Bishop Bradley, Verrett Ronald, Girvan Thomas
Private Practice, #203, 1890 Cooper Rd., Kelowna, BC, V1Y 8B7, Canada,
Sleep Breath. 2014 Mar;18(1):125-31. doi: 10.1007/s11325-013-0859-7. Epub 2013 May 9.
The purpose of this study was to determine whether treatment outcomes vary according to the design of the mandibular repositioning appliance (MRA). Two titratable MRA's were compared. The designs differ in advancement hardware and configuration of acrylic both in bulk and interocclusal contact.
The primary treatment outcome was the Respiratory Disturbance Index (RDI). Other outcomes that were compared included Sleep Apnea Quality of Life Index (SAQLI), Epworth Sleepiness Scale, oxygen saturation, and subjective feedback regarding experiences with the appliances. Twenty-four subjects were recruited from consecutive referrals for MRA therapy following diagnosis of obstructive sleep apnea (OSA) by polysomnography. Subjects were randomly assigned to a treatment arm of the crossover study. Each subject underwent an initial sleep study with a type III home monitor to establish a baseline RDI. Subjects were then treated with one of the two MRAs determined by random assignment. The MRA self-titration phase was monitored until a treatment position was determined, and the home sleep study was repeated. After a 2-week period without any OSA treatment, subjects received the second MRA and the self-titration treatment protocol was repeated. At completion of treatment with each appliance, subjects answered questionnaires and underwent a sleep study with the type III monitor. The outcome data for each appliance were compared using analysis of variance.
Eighteen subjects completed the treatment protocol. There were no significant statistical differences in treatment outcomes between the two appliances. There was a statistically significant (p ≤ 0.05) preference for a MRA design with minimal coverage of teeth and palate. The subjects' appliance selection was consistent with a corresponding reduction in SAQLI score for the selected appliance.
Although no statistically significant difference was observed between the two appliances in the outcomes measured, there was a trend toward greater improvement with the appliance with less acrylic resin bulk and less interocclusal contact. MRA selection should favor titratable, unobtrusive designs with appropriate construction to promote acceptance and adherence to MRA therapy.
本研究的目的是确定治疗结果是否因下颌重新定位矫治器（MRA）的设计而异。比较了两种可滴定的MRA。两种设计在推进硬件以及丙烯酸树脂的体积和咬合间接触的配置方面存在差异。
主要治疗结果是呼吸紊乱指数（RDI）。比较的其他结果包括睡眠呼吸暂停生活质量指数（SAQLI）、爱泼华嗜睡量表、血氧饱和度以及关于矫治器使用体验的主观反馈。通过多导睡眠图诊断为阻塞性睡眠呼吸暂停（OSA）后，从连续转诊接受MRA治疗的患者中招募了24名受试者。受试者被随机分配到交叉研究的一个治疗组。每个受试者使用III型家庭监测仪进行初始睡眠研究以建立基线RDI。然后受试者使用随机分配确定的两种MRA之一进行治疗。监测MRA自滴定阶段直至确定治疗位置，并重复家庭睡眠研究。在2周未进行任何OSA治疗后，受试者接受第二种MRA，并重复自滴定治疗方案。在用每种矫治器完成治疗后，受试者回答问卷并使用III型监测仪进行睡眠研究。使用方差分析比较每种矫治器的结果数据。
18名受试者完成了治疗方案。两种矫治器的治疗结果在统计学上没有显著差异。对于牙齿和腭部覆盖最小的MRA设计存在统计学上显著的（p≤0.05）偏好。受试者对矫治器的选择与所选矫治器的SAQLI评分相应降低一致。
尽管在测量的结果中两种矫治器之间未观察到统计学上的显著差异，但使用丙烯酸树脂体积较小且咬合间接触较少的矫治器有更大改善的趋势。MRA的选择应倾向于可滴定、不显眼且结构合适的设计，以促进对MRA治疗的接受和依从。
