Lee Chul-Hee, Jung Hahn Jin, Lee Woo Hyun, Rhee Chae Seo, Yoon In-Young, Yun Pil-Young, Kim Jeong-Whun
Department of Otorhinolaryngology, Seoul National University College of Medicine, Seongnam, Korea.
Arch Otolaryngol Head Neck Surg. 2012 May;138(5):479-83. doi: 10.1001/archoto.2012.452.
To evaluate retrospectively the efficacy of the mandibular advancement device (MAD) in patients with obstructive sleep apnea in terms of positional dependency.
Retrospective analysis.
Academic tertiary referral center.
One hundred patients with obstructive sleep apnea treated with the MAD at the Department of Otorhinolaryngology sleep clinic were included from January 1, 2005, through December 31, 2010.
All patients underwent nocturnal full-night polysomnography before and at least 3 months after intraoral MAD application.
Treatment results and prognostic factors deciding the success of MAD application.
Of the 100 patients, 80 showed positional dependency and 20 showed nondependency. In the position-dependent obstructive sleep apnea group, the median (interquartile range) apnea-hypopnea index (AHI) decreased from 32.1 (24.4-41.9) to 8.6 (3.7-13.8) (P < .001); in the nondependent group, from 56.4 (26.2-71.5) to 15.7 (6.8-30.7) (P < .001). The success rate (AHI reduction ≥50% and AHI <10) was 57.5% and 30.0% in position-dependent and position-nondependent groups, respectively (P = .04).
Identifying patients with obstructive sleep apnea as position dependent or nondependent may have important therapeutic implications in predicting the outcome of MAD treatment.
回顾性评估下颌前移装置（MAD）治疗阻塞性睡眠呼吸暂停患者时体位依赖性方面的疗效。
回顾性分析。
学术性三级转诊中心。
纳入2005年1月1日至2010年12月31日期间在耳鼻咽喉科睡眠诊所接受MAD治疗的100例阻塞性睡眠呼吸暂停患者。
所有患者在口内应用MAD之前及之后至少3个月均接受夜间全夜多导睡眠监测。
治疗结果及决定MAD应用成功的预后因素。
100例患者中，80例显示体位依赖性，20例显示非依赖性。在体位依赖性阻塞性睡眠呼吸暂停组，呼吸暂停低通气指数（AHI）的中位数（四分位间距）从32.1（24.4 - 41.9）降至8.6（3.7 - 13.8）（P <.001）；在非依赖性组，从56.4（26.2 - 71.5）降至15.7（6.8 - 30.7）（P <.001）。体位依赖性和非依赖性组的成功率（AHI降低≥50%且AHI <10）分别为57.5%和30.0%（P = 0.04）。
识别阻塞性睡眠呼吸暂停患者是体位依赖性还是非依赖性，对于预测MAD治疗的结果可能具有重要的治疗意义。
