Service de stomatologie et chirurgie maxillo-faciale, AP-HP, DHU FAST, GH Pitié - Salpêtrière - Charles-Foix, 75013, Paris, France; Sorbonne Universités, UPMC université Paris 06, UMR 8256 B2A, 75005, Paris, France.
Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Service des pathologies du Sommeil (Département ''R3S''), AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles-Foix, 75013 Paris, France.
J Stomatol Oral Maxillofac Surg. 2019 Feb;120(1):7-10. doi: 10.1016/j.jormas.2018.09.005. Epub 2018 Oct 27.
Continuous positive airways pressure, generally used to treat obstructive sleep apnea-hypopnea syndrome (OSAHS), is not tolerated well by many patients. An alternative is to treat OSAHS with mandibular advancement devices (MAD). This research assesses the long term (> 2 years) effectiveness and the side effects on dental and skeletal parameters of these devices.
We selected 24 patients with moderate to severe OSAHS. All were treated with MADs for at least 2 years. We gathered cephalometric teleradiographs in centric relation and sleep recordings before and after the patients were treated. We evaluated the patients' apnea-hypopnea indexes (AHI) as well as their Epworth sleepiness scale (ESS) scores. We measured the inclination of the central incisors and the positions of the upper and lower jaws.
Mandibular advancement devices were used for more than 2 years (3.9 ± 1.9 years). We observed a statistically significant decrease of the patients' AHI and their ESS scores. We also observed a modification of the inclination of the lower central incisors (+0.521; P = 0.047) and of the position of the maxilla (-0.287; P = 0.039).
We demonstrated the clinical effectiveness of mandibular advancement devices for treating OSAHS, with a very low rate of side effects on dental and skeletal positions.
持续气道正压通气（CPAP）通常用于治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS），但许多患者对此不耐受。另一种替代方法是使用下颌前伸装置（MAD）治疗 OSAHS。本研究评估了这些装置在治疗超过 2 年（>2 年）的长期有效性以及对牙齿和骨骼参数的副作用。
我们选择了 24 名中重度 OSAHS 患者。所有患者均使用 MAD 治疗至少 2 年。我们收集了患者治疗前后的正中关系头颅侧位片和睡眠记录。我们评估了患者的呼吸暂停低通气指数（AHI）和嗜睡量表（ESS）评分。我们测量了中切牙的倾斜度以及上下颌的位置。
MAD 的使用时间超过 2 年（3.9±1.9 年）。我们观察到患者的 AHI 和 ESS 评分有统计学意义的降低。我们还观察到下中切牙倾斜度（+0.521；P=0.047）和上颌位置（-0.287；P=0.039）的改变。
我们证明了下颌前伸装置治疗 OSAHS 的临床有效性，且对牙齿和骨骼位置的副作用发生率非常低。
