Department of Oral and Maxillofacial Radiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
Department of Orthodontics, School of Stomatology, Shandong University and Key Laboratory of Oral Biomedicine of Shandong, Jinan, China.
Eur J Orthod. 2019 May 24;41(3):308-315. doi: 10.1093/ejo/cjy085.
The primary aim of this study was to assess the differences in the upper airway morphology between responders and non-responders to mandibular advancement splint (MAS) treatment in obstructive sleep apnoea (OSA) management. The secondary aim was to assess the correlation between the minimum cross-sectional area of the upper airway and the anatomical structures (i.e. mandibular external length, maxillary length, soft palate length, area of the tongue, maxillomandibular enclosure size, and anatomical balance ratio) surrounding the upper airway. The third aim was to assess the differences in the overall skeletal configuration between responders and non-responders to MAS treatment.
Data from 64 patients (23 females and 41 males) diagnosed with OSA by polysomnography (PSG) at baseline and provided with an adjustable MAS were analysed. All patients had NewTom3G cone beam computed tomography (CBCT) scans, performed in the supine position, at baseline. After acclimatization to MAS, follow-up PSG tests were performed to assess the apnoea-hypopnea index (AHI) with the MAS in situ. Responders were defined by a post-treatment AHI less than 10/hour and at least 50 per cent reduction in AHI, and non-responders by a post-treatment AHI at least 10/hour or less than 50 per cent reduction in AHI. Several upper airway and anatomical variables surrounding the upper airway based on CBCT images were measured to determine the differences between responders and non-responders to MAS.
There were 36 responders (AHI = 24.8 ± 11.9 at baseline) and 28 non-responders (AHI = 31.2 ± 20.3 at baseline) to MAS. There were no significant differences in the upper airway morphology between responders and non-responders (P = 0.17-0.93) or in the anatomical structure surrounding the upper airway (P = 0.24-0.58).
Within the limitations of this study, it can be concluded that there are no significant differences in upper airway morphology and in anatomical structures surrounding the upper airway between responders and non-responders to MAS treatment. These findings suggest that the craniofacial anatomical structures analyzed in this study cannot explain the response to MAS treatment.
本研究的主要目的是评估下颌前伸矫治器（MAS）治疗阻塞性睡眠呼吸暂停（OSA）中，对 MAS 治疗有反应者和无反应者的上气道形态差异。次要目的是评估上气道周围最小横截面积与解剖结构（即下颌外长度、上颌长度、软腭长度、舌面积、上下颌包络大小和解剖平衡比）之间的相关性。第三个目的是评估 MAS 治疗有反应者和无反应者之间整体骨骼结构的差异。
对基线时经多导睡眠图（PSG）诊断为 OSA 并接受可调节 MAS 的 64 例患者（女性 23 例，男性 41 例）的数据进行了分析。所有患者均在基线时进行仰卧位新汤姆 3G 锥形束计算机断层扫描（CBCT）检查。在 MAS 适应后，进行后续 PSG 测试，以 MAS 在位时评估呼吸暂停低通气指数（AHI）。有反应者定义为治疗后 AHI ＜ 10/小时且 AHI 降低至少 50%，无反应者定义为治疗后 AHI 至少 10/小时或 AHI 降低＜50%。根据 CBCT 图像测量上气道和上气道周围的几个解剖变量，以确定 MAS 有反应者和无反应者之间的差异。
有 36 例（AHI = 24.8 ± 11.9 基线）和 28 例（AHI = 31.2 ± 20.3 基线）对 MAS 有反应。MAS 治疗有反应者和无反应者之间的上气道形态（P = 0.17-0.93）或上气道周围解剖结构（P = 0.24-0.58）无显著差异。
在本研究的限制范围内，可以得出结论，MAS 治疗有反应者和无反应者之间的上气道形态和上气道周围解剖结构无显著差异。这些发现表明，本研究分析的颅面解剖结构不能解释 MAS 治疗的反应。
