Marklund Marie, Stenlund Hans, Franklin Karl A
Department of Orthodontics, Umeå University, Sweden.
Chest. 2004 Apr;125(4):1270-8. doi: 10.1378/chest.125.4.1270.
To evaluate the tolerability and to find predictors of treatment success for an individually adjusted, one-piece mandibular advancement device in patients with snoring and obstructive sleep apnea.
Prospective study.
Departments of Respiratory Medicine and Orthodontics, Umeå University.
Six hundred nineteen of 630 patients (98%), who consecutively received treatment for sleep apnea and snoring from February 1989 to August 2000, were followed up. They had a mean apnea-hypopnea index of 16 (range, 0.0 to 76) and a mean body mass index of 28 (range, 19 to 42).
Interviews, questionnaires, and overnight sleep apnea recordings. Patients with an apnea-hypopnea index of >or=10 in the supine and/or lateral position were considered to have obstructive sleep apnea. A lateral apnea-hypopnea index of < 10, together with a supine apnea-hypopnea index of >or= 10, defined supine-dependent sleep apneas.
One hundred forty-eight of the 619 patients (24%) discontinued treatment. Female gender predicted treatment success, defined as an apnea-hypopnea index of < 10 in both the supine and lateral positions, with an odds ratio of 2.4 (p = 0.01). In the women, the odds ratios for treatment success were 12 for mild sleep apnea (p = 0.04), and 0.1 for complaints of nasal obstruction (p = 0.03). In the men, the odds ratios for treatment success were 6.0 for supine-dependent sleep apneas (p < 0.001), 2.5 for mild sleep apnea (p = 0.04), 1.3 for each millimeter of mandibular advancement (p = 0.03), and 0.8 for each kilogram of weight increase (p = 0.001).
The mandibular advancement device is recommended for women with sleep apnea, for men with supine-dependent sleep apneas defined by a lateral apnea-hypopnea index of < 10, and for snorers without sleep apnea. Men who increase in weight during treatment reduce their chance of treatment success and are advised to be followed up with a new sleep apnea recording with the device.
评估个体化调整的一体式下颌前移装置在打鼾和阻塞性睡眠呼吸暂停患者中的耐受性，并找出治疗成功的预测因素。
前瞻性研究。
于默奥大学呼吸内科和正畸科。
对1989年2月至2000年8月期间连续接受睡眠呼吸暂停和打鼾治疗的630例患者中的619例（98%）进行了随访。他们的平均呼吸暂停低通气指数为16（范围为0.0至76），平均体重指数为28（范围为19至42）。
访谈、问卷调查和夜间睡眠呼吸暂停记录。仰卧位和/或侧卧位呼吸暂停低通气指数≥10的患者被认为患有阻塞性睡眠呼吸暂停。侧卧位呼吸暂停低通气指数<10且仰卧位呼吸暂停低通气指数≥10定义为仰卧位依赖性睡眠呼吸暂停。
619例患者中有148例（24%）停止治疗。女性是治疗成功的预测因素，治疗成功定义为仰卧位和侧卧位呼吸暂停低通气指数均<10，优势比为2.4（p = 0.01）。在女性中，轻度睡眠呼吸暂停的治疗成功优势比为12（p = 0.04），鼻塞主诉的优势比为0.1（p = 0.03）。在男性中，仰卧位依赖性睡眠呼吸暂停的治疗成功优势比为6.0（p < 0.001），轻度睡眠呼吸暂停为2.5（p = 0.04），下颌前移每毫米为1.3（p = 0.03），体重每增加1公斤为0.8（p = 0.001）。
推荐将下颌前移装置用于患有睡眠呼吸暂停的女性、侧卧位呼吸暂停低通气指数<10定义的仰卧位依赖性睡眠呼吸暂停的男性以及无睡眠呼吸暂停的打鼾者。治疗期间体重增加的男性治疗成功的机会降低，建议使用该装置进行新的睡眠呼吸暂停记录随访。
