Barthlen GM, Brown LK, Wiland MR, Sadeh JS, Patwari J, Zimmerman M
Department of Medicine, Mount Sinai School of Medicine, NY, New York, USA
Sleep Med. 2000 Oct 1;1(4):299-305. doi: 10.1016/s1389-9457(00)00030-7.
Objective: To compare three different oral appliances: a mandibular advancement device (Snoreguard), a tongue retaining device, and a soft palate lift, for treatment of severe obstructive sleep apnea syndrome (OSAS).Background: Oral appliances are therapeutic options for patients with OSAS.Methods: Eight patients with a mean apnea hypopnea index (AHI) of 72.1 (SD+/-39.9) were studied. Polysomnographic measures during each of the treatment nights were compared to baseline.Results: Eight out of 8 patients completed the mandibular advancement device (MAD) night; 5/8 tolerated the tongue retaining device (TRD); only 2/8 could sleep with the soft palate lift (SPL) in place. Improvement using the MAD reached significance: overall AHI (mean+/-SD) decreased from 72.1+/-39.9 at baseline to 35.5+/-39.4 with the appliance in place (P<0.02). There was a non-significant increase in slow wave sleep (SWS) from 9.6%+/-8.7 to 14.4%+/-10.5 with the MAD in place. In five responders, the mean AHI decreased from 60.0+/-36.6 to 9.0+/-4.8; all were subjectively improved, using the MAD at 1 year follow-up. However, three non-responders had persistence of AHI>40. With the TRD, AHI decreased from 50.3+/-18.9 at baseline to 43.5+/-32.5 (ns). The SPL was not effective with an AHI at baseline of 52.4+/-8.0, and 47.3+/-31.0 with the device in place (ns), and not well tolerated.Conclusions: A mandibular advancement device is an effective treatment alternative in some patients with severe OSAS. In comparison, the tongue retaining device and the soft palate lift do not achieve satisfactory results.
比较三种不同的口腔矫治器：下颌前移装置（Snoreguard）、舌保持装置和软腭提升器，用于治疗重度阻塞性睡眠呼吸暂停综合征（OSAS）。背景：口腔矫治器是OSAS患者的治疗选择。方法：对8例平均呼吸暂停低通气指数（AHI）为72.1（标准差±39.9）的患者进行研究。将每个治疗夜晚的多导睡眠图测量结果与基线进行比较。结果：8例患者中有8例完成了下颌前移装置（MAD）治疗夜；5/8例患者耐受舌保持装置（TRD）；只有2/8例患者能戴着软腭提升器（SPL）入睡。使用MAD的改善达到显著水平：总体AHI（平均值±标准差）从基线时的72.1±39.9降至佩戴矫治器时的35.5±39.4（P<0.02）。佩戴MAD时慢波睡眠（SWS）从9.6%±8.7非显著增加至14.4%±10.5。在5例有反应者中，平均AHI从60.0±36.6降至9.0±4.8；在1年随访时，所有患者使用MAD后主观上均有改善。然而，3例无反应者的AHI持续>40。使用TRD时，AHI从基线时的50.3±18.9降至43.5±32.5（无统计学意义）。SPL无效，基线时AHI为52.4±8.0，佩戴该装置时为47.3±31.0（无统计学意义），且耐受性不佳。结论：下颌前移装置对一些重度OSAS患者是一种有效的治疗选择。相比之下，舌保持装置和软腭提升器未取得满意效果。
