多区域筋膜松解对阻塞性睡眠呼吸暂停患者心率及生理参数的影响：一项随机对照试验

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中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）与交感神经活动增强及心血管风险升高相关。针对自主神经调节的无创干预可能提供补充性治疗策略。
方法： 本随机对照试验旨在探讨多区域筋膜松解对OSA患者生理参数的急性影响。经多导睡眠监测确诊为中重度OSA（呼吸暂停低通气指数≥15次/小时）的患者被随机分配至干预组，接受标准化的16分钟多区域筋膜松解方案，或分配至对照组，在相应时间段内取仰卧位安静休息，不接受手法或触觉干预。干预在受控条件下针对颈部、胸部和腹部区域。主要结局包括心率、收缩压和舒张压以及外周血氧饱和度。测量在基线、干预后即刻以及干预后5分钟和15分钟进行。
结果： 共95例男性患者（平均年龄：48.12±10.21岁）完成研究。除心率外，两组基线特征具有可比性。使用混合协方差分析对基线心率进行调整后，心率未观察到显著的组×时间交互作用（P = .476，偏ηp2 = .008）。同样，收缩压、舒张压或外周血氧饱和度也未观察到显著的组×时间交互作用（均P > .05）。尽管某些生理参数观察到显著的时间效应，但这些效应的幅度因结局而异，且均未伴随显著的组×时间交互作用。因此，这些时间变化未被解释为干预特异性效应。未报告不良事件。
结论： 干预后心率随时间发生显著变化；然而，在对基线心率进行调整后，筋膜松解组与对照组之间的变化模式无显著差异。同样，血压或血氧饱和度随时间的变化也未观察到显著的组间差异。这些发现未能证明多区域筋膜松解对所评估的生理参数具有特定的急性效应。有必要使用更先进的自主神经功能测量方法和更长随访期开展进一步研究。

英文摘要

BACKGROUND: Obstructive sleep apnea (OSA) is associated with increased sympathetic activity and an elevated cardiovascular risk. Noninvasive interventions targeting autonomic regulation may offer complementary therapeutic strategies.
METHODS: This randomized controlled trial aimed to investigate the acute effects of multiregional fascial mobilization on the physiological parameters of patients with OSA. Patients with polysomnography-confirmed moderate-to-severe OSA (apnea-hypopnea index ≥ 15 events/hour) were randomly assigned to an intervention group that received a standardized 16-minute multiregional fascial mobilization protocol or a control group that rested quietly in the supine position for the corresponding period without receiving manual or tactile intervention. The intervention targeted the cervical, thoracic, and abdominal regions, under controlled conditions. The primary outcomes included heart rate, systolic and diastolic blood pressure, and peripheral oxygen saturation. Measurements were obtained at baseline, immediately post-intervention, and 5 and 15 minutes post-intervention.
RESULTS: A total of 95 male patients (mean age: 48.12 ± 10.21 years) completed the study. Baseline characteristics were comparable between the groups, except for heart rate. After adjustment for baseline heart rate using mixed analysis of covariance, no significant group × time interaction was observed for heart rate (P = .476, partial ηp2 = .008). Similarly, no significant group × time interactions were observed for systolic blood pressure, diastolic blood pressure, or peripheral oxygen saturation (all P > .05). Although significant time effects were observed for some physiological parameters, the magnitude of these effects varied across outcomes, and none was accompanied by a significant group × time interaction. Therefore, these temporal changes were not interpreted as intervention-specific effects. No adverse events were reported.
CONCLUSION: Heart rate changed significantly over time following the interventions; however, after adjustment for baseline heart rate, the pattern of change did not differ significantly between the fascial mobilization and control groups. Similarly, no significant between-group differences in changes over time were observed for blood pressure or oxygen saturation. These findings do not demonstrate a specific acute effect of multiregional fascial mobilization on the physiological parameters assessed. Further studies using advanced measures of autonomic function and longer follow-up periods are warranted.