、MDBP 无改善（P ＞0.05）。 实验组OA 治疗后，PP 有所下降，但与治疗前比较差异无统计学意义（P ＞0.05）；而对照组在6 个月后PP 升高，差异有统计学意义（P ＜0.05）。 组间比较MSBP、MDBP、PP 三个血压参数：在治疗前实验组与对照组差异均无统计学意义（P ＞0.05），在治疗后实验组比对照组均有下降，差异均有统计学意义（P ＜0.05）。

结论

对药物降压治疗效果不理想合并中度OSAS 的高血压患者，二维可调式OA 治疗可有效控制血压。

Objective

The objective of the study was to evaluate the effect of twodimensional adjustable oral appliance （OA） therapy on hypertension patients with obstructive sleep apnea syndrome （OSAS）.

Methods

106 patients （62 male and 24 female， mean age： 49 years） diagnosed as moderate OSAS with hypertension were studied before and after insertion of the two-dimensional adjustable oral appliance. Blood pressures of these patients were not effectively controlled after a routine anti-hypertensive drug therapy over three months before the OA therapy. 75 patients who wore OA for 6 months were classified as experimental group. 22 patients who wore OA for less than 1/3 of the 6 months' therapy time because of poorly tolerated were classified as control group. The other 9 patients who wore OA for more than 1/3 of the 6 mouths' therapy time but less than 6 mouths were not included in the study. Statistical analysis was used to evaluate the respiratory disturbance index （RDI）， lowest arterial oxygen saturation（SaO₂）， mean systolic blood pressure （MSBP）， mean diastolic blood pressure （MDBP） and pulse pressure （PP） in the two groups.

Results

Significant reduction in the RDI， MSBP， MDBP and significant increase in the lowest arterial oxygen saturation were found after OA therapy for 6 mouths in the experimental group（P ＜0.05）. In the control group， no significant changes were found for these parameters after incomplete OA therapy （P ＞0.05）. After OA therapy for 6 mouths， mild reduction in PP was found in the experimental group， but without significant difference （P ＞0.05）. Significant increases in PP was found in the control group after incomplete OA therapy for 6 mouths （P ＜0.05）. The MSBP， MDBP and PP in the two groups before and after OA therapy were further compared. There was no significant differences （P ＞ 0.05）between the two groups of pre-OA therapy but significant differences （P ＜0.05） were found between the two groups of post-OA therapy.

Conclusions

It is suggests that two-dimensional adjustable appliance could effectively lower the blood pressure in moderate OSAS patients with hypertension whose blood pressure could not be controlled by anti-hypertensive drug.