Division of Orthodontics, University of Kentucky College of Dentistry, Lexington Kentucky.
Department of Physiology, School of Medicine, University of Louisville, Louisville, Kentucky.
J Clin Sleep Med. 2021 Apr 1;17(4):833-848. doi: 10.5664/jcsm.9018.
This scoping review allows physicians, researchers, and others interested in obstructive sleep apnea to consider effectiveness of oral appliances (OAs). The intent is to improve understanding of OA effectiveness by considering morphologic interaction in patients with obstructive sleep apnea.
Morphologic and biomechanical criteria for positional alterations of the mandible assessed success rates of OA appliances. Searches of databases (Medline, PubMed, The Cochrane Library, EBSCO) using terms: OA treatment effectiveness and positive and/or negative outcome predictors. Craniofacial predictors of OAs and obstructive sleep apnea biomechanical factors of anatomical traits associated with OA effectiveness were included. Databases searched radiographic cephalometric imaging for morphology/phenotypes and apnea-hypopnea index responses. Articles were excluded if title or abstract was not relevant or a case report. If the analysis did not report mean or standard deviation for apnea-hypoxia index, it was excluded. No language, age, or sex restrictions were applied.
Analysis of 135 articles included in searched literature indicated alterations in musculature and pharyngeal airway structure through OA use. These alterations were individually unpredictable with wide variability 61.81% ± 12.29 (apnea-hypoxia index mean ± standard deviation). Morphologic variations as predictors were typically weak and idiosyncratic. Biomechanical factors and wide variations in the metrics of appliance application were unclear, identifying gaps in knowledge and practice of OAs.
An integrated basis to identify morphologic and biomechanical elements of phenotypic expressions of sleep-disordered breathing in the design and application of OAs is needed. Current knowledge is heterogeneous and shows high variability. Identification of subgroups of patients with obstructive sleep apnea responding to OAs is needed.
本范围综述使医生、研究人员和其他对阻塞性睡眠呼吸暂停感兴趣的人能够考虑口腔器具（OA）的有效性。目的是通过考虑阻塞性睡眠呼吸暂停患者的形态学相互作用来提高对 OA 有效性的理解。
通过使用术语对数据库（Medline、PubMed、The Cochrane Library、EBSCO）进行搜索：OA 治疗效果和阳性和/或阴性结果预测因素。纳入了颅面形态学预测因素和与 OA 有效性相关的解剖特征的阻塞性睡眠呼吸暂停生物力学因素。对数据库进行了影像学头颅侧位片的搜索，以获取形态/表型和呼吸暂停低通气指数的反应。如果标题或摘要不相关或为病例报告，则排除文章。如果分析未报告呼吸暂停低通气指数的平均值或标准差，则将其排除在外。未应用语言、年龄或性别限制。
对搜索文献中包含的 135 篇文章进行分析表明，通过 OA 使用改变了肌肉和咽气道结构。这些改变是不可预测的，个体差异很大，平均值为 61.81%±12.29（呼吸暂停低通气指数平均值±标准差）。作为预测因素的形态变化通常较弱且因人而异。生物力学因素和器具应用指标的广泛变化尚不清楚，这表明在 OA 的设计和应用方面存在知识和实践上的差距。
需要建立一个综合的基础，以确定睡眠呼吸障碍表型表达的形态学和生物力学要素在口腔器具的设计和应用中。目前的知识是异质的，表现出高度的可变性。需要确定对 OA 有反应的阻塞性睡眠呼吸暂停患者亚组。
