The George Washington University School of Medicine, Washington, DC, USA.
Children's National Medical Center, Washington, DC, 20010, USA.
Sleep Breath. 2018 May;22(2):541-546. doi: 10.1007/s11325-018-1643-5. Epub 2018 Mar 8.
In 2005, the American Academy of Sleep Medicine stated, "Oral appliances are indicated for use in patients with mild to moderate obstructive sleep apnea (OSA) who prefer them to CPAP therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP." However, this recommendation is based upon variable results from only six studies with more than 100 participants. These studies have assessed the effectiveness of mandibular advancement devices (MADs) in specific groups (military populations, academic institutions, or hospital settings) with no large study conducted in a fee-for-service private practice where the majority of patients receive MADs for OSA. The purpose of this study is to report outcomes of a board-certified dental sleep practitioner managing mild, moderate, and severe OSA using customized titratable MADs. We hypothesize that patients will demonstrate a significant reduction in apnea-hypopnea index (AHI) scores after adjusting their customized titratable MADs.
This is a 14-year retrospective study design with pre- and post-treatment sleep studies. An AHI score < 10 respiratory events per hour with therapy is defined as treatment success. This study was performed by a single private practitioner.
Of 2419 patient records analyzed, 544 (22%) had pre- and post-treatment sleep studies (89% polysomnograms). Of 510 patients with complete data, 459 (90%) revealed a decrease in AHI score < 10 respiratory events per hour indicating treatment success. Only 51 of these patients (10%) had a final AHI ≥ 10 and were considered treatment failures. Among the patients who lacked post overnight polysomnogram, 66/1921 (3%) discontinued the MAD due to adverse effects. Considering these patients as treatment failures as well, and therefore adding their number to the patients with complete sleep study data, the total treatment failures were 117/576 or 20%. Of the treatment successes, OSA was categorized by AHI at baseline as mild in 170 (34%), moderate in 181 (36%), and severe in 138 (28%).
In patients with evaluable data, there was an 80% success rate for treatment of OSA using a custom-fabricated adjustable MAD including substantial numbers of patients with moderate and severe disease.
2005 年，美国睡眠医学学会指出，“口腔矫治器适用于轻度至中度阻塞性睡眠呼吸暂停（OSA）患者，他们更喜欢口腔矫治器治疗，或者对 CPAP 治疗无反应、不适合、或 CPAP 治疗失败的患者。”然而，这一建议是基于仅有六项研究的结果，这些研究涉及 100 多名参与者，且这些研究评估了下颌前伸装置（MADs）在特定群体（军事人群、学术机构或医院环境）中的有效性，而没有在收费私人执业中进行大型研究，大多数患者在那里接受 MAD 治疗 OSA。本研究的目的是报告一位经过董事会认证的牙科睡眠从业者使用定制可调节 MAD 治疗轻度、中度和重度 OSA 的结果。我们假设，在调整定制可调节 MAD 后，患者的呼吸暂停低通气指数（AHI）评分将显著降低。
这是一项回顾性研究，设计时间为 14 年，有治疗前后的睡眠研究。AHI 评分＜10 次呼吸暂停低通气事件/小时被定义为治疗成功。这项研究是由一位私人执业者进行的。
在分析的 2419 份患者记录中，544 份（22%）有治疗前后的睡眠研究（89%为多导睡眠图）。在 510 名有完整数据的患者中，459 名（90%）的 AHI 评分＜10 次呼吸暂停低通气事件/小时，表明治疗成功。只有 51 名患者（10%）的最终 AHI≥10，被认为是治疗失败。在没有进行过夜多导睡眠图检查的患者中，有 66/1921 名（3%）因不良反应而停止使用 MAD。将这些患者也视为治疗失败，并将其数量添加到有完整睡眠研究数据的患者中，那么总的治疗失败病例数为 117/576 或 20%。在治疗成功的患者中，根据基线 AHI 将 OSA 分为轻度 170 例（34%）、中度 181 例（36%）和重度 138 例（28%）。
在可评估数据的患者中，使用定制可调节 MAD 治疗 OSA 的成功率为 80%，包括大量患有中度和重度疾病的患者。
