通过下颌单夜渐进性滴定，使用遥控下颌定位器作为阻塞性睡眠呼吸暂停患者下颌前移装置治疗的预测性筛查工具：一项系统评价。
The Use of Remotely Controlled Mandibular Positioner as a Predictive Screening Tool for Mandibular Advancement Device Therapy in Patients with Obstructive Sleep Apnea through Single-Night Progressive Titration of the Mandible: A Systematic Review.
作者信息
Kastoer Chloé, Dieltjens Marijke, Oorts Eline, Hamans Evert, Braem Marc J, Van de Heyning Paul H, Vanderveken Olivier M
机构信息
Antwerp University Hospital, Department of ENT, Head and Neck Surgery, Edegem, Antwerp, Belgium.
University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium.
出版信息
J Clin Sleep Med. 2016 Oct 15;12(10):1411-1421. doi: 10.5664/jcsm.6202.
STUDY OBJECTIVES
To perform a review of the current evidence regarding the use of a remotely controlled mandibular positioner (RCMP) and to analyze the efficacy of RCMP as a predictive selection tool in the treatment of obstructive sleep apnea (OSA) with oral appliances that protrude the mandible (OAm), exclusively relying on single-night RCMP titration.
METHODS
An extensive literature search is performed through PubMed.com, Thecochranelibrary.com (CENTRAL only), Embase.com, and recent conference meeting abstracts in the field.
RESULTS
A total of 254 OSA patients from four full-text articles and 5 conference meeting abstracts contribute data to the review. Criteria for successful RCMP test and success with OAm differed between studies. Study populations were not fully comparable due to range-difference in baseline apneahypopnea index (AHI). However, in all studies elimination of airway obstruction events during sleep by RCMP titration predicted OAm therapy success by the determination of the most effective target protrusive position (ETPP). A statistically significant association is found between mean AHI predicted outcome with RCMP and treatment outcome with OAm on polysomnographic or portable sleep monitoring evaluation (p < 0.05).
CONCLUSIONS
The existing evidence regarding the use of RCMP in patients with OSA indicates that it might be possible to protrude the mandible progressively during sleep under poly(somno)graphic observation by RCMP until respiratory events are eliminated without disturbing sleep or arousing the patient. ETPP as measured by the use of RCMP was significantly associated with success of OAm therapy in the reported studies. RCMP might be a promising instrument for predicting OAm treatment outcome and targeting the degree of mandibular advancement needed.
研究目的
对目前关于使用遥控下颌定位器（RCMP）的证据进行综述，并分析RCMP作为预测性选择工具在使用下颌前伸口腔矫治器（OAm）治疗阻塞性睡眠呼吸暂停（OSA）中的疗效，仅依靠单夜RCMP滴定。
方法
通过PubMed.com、Thecochranelibrary.com（仅CENTRAL）、Embase.com以及该领域近期会议摘要进行广泛的文献检索。
结果
来自4篇全文文章和5篇会议摘要的总共254例OSA患者为该综述提供了数据。不同研究中RCMP测试成功的标准以及OAm治疗成功的标准有所不同。由于基线呼吸暂停低通气指数（AHI）的范围差异，研究人群不完全具有可比性。然而，在所有研究中，通过RCMP滴定消除睡眠期间的气道阻塞事件可通过确定最有效的目标前伸位置（ETPP）来预测OAm治疗的成功。在多导睡眠图或便携式睡眠监测评估中，发现RCMP预测的平均AHI结果与OAm治疗结果之间存在统计学显著关联（p < 0.05）。
结论
关于在OSA患者中使用RCMP的现有证据表明，在多导睡眠图观察下，通过RCMP在睡眠期间逐渐前伸下颌，直到消除呼吸事件而不干扰睡眠或唤醒患者，这可能是可行的。在所报道的研究中，通过使用RCMP测量的ETPP与OAm治疗的成功显著相关。RCMP可能是一种有前景的工具，用于预测OAm治疗结果并确定所需的下颌前伸程度。
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