Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Center for Sleep Disorders at Fukuoka, Fukuoka Urasoe Clinic, Fukuoka, Japan.
J Prosthodont. 2019 Feb;28(2):e830-e836. doi: 10.1111/jopr.12619. Epub 2017 Apr 19.
To compare the efficacy of twin-block (i.e., allows mouth opening) and fixed (i.e., maintains mouth closure) mandibular advancement splints (MASs) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSA).
From 2011 to 2013, 23 patients with OSA in the twin-block group, and from 2013 to 2015, 29 patients in the fixed MAS group were included. All patients underwent polysomnography before and after 3 months of treatment. The two sets of polysomnographic and cephalometric variables were compared.
A significant difference (p < 0.001) was observed in the apnea-hypopnea index before and after MAS treatment in both groups (twin-block group: 20.6 ± 11.5 vs. 14.7 ± 9.4; fixed group: 21.4 ± 15.2 vs. 11.2 ± 9.7). In the twin-block group, 5 patients (21.7%) were complete responders, 9 (39.1%) were fair responders, and 9 (39.1%) were nonresponders; the corresponding figures for the fixed group were 14 (48.3%), 9 (31.0%), and 6 (20.7%) patients. A significant between-group difference was observed in the distribution of responders (p = 0.046). The fixed group showed a significant improvement in the snoring index (p = 0.003), arousal index (p = 0.036), and desaturation rate (p = 0.012). Finally, the change in incisal overjet was larger in the fixed group than in the twin-block group (p < 0.001).
These results suggest that fixed oral appliances are superior in treating OSA, based on their ability to prevent mouth opening and reduce incisal overjet.
比较双板（即允许张口）和固定（即保持闭口）下颌前伸矫治器（MAS）治疗阻塞性睡眠呼吸暂停低通气综合征（OSA）的疗效。
2011 年至 2013 年，23 例 OSA 患者纳入双板组，2013 年至 2015 年，29 例患者纳入固定 MAS 组。所有患者均在治疗前和治疗后 3 个月进行多导睡眠图检查。比较两组多导睡眠图和头影测量变量。
两组 MAS 治疗前后的呼吸暂停低通气指数均有显著差异（p < 0.001）（双板组：20.6 ± 11.5 比 14.7 ± 9.4；固定组：21.4 ± 15.2 比 11.2 ± 9.7）。在双板组中，5 例（21.7%）为完全应答者，9 例（39.1%）为中等应答者，9 例（39.1%）为无应答者；固定组相应的数字分别为 14 例（48.3%）、9 例（31.0%）和 6 例（20.7%）。两组间应答者分布存在显著差异（p = 0.046）。固定组的鼾声指数（p = 0.003）、觉醒指数（p = 0.036）和饱和度下降率（p = 0.012）均有显著改善。最后，固定组切牙覆盖的变化大于双板组（p < 0.001）。
这些结果表明，基于防止张口和减少切牙覆盖的能力，固定口腔矫治器在治疗 OSA 方面更具优势。
