Segù Marzia, Cosi Alessia, Santagostini Antonio, Scribante Andrea
Department of Clinical-Surgical,Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
Unit of Orthodontics and Paediatric Dentistry, Section of Dentistry, Department of Clinical,Surgical,Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
Int J Dent. 2021 Jun 17;2021:8811700. doi: 10.1155/2021/8811700. eCollection 2021.
Oral appliances (OAs) of various types have shown variable success in the treatment of mild-to-moderate obstructive sleep apnoea (OSA). In an OSA sample, this study evaluated the efficacy of a diagnostic trial OA (myTAP™); the efficacy of a definitive custom-fitted mandibular advancement device (MAD) (SomnoDent Flex™); and whether a trial device can be used to distinguish treatment responder from nonresponder patients. Patients underwent overnight home sleep recordings prior to and after fitting of these appliances in order to objectively assess their sleep quality in terms of polysomnographic (PSG) respiratory measures: apnoea-hypopnoea index (AHI), oxygen desaturation index (ODI), and minimum oxygen saturation (LowSpO). 40 patients with symptomatic OSAS were enrolled, 33 males and 7 females, with a mean age of 55.6 ± 12.73 years and an initial (T0) AHI of 26.51 ± 14.79. Trial devices were used in 16 patients (AHI: 29.9 ± 19.97, ODI: 21.06 ± 16.05, and LowSpO: 82 ± 10.22 at T0) and definitive MADs in 28 (AHI: 23.90 ± 9.19, ODI: 16.27 ± 11.34, and LowSpO: 82.87 ± 6.04 at T0). Statistically significant decreases in AHI (9.59 ± 8.94, < 0.0023) and ODI (8.20 ± 9.67, < 0.0129) were observed after treatment with the trial device. Only 8 of the patients in the trial device group went on to use the definitive device. Treatment with the definitive MAD produced statistically significant decreases in AHI (11.46 ± 9.65, < 0.0001) and ODI (9.10 ± 8.47, < 0.0016) and a significant improvement in LowSpO (85.09 ± 6.86, < 0.0004). Thus, both types of device proved effective in improving the PSG parameters. This study showed that introducing an easy-to-make and low-cost trial device into the therapeutic pathway of OSAS patients can circumvent the problem of individual responses to treatment by allowing effective classification of patients: in short, it allows a first distinction to be drawn between responders and nonresponders to treatment.
各种类型的口腔矫治器（OAs）在治疗轻至中度阻塞性睡眠呼吸暂停（OSA）方面已显示出不同程度的成功。在一个OSA样本中，本研究评估了诊断性试验口腔矫治器（myTAP™）的疗效；定制的确定性下颌前移装置（MAD）（SomnoDent Flex™）的疗效；以及试验装置是否可用于区分治疗反应者和无反应者患者。患者在佩戴这些矫治器之前和之后进行了夜间家庭睡眠记录，以便根据多导睡眠图（PSG）呼吸指标客观评估其睡眠质量：呼吸暂停低通气指数（AHI）、氧饱和度下降指数（ODI）和最低氧饱和度（LowSpO）。招募了40例有症状的阻塞性睡眠呼吸暂停低通气综合征（OSAS）患者，其中男性33例，女性7例，平均年龄55.6±12.73岁，初始（T0）AHI为26.51±14.79。16例患者使用了试验装置（T0时AHI：29.9±19.97，ODI：21.06±16.05，LowSpO：82±10.22），28例患者使用了确定性MAD（T0时AHI：23.90±9.19，ODI：16.27±11.34，LowSpO：82.87±6.04）。使用试验装置治疗后，观察到AHI（9.59±8.94，P<0.0023）和ODI（8.20±9.67，P<0.0129）有统计学意义的下降。试验装置组中只有8例患者继续使用确定性装置。使用确定性MAD治疗后，AHI（11.46±9.65，P<0.000(1)）和ODI（9.10±8.47，P<0.0016）有统计学意义的下降，LowSpO有显著改善（85.09±6.86，P<0.0004）。因此，两种类型的装置都被证明在改善PSG参数方面有效。本研究表明，在OSAS患者的治疗途径中引入一种易于制作且成本低廉的试验装置，可以通过对患者进行有效分类来规避个体对治疗反应的问题：简而言之，它允许在治疗反应者和无反应者之间进行初步区分。
