Tong Benjamin K, Tran Carolin, Ricciardiello Andrea, Chiang Alan, Donegan Michelle, Murray Nick, Szollosi Irene, Amatoury Jason, Carberry Jayne C, Eckert Danny J
Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.
School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
J Clin Sleep Med. 2020 Apr 15;16(4):483-492. doi: 10.5664/jcsm.8244.
High nasal resistance is associated with oral appliance treatment failure in obstructive sleep apnea (OSA). A novel oral appliance with a built-in oral airway has been shown to reduce pharyngeal pressure swings during sleep and may be efficacious in those with high nasal resistance. The role of posture and mandibular advancement on nasal resistance in OSA remains unclear. This study aimed to determine (1) the effects of posture and mandibular advancement on nasal resistance in OSA and (2) the efficacy of a new oral appliance device including in patients with high nasal resistance.
A total of 39 people with OSA (7 females, apnea-hypopnea index (AHI) (mean ± standard deviation) = 29 ± 21 events/h) completed split-night polysomnography with and without oral appliance (order randomized). Prior to sleep, participants were instrumented with a nasal mask, pneumotachograph, and a choanal pressure catheter for gold standard nasal resistance quantification seated, supine and lateral (with and without oral appliance, order randomized).
Awake nasal resistance increased from seated, to supine, to lateral posture (median [interquartile range] = 1.8 [1.4, 2.7], 2.7 [1.7, 3.5], 3.4 [1.9, 4.6] cm H₂O/L/s, P < .001). Corresponding measures of nasal resistance did not change with mandibular advancement (2.3 [1.4, 3.5], 2.5 [1.8, 3.6], 3.5 [1.9, 4.8] cm H₂O/L/s, P = .388). The median AHI reduced by 47% with oral appliance therapy (29 ± 21 versus 18 ± 15 events/h, P = .002). Participants with high nasal resistance (> 3 cm H₂O/L/s) had similar reductions in AHI versus those with normal nasal resistance (61 [-8, 82] versus 40 [-5, 62] %, P = .244).
Nasal resistance changes with posture in people with OSA. A novel oral appliance with a built-in oral airway reduces OSA severity in people with OSA, including in those with high nasal resistance.
Registry: ANZCTR; Title: Combination therapy for obstructive sleep apnoea; Identifier: ACTRN12617000492358; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372279.
高鼻阻力与阻塞性睡眠呼吸暂停（OSA）的口腔矫治器治疗失败有关。一种新型的内置口腔气道的口腔矫治器已被证明可减少睡眠期间的咽部压力波动，可能对高鼻阻力患者有效。姿势和下颌前伸对OSA患者鼻阻力的作用尚不清楚。本研究旨在确定：（1）姿势和下颌前伸对OSA患者鼻阻力的影响；（2）一种新型口腔矫治器在包括高鼻阻力患者在内的患者中的疗效。
共有39例OSA患者（7例女性，呼吸暂停低通气指数（AHI）（均值±标准差）=29±21次/小时）完成了佩戴和不佩戴口腔矫治器的分夜多导睡眠图检查（顺序随机）。睡前，参与者佩戴鼻面罩、呼吸流速仪和鼻后压力导管，以在坐位、仰卧位和侧卧位（佩戴和不佩戴口腔矫治器，顺序随机）进行金标准鼻阻力定量测定。
清醒时鼻阻力从坐位到仰卧位再到侧卧位逐渐增加（中位数[四分位间距]=1.8[1.4,2.7]、2.7[1.7,3.5]、3.4[1.9,4.6]cmH₂O/L/s，P<.001）。鼻阻力的相应测量值在下颌前伸时没有变化（2.3[1.4,3.5]、2.5[1.8,3.6]、3.5[1.9,4.8]cmH₂O/L/s，P=.388）。口腔矫治器治疗使AHI中位数降低了47%（29±21次/小时对18±15次/小时，P=.002）。高鼻阻力（>3cmH₂O/L/s）的参与者与鼻阻力正常的参与者相比，AHI降低程度相似（61[-8,82]%对40[-5,62]%，P=.244）。
OSA患者的鼻阻力随姿势而变化。一种新型的内置口腔气道的口腔矫治器可降低OSA患者的OSA严重程度，包括高鼻阻力患者。
注册机构：澳大利亚和新西兰临床试验注册中心；标题：阻塞性睡眠呼吸暂停的联合治疗；标识符：ACTRN12617000492358；网址：https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372279 。
