Nikolopoulou M, Byraki A, Ahlberg J, Heymans M W, Hamburger H L, De Lange J, Lobbezoo F, Aarab G
Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.
J Oral Rehabil. 2017 Jun;44(6):452-460. doi: 10.1111/joor.12505. Epub 2017 Apr 6.
Obstructive sleep apnoea syndrome (OSAS) is associated with several sleep disorders and sleep-related problems. Therefore, the aim of this study was to compare the effects of a mandibular advancement device (MAD) with those of nasal continuous positive airway pressure (nCPAP) on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. In this randomised placebo-controlled trial, sixty-four OSAS patients (52·0 ± 9·6 years) were randomly assigned to an MAD, nCPAP or an intra-oral placebo appliance in a parallel design. All participants filled out the validated Dutch Sleep Disorders Questionnaire (SDQ) twice: one before treatment and one after six months of treatment. With 88 questions, thirteen scales were constructed, representing common sleep disorders and sleep-related problems. Linear mixed model analyses were performed to study differences between the groups for the different SDQ scales over time. The MAD group showed significant improvements over time in symptoms corresponding with 'insomnia', 'excessive daytime sleepiness', 'psychiatric sleep disorder', 'periodic limb movements', 'sleep apnoea', 'sleep paralysis', 'daytime dysfunction', 'hypnagogic hallucinations/dreaming', 'restless sleep', 'negative conditioning' and 'automatic behaviour' (range of P values: 0·000-0·014). These improvements in symptoms were, however, not significantly different from the improvements in symptoms observed in the nCPAP and placebo groups (range of P values: 0·090-0·897). It can be concluded that there is no significant difference between MAD and nCPAP in their positive effects on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. These beneficial effects may be a result of placebo effects.
阻塞性睡眠呼吸暂停综合征（OSAS）与多种睡眠障碍及睡眠相关问题有关。因此，本研究旨在比较下颌前移矫治器（MAD）和鼻持续气道正压通气（nCPAP）对轻中度OSAS患者常见睡眠障碍及睡眠相关问题的自我报告症状的影响。在这项随机安慰剂对照试验中，64例OSAS患者（52.0±9.6岁）以平行设计随机分配至MAD组、nCPAP组或口腔内安慰剂矫治器组。所有参与者两次填写经过验证的荷兰睡眠障碍问卷（SDQ）：一次在治疗前，一次在治疗6个月后。该问卷有88个问题，构建了13个量表，代表常见睡眠障碍及睡眠相关问题。采用线性混合模型分析来研究不同SDQ量表在不同时间组间的差异。MAD组在与“失眠”“日间过度嗜睡”“精神性睡眠障碍”“周期性肢体运动”“睡眠呼吸暂停”“睡眠麻痹”“日间功能障碍”“入睡前幻觉/梦境”“睡眠不安”“负性条件反射”和“自动行为”相对应的症状方面随时间有显著改善（P值范围：0.000 - 0.014）。然而，这些症状的改善与nCPAP组和安慰剂组观察到的症状改善无显著差异（P值范围：0.090 - 0.897）。可以得出结论，MAD和nCPAP对轻中度OSAS患者常见睡眠障碍及睡眠相关问题的自我报告症状的积极影响无显著差异。这些有益效果可能是安慰剂效应的结果。
