Department of Prosthodontics, Medical University of Warsaw, Warsaw, Poland.
Second Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
Adv Exp Med Biol. 2019;1150:35-42. doi: 10.1007/5584_2018_275.
Obstructive sleep apnea (OSA) is defined as episodes of upper airway obstruction occurring during sleep. Conservative treatment of OSA consists of continuous positive airway pressure (CPAP). An alternative treatment in mild-to-moderate OSA could be the use of intraoral mandibular advancement devices (MAD). The aim of this study was to evaluate therapeutic efficacy of MAD in OSA patients intolerant to CPAP. The study group included 8 patients, who fulfilled specific inclusion criteria during a dental examination, out of the 30 CPAP intolerant patients who were referred for the possible use of MAD. The selected patients used MAD for 30 days and then switched to CPAP for 10 days to compare the effectiveness of both treatment methods. They had 3 polysomnographic (PSG) examination: baseline before treatment, and at the end of MAD and CPAP. We found that either treatment method resulted in comparable symptomatic improvements in OSA patients. In detail, the apnea-hypopnea index decreased, along with the overall number of obstructive, central, and mixed apneic episodes during sleep time. The mean arterial oxygen saturation (SaO) improved and the minimum SaO level noted during night time got enhanced. Differences in the sleep apnea indices after MAD and CPAP treatments were insignificant, but there was a consistent impression that CPAP was superior to MAD as it tended to improve symptoms to a somehow greater extent. We conclude that MAD is a sufficiently effective treatment alternative for OSA patients who are intolerant to CPAP or in whom CPAP therapy fails.
阻塞性睡眠呼吸暂停（OSA）定义为睡眠期间上呼吸道阻塞的发作。OSA 的保守治疗包括持续气道正压通气（CPAP）。在轻度至中度 OSA 中，另一种治疗方法可能是使用口腔下颌前伸装置（MAD）。本研究旨在评估 MAD 在 CPAP 不耐受的 OSA 患者中的治疗效果。研究组包括 8 名患者，他们在牙科检查中符合特定纳入标准，这是 30 名 CPAP 不耐受患者中有意愿使用 MAD 的患者。所选患者使用 MAD 治疗 30 天，然后切换到 CPAP 治疗 10 天，以比较两种治疗方法的效果。他们进行了 3 次睡眠多导图（PSG）检查：治疗前的基线，以及 MAD 和 CPAP 治疗结束时。我们发现，两种治疗方法都能使 OSA 患者的症状得到相当的改善。具体而言，呼吸暂停低通气指数降低，同时睡眠期间的阻塞性、中枢性和混合性呼吸暂停发作次数也减少。平均动脉血氧饱和度（SaO）提高，夜间最低 SaO 水平提高。MAD 和 CPAP 治疗后睡眠呼吸暂停指数的差异无统计学意义，但有一种一致的印象是 CPAP 优于 MAD，因为它倾向于在某种程度上更有效地改善症状。我们得出结论，MAD 是 CPAP 不耐受或 CPAP 治疗失败的 OSA 患者的一种有效替代治疗方法。
