[口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征不同治疗阶段的疗效]

Gong X, Zhao Y, Li W R, Gao X M

Department of orthodontics, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.

Department of Stomatology, Capital Medical University, Xuanwu Hospital, Beijing 100053, China.

Beijing Da Xue Xue Bao Yi Xue Ban. 2017 Feb 18;49(1):115-9.

OBJECTIVE

To investigate the long-term efficacy of oral appliance treating of obstructive sleep apnea and hypopnea syndrome (OSAHS) in different periods of treatment.

METHODS

A total of 55 patients were included in the study. Patients were all diagnosed with OSAHS by overnight polysomnography and all received oral appliance (OA) as the therapy. The OA positioned the mandible at 60%-70% of the maximal mandible advancement position and created a 4-5 mm incisor separation. The patients were instructed to wear the appliance during sleep, 6-8 hours per day, for 5-7 days per week. They were divided into four groups by the period of treatment, including less than 1 year group; 1-2 years group; 2-6 years group and 6-9 years group. The polysomnographic study was used to investigate the efficacy of the four groups. The outcome measures included the score on the apnea-hypopnea index (AHI), the longest apnea time and the lowest oxygen saturation (LSaO) levels during an overnight sleep.

RESULTS

The AHI decreased significantly in all the four groups. The less than 1 year group decreased from 24.50 (14.65, 54.05) to 7.40 (2.12,10.00) events/h (P<0.001); The 1-2 years group decreased from 19.50 (12.15, 39.23) to 1.80 (0.70, 6.58) events/h (P=0.001); The 2-6 years group decreased from 25.00 (11.41, 42.60) to 4.50 (1.35, 7.90) events/h (P=0.001); The 6-9 years group decreased from 26.2 (16.95, 47.45) to 4.00 (1.90, 26.70) events/h (P=0.043). The longest apnea decreased significantly in less than 1 year group, 1-2 years group and 2-6 years group. The longest apnea decreased from 57.00 (37.70, 61.50) to 25.00 (15.90, 33.50) seconds (P<0.001) in the less than 1 year group, from 41.00 (25.50, 62.26) to 13.10 (0.00, 22.10) seconds (P=0.001) in the 1-2 year group and from 42.50 (30.35, 58.15) to 15.60 (0.00, 28.10) seconds (P=0.003) in the 2-6 year group. The LSaO levels increased significantly in the less than 1 year group and 2-6 years group. The LSaO(2) levels rose significantly in the less than 1 year group, from 74.18%±7.96% to 84.06%±7.67% (P=0.001), and in the 2-6 years group, from 76.71%±10.98% to 84.06%±4.64% (P=0.006), The LSaO levels did not increase significantly in the 1-2 years and 6-9 years groups. Kruskal-Wallis test showed that there were no statistically significant differences in the AHI, longest apnea time and LSaO(2) in 4 the groups.

CONCLUSION

The oral appliance is an effective therapy for patients with OSAHS in the long-term treatment. However, it's recommended to make appointments with patients as a follow-up supervision whether there is any efficacy decrease. And the oral appliance should be replaced if necessary.

目的

探讨口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）不同疗程的远期疗效。

方法

共纳入55例患者。所有患者均经夜间多导睡眠图诊断为OSAHS，并均接受口腔矫治器（OA）治疗。OA将下颌定位在最大下颌前伸位置的60%-70%，并使切牙分开4-5毫米。指导患者在睡眠期间佩戴矫治器，每天6-8小时，每周5-7天。根据治疗疗程将患者分为四组，包括治疗时间小于1年组；1-2年组；2-6年组和6-9年组。采用多导睡眠图研究四组的疗效。观察指标包括夜间睡眠期间的呼吸暂停低通气指数（AHI）评分、最长呼吸暂停时间和最低血氧饱和度（LSaO）水平。

结果

四组患者的AHI均显著降低。治疗时间小于1年组从24.50（14.65，54.05）次/小时降至7.40（2.12，10.00）次/小时（P<0.001）；1-2年组从19.50（12.15，39.23）次/小时降至1.80（0.70，6.58）次/小时（P=0.001）；2-6年组从25.00（11.41，42.60）次/小时降至4.50（1.35，7.90）次/小时（P=0.001）；6-9年组从26.2（16.95，47.45）次/小时降至4.00（1.90，26.70）次/小时（P=0.043）。治疗时间小于1年组、1-2年组和2-6年组的最长呼吸暂停时间显著降低。治疗时间小于1年组的最长呼吸暂停时间从57.00（37.70，61.50）秒降至25.00（15.90，33.50）秒（P<0.001），1-2年组从41.00（25.50，62.26）秒降至13.10（0.00，22.10）秒（P=0.001），2-6年组从42.50（30.35，58.15）秒降至15.60（0.00，28.10）秒（P=0.003）。治疗时间小于1年组和2-6年组的LSaO水平显著升高。治疗时间小于1年组的LSaO₂水平从74.18%±7.96%显著升至84.06%±7.67%（P=0.001），2-6年组从76.71%±10.98%升至84.06%±4.64%（P=0.006），1-2年组和6-9年组的LSaO水平无显著升高。Kruskal-Wallis检验显示四组患者的AHI、最长呼吸暂停时间和LSaO₂无统计学显著差异。