Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington, DC 20307, USA.
J Clin Sleep Med. 2011 Oct 15;7(5):439-45. doi: 10.5664/JCSM.1300.
To compare the efficacy of adjustable and fixed oral appliances for the treatment of OSA.
Retrospective review of consecutive patients with OSA treated with either adjustable or fixed oral appliances. Polysomnography was conducted before and during therapy. Effective treatment was defined as an apnea-hypopnea index (AHI) < 5 events/h or < 10 events/h with resolution of sleepiness (Epworth < 10). We compared efficacy rates between fixed and adjustable appliances and sought to identify factors associated with greater success.
We included 805 patients, 602 (74.8%) treated with an adjustable and 203 (25.2%) a fixed oral appliances. Among the cohort, 86.4% were men; mean age was 41.3 ± 9.2 years. Mean AHI was 30.7 ± 25.6, with 34.1% having mild (AHI 5-14.9), 29.2% moderate (AHI 15-29.9), and 36.8% severe (AHI ≥ 30) OSA. Successful therapy was significantly more common with adjustable appliances. Obstructive events were reduced to < 5/h in 56.8% with adjustable compared to 47.0% with fixed appliances (p = 0.02). Similarly, a reduction of events to < 10 with resolution of sleepiness occurred in 66.4% with adjustable appliances versus 44.9% with fixed appliances (p < 0.001). For both devices, success was more common in younger patients, with lower BMI and less severe disease.
Adjustable devices produced greater reductions in obstructive events and were more likely to provide successful therapy, especially in moderate-severe OSA. Fixed appliances were effective in mild disease, but were less successful in those with higher AHIs. Given these findings, the baseline AHI should be considered when selecting the type of oral appliance.
比较可调节和固定口腔矫治器治疗阻塞性睡眠呼吸暂停（OSA）的疗效。
回顾性分析连续接受可调节或固定口腔矫治器治疗的 OSA 患者。治疗前后进行多导睡眠图检查。有效治疗定义为呼吸暂停低通气指数（AHI）<5 次/小时或<10 次/小时，且嗜睡缓解（Epworth <10）。我们比较了固定和可调节矫治器的疗效，并试图确定与更高成功率相关的因素。
共纳入 805 例患者，其中 602 例（74.8%）接受可调节矫治器治疗，203 例（25.2%）接受固定口腔矫治器治疗。队列中，86.4%为男性；平均年龄为 41.3±9.2 岁。平均 AHI 为 30.7±25.6，其中 34.1%为轻度（AHI 5-14.9），29.2%为中度（AHI 15-29.9），36.8%为重度（AHI≥30）OSA。可调节矫治器治疗成功率显著更高。与固定矫治器相比，可调节矫治器可将阻塞性事件减少至<5 次/小时的比例为 56.8%，而固定矫治器为 47.0%（p=0.02）。同样，可调节矫治器中 66.4%的患者事件减少至<10 次且嗜睡缓解，而固定矫治器为 44.9%（p<0.001）。对于两种设备，在年轻患者、BMI 较低和疾病较轻的患者中，成功率更高。
可调节矫治器可更有效地减少阻塞性事件，且更可能提供成功的治疗，特别是在中重度 OSA 患者中。在轻度疾病中，固定矫治器有效，但在 AHI 较高的患者中成功率较低。鉴于这些发现，在选择口腔矫治器类型时应考虑基线 AHI。
