Orofacial Pain Clinic, Dental School, National and Kapodistrian University of Athens, GR-11527, Athens, Greece.
Department of Prosthodontics, Dental School, National and Kapodistrian University of Athens, GR-11527 , Athens, Greece.
Sleep Breath. 2022 Dec;26(4):1747-1758. doi: 10.1007/s11325-021-02561-3. Epub 2022 Jan 11.
To compare the short-term treatment effect of a mandibular advancement device (MAD) with and without previous drug-induced sleep endoscopy (DISE) on polysomnography (PSG) and other sleep apnea-related treatment outcomes (Short Form Health Survey [SF-36] and Epworth Sleepiness Scale [ESS]) among adults with mild, moderate, and severe obstructive sleep apnea (OSA). We hypothesized that using DISE would improve the efficacy of MADs on the sleep apnea parameters.
The study sample consisted of patients with OSA who were unable or unwilling to tolerate a CPAP device, divided into an experimental (with DISE) and a control (without DISE) group.
Of 50 patients with OSA, 40 men (80%), mean age was 48.8 ± 12,3 years. The mean apnea-hypopnea index (AHI) score of both groups decreased significantly between baseline and the 8-week follow-up titration PSG with MAD in situ, from 31.7 ± 17.3 (mean ± SD) apnea-hypopnea episodes/h to 7.0 ± 6.4/h (p < 0.0001) in the experimental group, and from 22.5 ± 16.6 episodes/h to 11.4 ± 8.0/h (p < 0.024) in the control group. Capillary oxygen saturation (SpO) levels did not change significantly between the two timepoints for either group. The SF-36 (p < 0.023) and ESS (p < 0.036) results of both groups improved significantly between baseline and the 8-week follow-up after starting MAD treatment; however, the improvement in quality of life was significantly more pronounced in the experimental group than in the control group (p < 0.0001).
DISE provides a significant benefit to patients with OSA undergoing MAD treatment. It can be used as a valuable prediction tool in clinical practice for the management of patients with OSA, even those with moderate and severe disease.
比较下颌前伸装置（MAD）与药物诱导睡眠内镜（DISE）联合治疗对轻、中、重度阻塞性睡眠呼吸暂停（OSA）患者的多导睡眠图（PSG）和其他与睡眠呼吸暂停相关的治疗结果（健康调查简表 36 项[SF-36]和Epworth 嗜睡量表[ESS]）的短期治疗效果。我们假设使用 DISE 会提高 MAD 治疗睡眠呼吸暂停参数的疗效。
研究样本包括无法或不愿耐受 CPAP 装置的 OSA 患者，分为实验组（使用 DISE）和对照组（不使用 DISE）。
50 例 OSA 患者中，男性 40 例（80%），平均年龄 48.8±12.3 岁。两组基线和 MAD 在位 8 周 PSG 滴定后，呼吸暂停低通气指数（AHI）评分均显著降低，实验组从 31.7±17.3（均值±标准差）呼吸暂停低通气事件/小时降至 7.0±6.4/小时（p<0.0001），对照组从 22.5±16.6 事件/小时降至 11.4±8.0/小时（p<0.024）。两组在两个时间点的毛细血管血氧饱和度（SpO）水平均无显著变化。两组在开始 MAD 治疗后 8 周的随访时，SF-36（p<0.023）和 ESS（p<0.036）结果均显著改善；然而，实验组的生活质量改善明显更明显（p<0.0001）。
DISE 为接受 MAD 治疗的 OSA 患者带来显著获益。它可以作为临床实践中管理 OSA 患者的一种有价值的预测工具，即使是中重度疾病患者。
