下颌前伸式阻鼾器治疗老年阻塞性睡眠呼吸暂停综合征合并冠心病患者的应用效果
Clinical Effect of Mandibular Advancement Devices Applying in Therapy of Elderly Patients with Obstructive Sleep Apnea Syndrome and Coronary Heart Disease
徐静 1潘昱 1严美爱 1卢钰芬1
作者信息
- 1. 佛山市第一人民医院口腔正畸科,广东佛山 528000
- 折叠
摘要
目的 探究下颌前伸式阻鼾器治疗老年阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)合并冠状动脉粥样硬化性心脏病(冠心病)患者的应用效果.方法 选择2018年3月至2021年3月佛山市第一人民医院收治的OSAS合并冠心病老年患者60例作为研究对象,将其随机分为2组,分别为研究组和对照组,所有患者均接受冠心病常规药物治疗,研究组同时采用下颌前伸式阻鼾器辅助治疗.收集患者治疗前、治疗后3个月的临床资料,包括临床改善率、睡眠参数[快速眼动(rapid eye movement,REM)期睡眠、非快速眼动(non-rapid eye movement,NREM)期睡眠],计算N1 期、N2 期、N3 期以及REM期与总睡眠时间的比例.记录呼吸参数包括呼吸暂停低通气指数(apnea-hypopnea index,AHI)、平均血氧饱和度(oxygen saturation,SaO2).检测记录患者高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)以及血清肿瘤坏死因子(tumor necro-sis factor,TNF)浓度.结果 研究组患者的临床症状改善率明显优于对照组,差异有统计学意义(P<0.05).治疗后3个月,较治疗前,研究组患者的AHI显著降低[(8.65±2.64)次/h vs.(26.87±4.21)次/h,P<0.05],SaO2 显著升高(92.76%±12.84%vs.86.64%±12.51%,P<0.05),hs-CRP浓度显著降低[(6.13±0.32)mg/L vs.(4.92±0.41)mg/L,P<0.05],血清TNF浓度显著降低[(13.27±3.62)μg/L vs.(21.62±4.12)μg/L,P<0.05],REM、N2以及N3期睡眠占总睡眠时间的比例显著升高,N1期睡眠占总睡眠时间的比例显著降低,差异均有统计学意义(P<0.05).但在对照组中,各指标与治疗前比较,差异均无统计学意义(P>0.05).结论 下颌前伸式阻鼾器治疗老年OSAS合并冠心病患者能有效增加上气道截面积,改善患者的睡眠质量、提高血氧浓度、降低炎性因子水平.
Abstract
Objectives To investigate the clinical effect of mandibular advancement device in the therapy of elderly patients with obstructive sleep apnea syndrome(OSAS)and coronary heart disease.Methods A total of 60 elderly patients with OSAS and coronary heart disease who were admitted to Foshan First People's Hospital from March 2018 to March 2021 were selected as the objects,and they were randomly divided into study group and control group.All the patients received conventional medical treatment for coronary heart disease,and patients in study group received a mandibular advancement device therapy.Clinical data of patients before treatment and 3 months after treatment,including improve-ment rate of clinical symptoms,sleep parameters[rapid eye movement(REM)sleep,non-rapid eye movement(NREM)sleep]were collected,and the ratios of N1 stage,N2 stage,N3 stage and REM stage to total sleep time were calculated.Breathing parameters include apnea-hypopnea index(AHI)and average oxygen saturation(SaO2)were collected.The patients'serum concentrations of high-sensitivity C-reactive proteinhs(hs-CRP)and tumor necrosis factor(TNF)were checked.Results The improvement rate of clinical symptoms in study group was significantly better than that in control group(P<0.05).Three months after treatment,the AHI of study group was significantly reduced[(8.65±2.64)times/h vs.(26.87±4.2)times/h,P<0.05],the average SaO2 significantly increased(92.76%±12.84%vs.86.64%±12.51%,P<0.05),the serum concentration of hs-CRP significantly decreased[(6.13±0.32)mg/L vs.(4.92±0.41)mg/L,P<0.05],the serum concentration of TNF significantly reduced[(13.27±3.62)μg/L vs.(21.62±4.12)μg/L,P<0.05],the propor-tion of REM,N2,and N3 sleep in the total sleep time increased significantly,and the proportion of N1 sleep in the total sleep time significantly decreased.However,in control group,no indicators were significant changed(P>0.05).Conclusions Mandibular advancement device in the treatment of elderly patients with OSAS and coronary heart disease can effectively increase the upper airway cross-sectional area,improve the patients'sleep quality,increase blood oxygen concentration,and reduce the level of inflammatory.
关键词
冠状动脉疾病/下颌前伸式阻鼾器/阻塞性睡眠呼吸暂停综合征/血氧浓度/睡眠质量Key words
coronary heart disease/mandibular advancement device/obstructive sleep apnea syndrome/blood oxygen concentration/sleep quality引用本文复制引用
基金项目
佛山市科技局科技项目(2020001005250)
佛山市科技局科技项目(2220001003794)
出版年
2024
NETL
NSTL
维普
万方数据