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远程控制下颌定位器可预测口腔矫治器治疗睡眠呼吸暂停的疗效。

Remotely controlled mandibular positioner predicts efficacy of oral appliances in sleep apnea.

作者信息

Tsai Willis H, Vazquez Juan-Carlos, Oshima Tsutomu, Dort Leslie, Roycroft Brian, Lowe Alan A, Hajduk Eric, Remmers John E

机构信息

University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N2, Canada.

出版信息

Am J Respir Crit Care Med. 2004 Aug 15;170(4):366-70. doi: 10.1164/rccm.200310-1446OC. Epub 2004 Apr 22.

Abstract

Anterior mandibular positioners (AMPs) have become increasingly popular as alternatives to continuous positive airway pressure for the treatment of obstructive sleep apnea. However, widespread acceptance of AMP is limited by an efficacy rate of 50-80% and an inability to predict which patients will respond to therapy. We evaluated 23 patients with obstructive sleep apnea (respiratory disturbance index [RDI] >/= 15 h(-1)) with a remotely controlled mandibular positioner (RCMP), a temporary oral appliance that can advance or retract the mandible in a process analogous to changing the mask pressure during a continuous positive airway pressure titration study. We hypothesized that the elimination of respiratory events and significant nocturnal oxygen desaturation during an RCMP overnight study would predict AMP efficacy, as defined by an absolute reduction in RDI to less than 15 h(-1), a relative reduction in RDI of more than 30% from baseline, and a subjective improvement in symptoms. AMP compliance was 82%, and therapeutic efficacy was 53%. Among compliant patients, the positive and negative predictive value of an RCMP study in predicting AMP treatment success was 90% and 89%, respectively. An overnight RCMP study is highly predictive of AMP response.

摘要

下颌前位矫治器(AMPs)作为治疗阻塞性睡眠呼吸暂停的持续气道正压通气替代方法,越来越受到欢迎。然而,AMPs的广泛应用受到50%-80%的有效率以及无法预测哪些患者对治疗有反应的限制。我们使用遥控下颌定位器(RCMP)对23例阻塞性睡眠呼吸暂停患者(呼吸紊乱指数[RDI]≥15次/小时)进行了评估,RCMP是一种临时口腔矫治器,可在类似于持续气道正压通气滴定研究中改变面罩压力的过程中使下颌前移或后缩。我们假设,在RCMP夜间研究期间消除呼吸事件和显著的夜间氧饱和度下降将预测AMPs的疗效,其定义为RDI绝对降低至小于15次/小时、RDI相对于基线降低超过30%以及症状主观改善。AMPs的依从率为82%,治疗有效率为53%。在依从性患者中,RCMP研究预测AMPs治疗成功的阳性预测值和阴性预测值分别为90%和89%。夜间RCMP研究对AMPs反应具有高度预测性。

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