Francis Claire E, Quinnell Tim
Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
Pulm Ther. 2021 Jun;7(1):25-36. doi: 10.1007/s41030-020-00137-2. Epub 2020 Nov 10.
Obstructive sleep apnea (OSA) is a prevalent condition causing unrefreshing sleep and excessive daytime sleepiness. It has individual socioeconomic impacts and, through association with increased risk of road traffic accidents, diabetes, and cardiovascular disease, OSA is a public health issue. Continuous positive airway pressure (CPAP) is the first-line treatment for moderate-to-severe OSA. It is effective in improving excessive daytime sleepiness and quality of life. There is also evidence that CPAP therapy has cardiovascular benefits although nature and extent remain uncertain. Despite its benefits, a significant proportion of patients are unable to tolerate CPAP. There are also patients with mild but symptomatic disease, for whom CPAP is usually not available or appropriate, so there is a need for other treatment options. Mandibular advancement devices (MADs) offer an effective alternative to CPAP and can improve daytime symptoms and quality of life. There are many devices available, representing a range of complexity and cost. It is challenging to properly evaluate the effectiveness of this ever-evolving range. The more basic MADs are cheaper and more accessible but are less well tolerated. More complex devices are better tolerated and may be more effective. However, they are more expensive and often require dental expertise, so access is more limited. Efforts continue to try to improve accessibility to effective MAD therapy. Alongside increasing awareness, this may be facilitated by developing and refining devices that could be fitted by non-dental clinicians, and potentially by patients themselves. Research efforts need to focus on determining how to efficiently identify patients who are likely to respond to MAD therapy, so as to improve clinical and cost-effectiveness of OSA therapy overall.
阻塞性睡眠呼吸暂停（OSA）是一种常见病症，会导致睡眠不能解乏以及日间过度嗜睡。它对个人有社会经济影响，并且通过与道路交通事故、糖尿病和心血管疾病风险增加相关联，OSA成为了一个公共卫生问题。持续气道正压通气（CPAP）是中重度OSA的一线治疗方法。它在改善日间过度嗜睡和生活质量方面有效。也有证据表明CPAP治疗有心血管益处，尽管其性质和程度仍不确定。尽管有这些益处，但相当一部分患者无法耐受CPAP。也有轻度但有症状的患者，对于他们来说CPAP通常不可用或不合适，所以需要其他治疗选择。下颌前移装置（MADs）为CPAP提供了一种有效的替代方法，并且可以改善日间症状和生活质量。有许多种装置可供选择，其复杂程度和成本各不相同。正确评估这一不断发展的系列装置的有效性具有挑战性。更基本的MADs更便宜且更容易获得，但耐受性较差。更复杂的装置耐受性更好，可能也更有效。然而，它们更昂贵，并且通常需要牙科专业知识，所以可及性更有限。人们继续努力尝试改善有效MAD治疗的可及性。除了提高认识之外，开发和改进可由非牙科临床医生安装的装置，甚至可能由患者自己安装的装置，可能会促进这一点。研究工作需要集中于确定如何有效地识别可能对MAD治疗有反应的患者，以便总体上提高OSA治疗的临床和成本效益。
