Ishiyama Hiroyuki, Hideshima Masayuki, Inukai Shusuke, Tamaoka Meiyo, Nishiyama Akira, Miyazaki Yasunari
Dental Anesthesiology and Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan.
Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo 113-8549, Japan.
J Clin Med. 2021 Mar 18;10(6):1255. doi: 10.3390/jcm10061255.
The aim of this study was to determine the utility of respiratory resistance as a predictor of oral appliance (OA) response in obstructive sleep apnea (OSA). Twenty-seven patients with OSA (mean respiratory event index (REI): 17.5 ± 6.5 events/h) were recruited. At baseline, the respiratory resistance (R20) was measured by impulse oscillometry (IOS) with a fitted nasal mask in the supine position, and cephalometric radiographs were obtained to analyze the pharyngeal airway space (SPAS: superior posterior airway space, MAS: middle airway space, IAS: inferior airway space). The R20 and radiographs after the OA treatment were evaluated, and the changes from the baseline were analyzed. A sleep test with OA was carried out using a portable device. The subjects were divided into Responders and Non-responders based on an REI improvement ≥ 50% from the baseline, or REI < 5 after treatment, and the R20 reduction rate between the two groups were compared. The subjects comprised 20 responders and 7 non-responders. The R20 reduction rate with OA in responders was significantly greater than it was in non-responders (14.4 ± 7.9 % versus 2.4 ± 9.8 %, < 0.05). In responders, SPAS, MAS, and IAS were significantly widened and R20 was significantly decreased with OA ( < 0.05). There was no significant difference in non-responders ( 0.05). A logistic multiple regression analysis showed that the R20 reduction rate was predictive for OA treatment responses (2% incremental odds ratio (OR), 24.5; 95% CI, 21.5-28.0; = 0.018). This pilot study confirmed that respiratory resistance may have significant clinical utility in predicting OA treatment responses.
本研究的目的是确定呼吸阻力作为阻塞性睡眠呼吸暂停（OSA）患者口腔矫治器（OA）治疗反应预测指标的效用。招募了27例OSA患者（平均呼吸事件指数（REI）：17.5±6.5次/小时）。在基线时，采用脉冲振荡法（IOS），使用适合的鼻面罩在仰卧位测量呼吸阻力（R20），并获取头影测量X线片以分析咽气道空间（SPAS：上后气道空间、MAS：中气道空间、IAS：下气道空间）。评估OA治疗后的R20和X线片，并分析与基线的变化。使用便携式设备进行OA睡眠测试。根据REI较基线改善≥50%或治疗后REI<5次/小时，将受试者分为反应者和无反应者，并比较两组之间的R20降低率。受试者包括20例反应者和7例无反应者。反应者使用OA后的R20降低率显著高于无反应者（14.4±7.9%对2.4±9.8%，P<0.05）。在反应者中，使用OA后SPAS、MAS和IAS显著增宽，R20显著降低（P<0.05）。无反应者无显著差异（P>0.05）。逻辑多元回归分析显示，R20降低率可预测OA治疗反应（增量优势比（OR）为2%，24.5；95%CI，21.5 - 28.0；P = 0.018）。这项初步研究证实，呼吸阻力在预测OA治疗反应方面可能具有显著的临床效用。
