Wang Lan, Liu Ye-hai
Department of Orthodontics, Stomatological Hospital of Hefei City. Hefei 230011;Anhui Province, China.E-mail:
Shanghai Kou Qiang Yi Xue. 2014 Dec;23(6):713-7.
To evaluate the efficacy of 2 mandibular advancement devices in 6-week treatment of patient with severe obstructive sleep apnea hypopnea syndrome (OSAHS) who refused to CPAP or CPAP therapy.
A randomized cross-over study was designed and conducted. Twenty-two male patients with severe OSAHS were included for treatment. Rod type and controllable type mandibular advancement devices (MADs) were used respectively in 6 weeks with 2-week interval, while the whole experimental duration was 14 weeks. The differences of the indexes of the polysomnography (PSG) were analyzed, which were gained before the intervention and 6 weeks after use of 2 types of MADs. Questionnaires with Epworth sleep and SCL-90 symptoms self evaluation scales were proceeded. Meanwhile, the parameters such as the stability of the MAD, the adverse reaction and the subjective symptom relief were assessed. The result was statistically analyzed by SPSS19.0 software package.
Compared with the apnea hypopnea index (AHI) before the intervention (48.16±13.99 times/hr), both the AHI of the rod type (19.16±2.74 times/hr) and the controllable type (18.93±2.57 times/hr) were reduced by 50%. The remaining parameters showed that both types of MADs had a significant effect on mandibular advancement. There was significant different decrease in each index of the SCL-90 (P<0.01), while significant differences were found in somatization, interpersonal sensitivity and anxiety compared with those before intervention(P<0.05). At the same time, there were significant differences in the indexes of stability and results occlusive comfort between the rod type and the controllable MADs (P<0.05).
The objective results and the patients' physical and mental health are improved obviously by using the 2 types of MADs. Controllable MADs have more advantages in compliance; however, further research should be conducted for long-time outcome.
评估两种下颌前移装置对拒绝持续气道正压通气（CPAP）或CPAP治疗的重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者进行6周治疗的疗效。
设计并进行一项随机交叉研究。纳入22例重度OSAHS男性患者进行治疗。分别使用杆式和可控式下颌前移装置（MADs），各使用6周，间隔2周，整个实验持续时间为14周。分析干预前及使用两种MADs 6周后多导睡眠图（PSG）指标的差异。进行Epworth睡眠问卷和SCL-90症状自评量表调查。同时，评估MADs的稳定性、不良反应和主观症状缓解等参数。结果采用SPSS19.0软件包进行统计学分析。
与干预前的呼吸暂停低通气指数（AHI）（48.16±13.99次/小时）相比，杆式（19.16±2.74次/小时）和可控式（18.93±2.57次/小时）的AHI均降低了50%。其余参数表明两种类型的MADs对下颌前移均有显著效果。SCL-90各指标均有显著下降（P<0.01），与干预前相比，躯体化、人际敏感和焦虑方面有显著差异（P<0.05）。同时，杆式和可控式MADs在稳定性指标和咬合舒适度方面存在显著差异（P<0.05）。
使用这两种类型的MADs可明显改善客观结果及患者的身心健康。可控式MADs在依从性方面更具优势；然而，对于长期疗效仍需进一步研究。
