Uniken Venema Julia A M, Doff Michiel H J, Joffe-Sokolova Dilyana, Wijkstra Peter J, van der Hoeven Johannes H, Stegenga Boudewijn, Hoekema Aarnoud
Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
J Clin Sleep Med. 2020 Mar 15;16(3):353-359. doi: 10.5664/jcsm.8204. Epub 2020 Jan 14.
Obstructive sleep apnea (OSA) is a sleep-related breathing disorder, commonly managed by either continuous positive airway pressure (CPAP) or a mandibular advancement device (MAD). Long-term follow-up and comparison regarding efficacy of these therapies is scarce. In this study the results of treatment, patient adherence, and satisfaction over a 10-year follow-up of these therapies are reported.
This is a longitudinal follow-up study taken from a subset of patients initially enrolled in a randomized controlled clinical trial of 103 patients with OSA (51 and 52 patients randomized for MAD and CPAP, respectively). After a 10-year follow-up period, 14 patients using MAD and 17 patients using CPAP could be evaluated for this longitudinal follow-up study. Data were analyzed at baseline, after 3 months and at 1-, 2-, and 10-year follow-up. All 31 patients with OSA underwent polysomnography and self-reported measurements.
Polysomnography results showed a favorable outcome of both therapies at 10-year follow-up. At baseline, included patients in both groups did not significantly differ in apnea-hypopnea index (AHI) values. At 10-year follow-up, both the MAD and CPAP groups showed a significant reduction in AHI. At baseline the mean AHI in the MAD group was 31.7 ± 20.6 events/h whereas in the CPAP group it was 49.2 ± 26.1 events/h. At 10-year follow-up the mean AHI in the MAD group was 9.9 ± 10.3 events/h and in the CPAP group it was 3.4 ± 5.4 events/h. Both therapies resulted in a substantial improvement in self-reported neurobehavioral outcomes at 10-year follow-up.
Both CPAP and MAD therapy demonstrate good and stable treatment effects after a 10-year follow-up period. Therefore, when indicated, both therapies are appropriate modalities for the long-term management of OSA.
Registry: Netherlands Trial Register; Name: Management of the Obstructive Sleep Apnea-Hypopnea Syndrome: Oral Appliance versus Continuous Positive Airway Pressure Therapy; Identifier: NL75; URL: https://www.trialregister.nl/trial/75.
阻塞性睡眠呼吸暂停（OSA）是一种与睡眠相关的呼吸障碍，通常采用持续气道正压通气（CPAP）或下颌前移装置（MAD）进行治疗。关于这些疗法疗效的长期随访和比较较为缺乏。在本研究中，报告了这些疗法在10年随访期内的治疗结果、患者依从性和满意度。
这是一项纵向随访研究，选取了最初纳入一项随机对照临床试验的103例OSA患者中的一部分（分别有51例和52例患者被随机分配至MAD组和CPAP组）。经过10年的随访期后，可对14例使用MAD的患者和17例使用CPAP的患者进行此项纵向随访研究。在基线、3个月后以及1年、2年和10年随访时对数据进行分析。所有31例OSA患者均接受了多导睡眠图检查和自我报告测量。
多导睡眠图结果显示，在10年随访时两种疗法均取得了良好的效果。在基线时，两组纳入的患者在呼吸暂停低通气指数（AHI）值方面无显著差异。在10年随访时，MAD组和CPAP组的AHI均显著降低。在基线时，MAD组的平均AHI为31.7±20.6次/小时，而CPAP组为49.2±26.1次/小时。在10年随访时，MAD组的平均AHI为9.9±10.3次/小时，CPAP组为3.4±5.4次/小时。两种疗法在10年随访时均使自我报告的神经行为结果有了显著改善。
在10年随访期后，CPAP和MAD疗法均显示出良好且稳定治疗效果。因此，在有指征时，这两种疗法都是OSA长期管理的合适方式。
注册机构：荷兰试验注册中心；名称：阻塞性睡眠呼吸暂停低通气综合征的管理：口腔矫治器与持续气道正压通气治疗；标识符：NL75；网址：https://www.trialregister.nl/trial/75 。
