Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.
Sleep. 2011 Apr 1;34(4):469-77. doi: 10.1093/sleep/34.4.469.
Oral appliances are increasingly being used for treatment of obstructive sleep apnea (OSA). Mandibular advancement splint (MAS) mechanically protrudes the mandible, while the tongue stabilizing device (TSD) protrudes and holds the tongue using suction. Although both appliances can significantly improve or ameliorate OSA, their comparative effects on upper airway structure have not been investigated.
Cohort study.
Sleep Investigation Unit.
39 patients undergoing oral appliance treatment for OSA.
OSA patients underwent magnetic resonance imaging (MRI) of the upper airway during wakefulness at baseline and with MAS and TSD in randomized order. Treatment efficacy was determined by polysomnography in a subset of 18 patients.
Upper airway lumen and surrounding soft tissue structures were segmented using image analysis software. Upper airway dimensions and soft tissue centroid movements were determined. Both appliances altered upper airway geometry, associated with movement of the parapharyngeal fat pads away from the airway. TSD increased velopharyngeal lateral diameter to a greater extent (+0.35 ± 0.07 vs. +0.18 ± 0.05 cm; P<0.001) and also increased antero-posterior diameter with anterior displacement of the tongue (0.68 ± 0.04 cm; P<0.001) and soft palate (0.12 ± 0.03 cm; P<0.001). MAS resulted in significant anterior displacement of the tongue base muscles (0.35 ± 0.04 cm). TSD responders (AHI reduction ≥50%) increased velopharyngeal volume more than non-responders (+2.65 ± 0.9 vs. -0.44 ± 0.8 cm(3); P < 0.05). Airway structures did not differ between MAS responders and non-responders.
These results indicate that the patterns and magnitude of changes in upper airway structure differ between appliances. Further studies are warranted to evaluate the clinical relevance of these changes, and whether they can be used to predict treatment outcome.
口腔矫治器越来越多地用于治疗阻塞性睡眠呼吸暂停（OSA）。下颌前伸矫治器（MAS）通过机械方式将下颌前伸，而舌稳定器（TSD）通过吸力将舌前伸并保持。虽然这两种器具都可以显著改善或缓解 OSA，但它们对上气道结构的比较影响尚未得到研究。
队列研究。
睡眠调查单位。
39 例因 OSA 接受口腔矫治器治疗的患者。
OSA 患者在清醒时接受磁共振成像（MRI）上气道检查，然后随机接受 MAS 和 TSD 治疗。18 例患者的部分患者进行了多导睡眠图（PSG）检查以确定治疗效果。
使用图像分析软件对气道进行分割。确定气道尺寸和软组织质心运动。两种器具都改变了上气道几何形状，与咽旁脂肪垫从气道移开有关。TSD 增加了咽腔横向直径（增加 0.35 ± 0.07 比 0.18 ± 0.05 cm；P<0.001），并通过舌的前移位增加了前后直径（0.68 ± 0.04 cm；P<0.001）和软腭（0.12 ± 0.03 cm；P<0.001）。MAS 导致舌基底肌肉的显著前移位（0.35 ± 0.04 cm）。TSD 应答者（AHI 降低≥50%）的咽腔容积增加量大于非应答者（+2.65 ± 0.9 比-0.44 ± 0.8 cm(3)；P < 0.05）。MAS 应答者和非应答者之间的气道结构没有差异。
这些结果表明，上气道结构的变化模式和幅度在器具之间不同。需要进一步的研究来评估这些变化的临床意义，以及它们是否可用于预测治疗效果。
