Department of Otorhinolaryngology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea.
Eur Arch Otorhinolaryngol. 2018 Jul;275(7):1811-1817. doi: 10.1007/s00405-018-5007-3. Epub 2018 May 23.
It is unclear whether soft palate-associated changes in cephalometry associated with a mandibular advancement device (MAD) are independently associated with improvements in polysomnography (PSG) respiratory parameters in obstructive sleep apnea (OSA).
This retrospective review aimed to identify the association between soft palate-associated changes in cephalometry and PSG changes after application of an MAD. Korean patients diagnosed with OSA who underwent cephalometry with or without an MAD were enrolled. All the patients were evaluated after undergoing full-night PSG twice: once with an MAD and once without. Cephalometric findings were measured using an image analyzer.
Mean apnea-hypopnea index significantly decreased with an MAD from 36.4/h to 14.7/h (p < 0.001). Retropalatal airway space significantly increased with an MAD from 6.6 to 7.3 mm (p = 0.013). Soft palate length also significantly decreased with an MAD from 43.6 to 42.3 mm (p = 0.02). Although these findings were shown by responders (patients with a reduction of apnea-hypopnea index by more than 50%), there were no significant changes in non-responders. However, retroglossal airway space did not significantly increase with an MAD even in responders.
Improvement of OSA with an MAD can be predicted with soft palate-associated upper airway changes shown in cephalometry.
目前尚不清楚下颌前伸装置（MAD）相关的头影测量中软腭相关变化是否与阻塞性睡眠呼吸暂停（OSA）的多导睡眠图（PSG）呼吸参数的改善独立相关。
本回顾性研究旨在确定头影测量中软腭相关变化与 MAD 应用后 PSG 变化之间的关联。纳入了经头影测量诊断为 OSA 并接受 MAD 治疗的韩国患者。所有患者均在两次接受整夜 PSG 评估后接受了评估：一次使用 MAD，一次不使用。使用图像分析仪测量头影测量结果。
MAD 治疗后，呼吸暂停低通气指数从 36.4/h 显著降低至 14.7/h（p<0.001）。MAD 治疗后，后咽气道空间从 6.6 显著增加至 7.3 mm（p=0.013）。软腭长度也随着 MAD 的使用从 43.6 显著减少至 42.3 mm（p=0.02）。虽然这些发现见于应答者（呼吸暂停低通气指数降低超过 50%的患者），但在无应答者中没有发现显著变化。然而，即使在应答者中，舌后气道空间也没有随着 MAD 的使用而显著增加。
MAD 改善 OSA 可以通过头影测量中显示的与软腭相关的上气道变化来预测。
