功能性影像学可改善下颌前伸装置治疗睡眠呼吸障碍患者的预后选择：一项前瞻性研究。
Functional imaging improves patient selection for mandibular advancement device treatment outcome in sleep-disordered breathing: a prospective study.
机构信息
Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.
出版信息
J Clin Sleep Med. 2022 Mar 1;18(3):739-750. doi: 10.5664/jcsm.9694.
STUDY OBJECTIVES
Mandibular advancement devices (MADs) are a noninvasive treatment option for patients with obstructive sleep apnea (OSA) and act by increasing the upper airway volume. However, the exact therapeutic mechanism of action remains unclear. The aim of this study was to assess MAD mechanisms using functional imaging that combines imaging techniques and computational fluid dynamics and assess associations with treatment outcome.
METHODS
One hundred patients with OSA were prospectively included and treated with a custom-made MAD at a fixed 75% protrusion. A low-dose computed tomography scan was made with and without MADs for computational fluid dynamics analysis. Patients underwent a baseline and 3-month follow-up polysomnography to evaluate treatment efficacy. A reduction in apnea-hypopnea index ≥ 50% defined treatment response.
RESULTS
Overall, 71 patients completed both 3-month follow-up polysomnography and low-dose computed tomography scan with computational fluid dynamics analysis. MAD treatment significantly reduced the apnea-hypopnea index (16.5 [10.4-23.6] events/h to 9.1 [3.9-16.4] events/h; < .001, median [quartile 1-quartile 3]) and significantly increased the total upper airway volume (8.6 [5.4-12.8] cm vs 10.7 [6.4-15.4] cm; = .003), especially the velopharyngeal volume (2.1 [0.5-4.1] cm vs 3.3 [1.8-6.0] cm; < .001). However, subanalyses in responders and nonresponders only showed a significant increase in the total upper airway volume in responders, not in nonresponders.
CONCLUSIONS
MAD acts by increasing the total upper airway volume, predominantly due to an increase in the velopharyngeal volume. Responders showed a significant increase in the total upper airway volume with MAD treatment, while there was no significant increase in nonresponders. Findings add evidence to implement functional imaging using computational fluid dynamics in routine MAD outcome prediction.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Name: Predicting Therapeutic Outcome of Mandibular Advancement Device Treatment in Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT01532050; Identifier: NCT01532050.
CITATION
Van Gaver H, Op de Beeck S, Dieltjens M, et al. Functional imaging improves patient selection for mandibular advancement device treatment outcome in sleep-disordered breathing: a prospective study. 2022;18(3):739-750.
研究目的
下颌前伸装置（MADs）是治疗阻塞性睡眠呼吸暂停（OSA）患者的一种非侵入性治疗选择，通过增加上气道容积起作用。然而，确切的治疗作用机制仍不清楚。本研究旨在使用结合成像技术和计算流体动力学的功能成像来评估 MAD 机制，并评估与治疗结果的相关性。
方法
前瞻性纳入 100 例 OSA 患者，采用定制的 MAD 以固定的 75%前伸度进行治疗。使用 MAD 进行低剂量计算机断层扫描以进行计算流体动力学分析。患者在基线和 3 个月随访时进行多导睡眠图检查，以评估治疗效果。定义 apnea-hypopnea 指数降低≥50%为治疗反应。
结果
总体而言，71 例患者均完成了 3 个月随访多导睡眠图检查和低剂量计算机断层扫描与计算流体动力学分析。MAD 治疗显著降低 apnea-hypopnea 指数（16.5[10.4-23.6]次/小时至 9.1[3.9-16.4]次/小时；<0.001，中位数[四分位数 1-四分位数 3]），并显著增加总上气道容积（8.6[5.4-12.8]cm 至 10.7[6.4-15.4]cm；=0.003），特别是软腭后区容积（2.1[0.5-4.1]cm 至 3.3[1.8-6.0]cm；<0.001）。然而， responders 和 nonresponders 的亚分析仅显示 responders的总上气道容积有显著增加，而 nonresponders 没有。
结论
MAD 通过增加总上气道容积起作用，主要是由于软腭后区容积的增加。在 MAD 治疗中， responders 表现出总上气道容积的显著增加，而 nonresponders 则没有。研究结果为在常规 MAD 治疗效果预测中使用计算流体动力学进行功能成像提供了证据。
临床试验注册
ClinicalTrials.gov；名称：预测下颌前伸装置治疗阻塞性睡眠呼吸暂停的治疗效果；网址：https://clinicaltrials.gov/ct2/show/NCT01532050；标识符：NCT01532050。
引文
Van Gaver H，Op de Beeck S，Dieltjens M，et al. 功能成像可改善睡眠呼吸暂停患者下颌前伸装置治疗效果的患者选择：一项前瞻性研究。2022；18（3）：739-750。
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