Hoekema A
Universitair Medisch Centrum Groningen, afd. Kaakchirurgie, Postbus 30.001, 9700 RB Groningen.
Ned Tijdschr Geneeskd. 2006 Jan 28;150(4):175-8.
In the management of the obstructive sleep apnoea syndrome (OSAS), clinicians may consider various conservative, non-invasive and surgical treatment modalities. Continuous positive airway pressure (CPAP) is regarded as the treatment of choice for, especially, moderate to severe OSAS. However, due to the obtrusive nature of this conservative treatment, especially in mild manifestations ofOSAS, the effectiveness of CPAP may be compromised due to poor therapeutic acceptance and adherence. Over the last decade, oral appliance therapy has emerged as an increasingly popular treatment alternative to CPAP. However, due to the methodological limitations of most trials studying this dental treatment modality, the precise indication for oral appliance therapy is still indistinct. In addition, based on the current level of evidence, most surgical interventions in OSAS should generally be reserved for patients with failing CPAP therapy. In order to determine whether the available treatment alternatives are competitive with CPAP, methodologically sound and preferably randomised studies are indicated.
在阻塞性睡眠呼吸暂停综合征(OSAS)的治疗中,临床医生可考虑多种保守、非侵入性和手术治疗方式。持续气道正压通气(CPAP)被视为尤其是中重度OSAS的首选治疗方法。然而,由于这种保守治疗具有侵入性,特别是在轻度OSAS表现中,CPAP的有效性可能会因治疗接受度和依从性差而受到影响。在过去十年中,口腔矫治器疗法已成为一种越来越受欢迎的替代CPAP的治疗方法。然而,由于大多数研究这种牙科治疗方式的试验存在方法学上的局限性,口腔矫治器疗法的确切适应症仍然不明确。此外,根据目前的证据水平,OSAS中的大多数手术干预通常应保留给CPAP治疗失败的患者。为了确定现有的治疗选择是否与CPAP具有竞争力,需要进行方法学合理且最好是随机的研究。