在用于治疗阻塞性睡眠呼吸暂停的口腔矫治器中尽量减少下颌前伸。

Minimizing the mandibular advancement in an oral appliance for the treatment of obstructive sleep apnea.

作者信息

Anitua Eduardo, Durán-Cantolla Joaquín, Almeida Gabriela Zamora, Alkhraisat Mohammad Hamdan

机构信息

Clínica Eduardo Anitua, Vitoria, Spain; BTI Biotechnology Institute, Vitoria, Spain.

Clínica Eduardo Anitua, Vitoria, Spain; Bioaraba Research Institute, OSI Araba University Hospital, Vitoria, Spain; Interdisciplinary Sleep Unit, OSI Araba University Hospital, Vitoria, Spain; Basque Country University, Medicine Department, Vitoria, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Madrid, Spain.

出版信息

Sleep Med. 2017 Jun;34:226-231. doi: 10.1016/j.sleep.2016.12.019. Epub 2017 Jan 29.

DOI:10.1016/j.sleep.2016.12.019

PMID:28228337

Abstract

OBJECTIVE

In the treatment of obstructive sleep apnea (OSA) with an oral appliance (OA), there is no gold standard method to fine-tune the mandibular advancement. This study aimed to analyze the effect of gradual increment of mandibular advancement on the evolution of the apnea-hypopnea index (AHI).

METHODS

OSA patients were recruited from a sleep unit. All treatments started with an oral appliance without mandibular advancement. After two weeks, the AHI was assessed with respiratory polygraphy. Mandibular advancement was initiated with a step size of 1 mm and evolution in the AHI was assessed. The target protrusion was the one that achieved the highest reduction in AHI and the least side effects. Anthropometric data, sleep questionnaire and Epworth sleepiness scale score were obtained.

RESULTS

Thirty six patients (22 men) participated in this study. The patient's mean age was 57 ± 12 years and the body mass index was 25.4 ± 4.1 kg/m. The oral appliance reduced the AHI from 20.8 ± 12.9/h to 8.4 ± 5.1/h (P = 0.000). Ten of the 26 patients with ≥50% reduction in AHI (39%) had zero advancement. The mean mandibular advancement was 1.7 ± 1.5 mm achieving ≥50% reduction in AHI in 72% of the patients. Twenty seven patients had an AHI <10/h. Of the 21 patients with moderate-severe OSA, 17 had the highest decrease in the AHI in a mandibular advancement ≤3 mm.

CONCLUSIONS

Monitoring the subjective symptoms of the patient and objective evolution in the AHI could minimize the mandibular advancement needed for the treatment of OSA.

摘要

目的

在使用口腔矫治器（OA）治疗阻塞性睡眠呼吸暂停（OSA）时，尚无微调下颌前伸的金标准方法。本研究旨在分析下颌前伸逐渐增加对呼吸暂停低通气指数（AHI）变化的影响。

方法

从睡眠科招募OSA患者。所有治疗均从无下颌前伸的口腔矫治器开始。两周后，通过呼吸多导记录仪评估AHI。以1毫米的步长开始下颌前伸，并评估AHI的变化。目标前伸量是使AHI降低最多且副作用最小的前伸量。获取人体测量数据、睡眠问卷和爱泼华嗜睡量表评分。

结果

36名患者（22名男性）参与了本研究。患者的平均年龄为57±12岁，体重指数为25.4±4.1kg/m²。口腔矫治器使AHI从20.8±12.9次/小时降至8.4±5.1次/小时（P = 0.000）。26名AHI降低≥50%的患者中有10名（39%）无前伸。平均下颌前伸量为1.7±1.5毫米，72%的患者AHI降低≥50%。27名患者的AHI<10次/小时。在21名中重度OSA患者中，17名在≤3毫米的下颌前伸量时AHI下降最多。