下颌前伸术可长期抑制阻塞性睡眠呼吸暂停综合征患者的呼吸不适。

Mandibular advancement reveals long-term suppression of breathing discomfort in patients with obstructive sleep apnea syndrome.

机构信息

Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.

AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France.

出版信息

Respir Physiol Neurobiol. 2019 May;263:47-54. doi: 10.1016/j.resp.2019.03.005. Epub 2019 Mar 11.

DOI:10.1016/j.resp.2019.03.005

PMID:30872167

Abstract

Obstructive sleep apnoea syndrome (OSAS) patients do not report breathing discomfort in spite of abnormal upper airway mechanics. We studied respiratory sensations in OSAS patients without and with mandibular advancement device (MAD). Fifty-seven moderate to severe non obese OSAS patients were asked about breathing discomfort using visual analogue scales (VAS) in the sitting position (VAS-1), after lying down (VAS-2), then with MAD (VAS-3). Awake critical closing pressure (awake Pcrit) was measured in 15 patients without then with MAD. None of the patients reported breathing discomfort when sitting but 19 patients (33%) did when lying (VAS-2: -20% or less). A feeling of "easier breathing" with MAD was observed and was more marked in patients reporting breathing discomfort when supine (VAS-3: +66.0% [49.0; 89.0]) than in those not doing so (VAS-3: +28.5% [1.0; 56.5], p = 0.007). MAD-induced change in awake Pcrit was correlated to VAS-3. In conclusion, MAD revealed "latent dyspnea" related to the severity of upper airways mechanics abnormalities in OSAS patients.

摘要

阻塞性睡眠呼吸暂停综合征（OSAS）患者尽管上气道力学异常，但并不报告呼吸不适。我们研究了无下颌前伸装置（MAD）和有 MAD 的 OSAS 患者的呼吸感觉。57 例中重度非肥胖 OSAS 患者分别在坐位（VAS-1）、卧位（VAS-2）和戴用 MAD 后（VAS-3）使用视觉模拟量表（VAS）报告呼吸不适。15 例患者在无 MAD 和有 MAD 时测量清醒临界关闭压（awake Pcrit）。但 19 例患者（33%）卧位时报告呼吸不适（VAS-2：-20%或更少）。戴用 MAD 后观察到呼吸感觉“更轻松”，且仰卧位时报告呼吸不适的患者更明显（VAS-3：+66.0% [49.0；89.0]），而非仰卧位时报告呼吸不适的患者则不明显（VAS-3：+28.5% [1.0；56.5]，p = 0.007）。MAD 诱导的 awake Pcrit 变化与 VAS-3 相关。总之，MAD 揭示了 OSAS 患者与上气道力学异常严重程度相关的“潜在呼吸困难”。