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滴定式舌稳定装置治疗阻塞性睡眠呼吸暂停的疗效:一项准实验研究。

The efficacy of a titrated tongue-stabilizing device on obstructive sleep apnea: a quasi-experimental study.

作者信息

Alshhrani Waled M, Hamoda Mona M, Okuno Kentaro, Kohzuka Yuuya, Fleetham John A, Ayas Najib T, Comey Robert, Almeida Fernanda R

机构信息

Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.

Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.

出版信息

J Clin Sleep Med. 2021 Aug 1;17(8):1607-1618. doi: 10.5664/jcsm.9260.

Abstract

STUDY OBJECTIVES

To evaluate the short-term efficacy and self-reported outcomes of tongue-stabilizing device (TSD) therapy as compared to those of mandibular advancement device (MAD) therapy in an adult population diagnosed with obstructive sleep apnea.

METHODS

This study is a parallel, nonrandomized clinical trial of the TSD and MAD therapies. The efficacy of both interventions was evaluated objectively by level 3 home sleep apnea testing and by self-report using the Epworth Sleepiness Scale, the Functional Outcomes of Sleep Questionnaire, the Chalder Fatigue Scale, and the 36-Item Short-Form Health Survey. Adherence and adverse effects were self-reported.

RESULTS

Of the 39 patients who received TSD therapy, 27 managed to adapt and complete the trial and were matched with 26 patients who received MAD therapy. At the 2-month follow-up, the acceptance rate of the TSD therapy was 53.8%. Both patients receiving TSD therapy and patients receiving MAD therapy showed significant improvements in their respiratory event index ( < .05), with no difference between the treatments ( > .05). In those receiving TSD therapy (n = 27), the only self-reported efficacy measure that significantly improved with TSD therapy was the Chalder Fatigue Scale ( < .05). In contrast, all 4 self-reported measures (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, 36-Item Short-Form Health Survey, and Chalder Fatigue Scale) showed a significant improvement with MAD therapy.

CONCLUSIONS

This study revealed similar improvements in apneas and oxygen saturation between TSD and MAD therapies. Whereas MAD therapy was a better treatment for obstructive sleep apnea in terms of daytime sleepiness and quality-of-life improvements, TSD therapy had a low treatment acceptance rate.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: The Efficacy of Tongue Stabilizing Device in Patients with Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT02329925; Identifier: NCT02329925; and Registry: ClinicalTrials.gov; Name: Adherence and Preference of Continuous Positive Airway Pressure vs Mandibular Advancement Splints in Obstructive Sleep Apnea Patients: A Randomized Trial (CHOICE); URL: https://clinicaltrials.gov/ct2/show/NCT02242617; Identifier: NCT02242617.

CITATION

Alshhrani WM, Hamoda MM, Okuno K, et al. The efficacy of a titrated tongue-stabilizing device on obstructive sleep apnea: a quasi-experimental study. 2021;17(8):1607-1618.

摘要

研究目的

评估在诊断为阻塞性睡眠呼吸暂停的成年人群中,与下颌前移装置(MAD)治疗相比,舌稳定装置(TSD)治疗的短期疗效和自我报告的结果。

方法

本研究是TSD和MAD治疗的平行、非随机临床试验。通过3级家庭睡眠呼吸暂停测试以及使用爱泼华嗜睡量表、睡眠问卷功能结果量表、查尔德疲劳量表和36项简短健康调查问卷进行自我报告,客观评估两种干预措施的疗效。依从性和不良反应通过自我报告。

结果

在接受TSD治疗的39例患者中,27例成功适应并完成试验,与接受MAD治疗的26例患者进行匹配。在2个月的随访中,TSD治疗的接受率为53.8%。接受TSD治疗的患者和接受MAD治疗的患者的呼吸事件指数均有显著改善(P<0.05),治疗之间无差异(P>0.05)。在接受TSD治疗的患者(n=27)中,TSD治疗后唯一显著改善的自我报告疗效指标是查尔德疲劳量表(P<0.05)。相比之下,MAD治疗后所有4项自我报告指标(爱泼华嗜睡量表、睡眠问卷功能结果量表、36项简短健康调查问卷和查尔德疲劳量表)均有显著改善。

结论

本研究显示TSD和MAD治疗在呼吸暂停和血氧饱和度方面有相似的改善。虽然就白天嗜睡和生活质量改善而言,MAD治疗对阻塞性睡眠呼吸暂停是更好的治疗方法,但TSD治疗的接受率较低。

临床试验注册

注册机构:ClinicalTrials.gov;名称:舌稳定装置对阻塞性睡眠呼吸暂停患者的疗效;网址:https://clinicaltrials.gov/ct2/show/NCT02329925;标识符:NCT02329925;以及注册机构:ClinicalTrials.gov;名称:阻塞性睡眠呼吸暂停患者持续气道正压通气与下颌前移矫治器的依从性和偏好:一项随机试验(CHOICE);网址:https://clinicaltrials.gov/ct2/show/NCT02242617;标识符:NCT02242617。

引用文献

Alshhrani WM, Hamoda MM, Okuno K,等。滴定式舌稳定装置对阻塞性睡眠呼吸暂停的疗效:一项准实验研究。2021;17(8):1607 - 1618。

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