Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.
Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Adv Exp Med Biol. 2022;1384:373-385. doi: 10.1007/978-3-031-06413-5_22.
Mandibular advancement splint (MAS) therapy is the leading alternative to continuous positive airway pressure (CPAP) therapy for the treatment of obstructive sleep apnoea. A MAS is an oral appliance which advances the mandible in relation to the maxilla, thus increasing airway calibre and reducing collapsibility. Although it is less effective than CPAP in reducing the apnoea-hypopnoea index (AHI), it has demonstrated equivalence to CPAP in a number of key neurobehavioural and cardiovascular health outcomes, perhaps due to increased tolerability and patient adherence when compared to CPAP. However, response to MAS is variable, and reliable prediction tools for patients who respond best to MAS therapy have thus far been elusive; this is one of the key clinical barriers to wider uptake of MAS therapy. In addition, the most effective MAS devices are custom-made by a dentist specialising in the treatment of sleep disorders, which may present financial or accessibility barriers for some patients. MAS devices are generally well tolerated but may have side effects including temporomandibular joint (TMJ) dysfunction, hypersalivation, tooth pain and migration as well as occlusal changes. A patient-centred approach to treatment from a multidisciplinary team perspective is recommended. Evidence-based clinical practice points and areas of future research are summarised at the conclusion of the chapter.
下颌前移矫治器 (MAS) 疗法是治疗阻塞性睡眠呼吸暂停的首选替代连续气道正压通气 (CPAP) 疗法。MAS 是一种口腔器具,可使下颌相对于上颌向前推进,从而增加气道口径并减少塌陷。尽管它在降低呼吸暂停低通气指数 (AHI) 方面的效果不如 CPAP,但它在许多关键的神经行为和心血管健康结果方面与 CPAP 等效,这可能是由于与 CPAP 相比,它的耐受性和患者依从性更高。然而,对 MAS 的反应是可变的,因此到目前为止,仍然缺乏预测哪些患者对 MAS 治疗反应最好的可靠预测工具;这是广泛采用 MAS 治疗的关键临床障碍之一。此外,最有效的 MAS 设备由专门治疗睡眠障碍的牙医定制,这可能会给一些患者带来经济或可及性障碍。MAS 设备通常具有良好的耐受性,但可能会有副作用,包括颞下颌关节 (TMJ) 功能障碍、唾液分泌过多、牙痛和迁移以及咬合变化。建议从多学科团队的角度采取以患者为中心的治疗方法。在章节结束时总结了基于证据的临床实践要点和未来研究领域。