Lin Ching-Chi, Wang Huey-Yuan, Chiu Chung-Hsin, Liaw Shwu-Fang
Chest Division, Department of Internal Medicine, Mackay Memorial Hospital, #92, Section 2, Chung Shan North Road, Taipei, Taiwan,
Clin Oral Investig. 2015 Mar;19(2):437-44. doi: 10.1007/s00784-014-1234-1. Epub 2014 Apr 3.
This study evaluated the effects of mandibular advancement device (MAD) on serum levels of nitric oxide derivatives and endothelial function by endothelium-dependent flow-mediated dilation (FMD) in obstructive sleep apnea syndrome (OSAS).
Thirty patients with moderately severe-to-severe OSAS who desired MAD and 15 healthy controls were prospectively enrolled. FMD was measured by high-resolution B-mode ultrasonography, while serum NO x level from peripheral blood samples was measured by ELISA. All subjects participated in the sleep studies, which were repeated 2 months after MAD in OSAS patients.
Serum NO x level and FMD were lower in patients with OSAS than in controls prior to MAD. Serum NO x levels in 19 of 30 patients with OSAS, the designated MAD responders, increased from 11.8 ± 5.8 μM pre-MAD to 22.7 ± 4.9 μM post-MAD. The FMD increased from 5.9 ± 4.6 pre-MAD to 10.5 ± 4.8 post-MAD. For the 11 unresponsive patients, serum NO x and FMD remained impaired after MAD.
Successful treatment of OSAS with MAD can restore serum levels of NO x and FMD.
Endothelial function can be improved following effective treatment of OSAS using MAD.
本研究通过内皮依赖性血流介导的血管舒张功能（FMD）评估下颌前移装置（MAD）对阻塞性睡眠呼吸暂停综合征（OSAS）患者血清一氧化氮衍生物水平和内皮功能的影响。
前瞻性纳入30例希望使用MAD的中重度至重度OSAS患者和15名健康对照者。采用高分辨率B型超声测量FMD，采用酶联免疫吸附测定法（ELISA）检测外周血样本中的血清NOx水平。所有受试者均参与睡眠研究，OSAS患者在使用MAD 2个月后重复进行。
在使用MAD之前，OSAS患者的血清NOx水平和FMD低于对照组。30例OSAS患者中有19例（指定为MAD反应者）的血清NOx水平从使用MAD前的11.8±5.8μM增加到使用MAD后的22.7±4.9μM。FMD从使用MAD前的5.9±4.6增加到使用MAD后的10.5±4.8。对于11例无反应的患者，使用MAD后血清NOx和FMD仍受损。
使用MAD成功治疗OSAS可恢复血清NOx水平和FMD。
使用MAD有效治疗OSAS后可改善内皮功能。
