Department of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney, NSW, Australia; Harvard School of Dental Medicine, Boston, MA.
Department of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney, NSW, Australia.
Chest. 2011 Jun;139(6):1331-1339. doi: 10.1378/chest.10-2224. Epub 2011 Feb 3.
Mandibular advancement splints (MASs) can effectively treat obstructive sleep apnea (OSA); however, no validated and reliable prediction method for treatment outcome currently exists. The efficacy of MAS may relate to anatomic factors, including craniofacial size and upper-airway soft-tissue volume and anatomic balance between them. We aimed to assess whether craniofacial and oral measurements are associated with MAS treatment outcome.
Dental impressions and lateral cephalometric radiographs were obtained from patients with OSA prior to commencing MAS treatment. Intertooth distances and palatal depths were measured on dental casts, and standard cephalometric analysis was performed with the addition of cross-sectional area (CSA) of the tongue and bony oral enclosure. Treatment outcome was determined by polysomnography.
Of 53 patients, 25 were complete responders (posttreatment apnea-hypopnea index [AHI] < 5/h), 17 were partial responders (≥ 50% AHI reduction), and 11 were nonresponders (< 50% AHI reduction). Cephalometric analyses did not reveal any significant differences between responders and nonresponders. Oral cavity measurements or CSA did not differ with treatment outcome; however, there was a trend toward a larger tongue CSA in complete vs partial and nonresponders (39.5 ± 1.3 cm(2) vs 35.5 ± 0.5 cm(2), P = .09). Tongue/oral enclosure CSA ratio, indicating a larger tongue for a given oral cavity size, was greater in complete responders (P = .012, n = 30).
Oral dimensions do not appear to differ between patients who respond and those who do not respond to MAS treatment. However, the larger tongue for a given oral cavity size in responders suggests that MAS may help to correct anatomic imbalance. Further research to assess whether the ratio between tongue and bony oral enclosure size may be useful in selecting patients for MAS treatment is warranted.
下颌前移矫治器（MAS）可有效治疗阻塞性睡眠呼吸暂停（OSA）；然而，目前尚无有效的、可靠的治疗效果预测方法。MAS 的疗效可能与解剖因素有关，包括颅面大小、上气道软组织体积以及它们之间的解剖平衡。我们旨在评估颅面和口腔测量是否与 MAS 治疗效果相关。
在开始 MAS 治疗之前，从 OSA 患者中获取牙模和侧位头颅侧位片。在牙模上测量牙间距离和腭部深度，并进行标准的头颅侧位分析，同时还分析了舌部横截面积（CSA）和骨性口腔容积。通过多导睡眠图来确定治疗效果。
在 53 名患者中，25 名是完全应答者（治疗后呼吸暂停低通气指数[AHI]＜5/h），17 名是部分应答者（AHI 降低≥50%），11 名是无应答者（AHI 降低＜50%）。应答者和无应答者之间的头颅侧位分析没有发现任何显著差异。口腔测量值或 CSA 与治疗效果无差异；然而，在完全应答者中，CSA 有增大的趋势（39.5±1.3cm²vs.35.5±0.5cm²，P=0.09）。完整应答者的舌/口腔 CSA 比值（表示在给定的口腔大小下，舌部更大）更大（P=0.012，n=30）。
在对 MAS 治疗有反应和无反应的患者之间，口腔尺寸似乎没有差异。然而，在给定的口腔大小下，应答者的舌部更大，这表明 MAS 可能有助于纠正解剖学失衡。进一步研究评估舌和骨性口腔容积的比例是否可用于选择 MAS 治疗的患者是有必要的。
