Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Service d'ORL et de Chirurgie Cervico-Faciale, Clichy, France.
J Clin Sleep Med. 2009 Oct 15;5(5):431-8.
The tongue-retaining device is a customized monobloc oral appliance used in the treatment of obstructive sleep apnea syndrome (OSAS). This study evaluated tongue-retaining device efficacy and its tolerance by patients with OSAS.
The charts of 84 apneic patients were retrospectively analyzed, and patients were contacted by telephone to answer an oral questionnaire. The median follow-up time was 5 years.
Based on the apnea-hypopnea index, a complete or partial response was obtained in 71% of the cases. The mean apnea-hypopnea index decreased significantly from 38 to 14 (p < 0.001) with the tongue-retaining device. The subjective intensity of snoring decreased by 68% (p < 0.0001) and the Epworth Sleepiness Scale score decreased from 9 to 6 (p < 0.05). An age of more than 60 years associated with a mandibular protrusion distance inferior or equal to 7 mm was predictive of a nonresponse (odds ratio [OR]: 7.25; 95% confidence interval [CI]: 1.43-36.7; p < 0.02). The compliance rate, as determined by answers to the questionnaire, was 52% after 5 years of follow-up. Nasal obstruction was a negative predictor of good compliance (OR: 6.94; 95% CI: 0.28-0.79; p < 0.005), whereas patients with Class I occlusion were more compliant than patients with Class II or III occlusions (OR: 3.83; 95% CI: 1.00-2.81; p < 0.05).
Tongue-retaining device performance tended to be similar to that of the mandibular advancement device. Thus, teams trained in tongue-retaining device fabrication and fitting may propose it as an alternative to continuous positive airway pressure, taking nasal obstruction into consideration as a contraindication.
舌保持器是一种用于治疗阻塞性睡眠呼吸暂停综合征（OSAS）的定制式单体口腔矫治器。本研究评估了舌保持器治疗 OSAS 的疗效及其患者的耐受性。
回顾性分析 84 例呼吸暂停患者的图表，并通过电话联系患者回答口腔问卷。中位随访时间为 5 年。
根据呼吸暂停低通气指数，71%的病例获得完全或部分缓解。使用舌保持器后，呼吸暂停低通气指数从 38 降至 14，显著降低（p < 0.001）。打鼾的主观强度降低了 68%（p < 0.0001），Epworth 嗜睡量表评分从 9 降至 6（p < 0.05）。年龄大于 60 岁且下颌前突距离小于或等于 7 毫米与无反应相关（比值比 [OR]：7.25；95%置信区间 [CI]：1.43-36.7；p < 0.02）。通过问卷回答确定的依从率在 5 年随访后为 52%。鼻阻塞是良好依从性的负预测因素（OR：6.94；95%CI：0.28-0.79；p < 0.005），而 Class I 咬合的患者比 Class II 或 III 咬合的患者更依从（OR：3.83；95%CI：1.00-2.81；p < 0.05）。
舌保持器的性能倾向于与下颌前伸装置相似。因此，接受过舌保持器制作和适配培训的团队可能会考虑将其作为持续气道正压通气的替代方案，同时将鼻阻塞作为禁忌症。
