使用下颌前伸装置治疗时出现的治疗中出现的中枢性睡眠呼吸暂停的患病率。

The prevalence of treatment-emergent central sleep apnea with mandibular advancement device therapy.

机构信息

Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.

ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.

出版信息

J Clin Sleep Med. 2023 Dec 1;19(12):2035-2041. doi: 10.5664/jcsm.10742.

DOI:10.5664/jcsm.10742

PMID:37539639

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10692941/

Abstract

STUDY OBJECTIVES

Treatment-emergent central sleep apnea (TECSA) describes the appearance or persistence of central sleep apnea while undergoing treatment for obstructive sleep apnea. TECSA is well studied in continuous positive airway pressure therapy with an estimated prevalence of 8%. Based on a few case reports, mandibular advancement devices (MAD) may also provoke TECSA. This study aims to gain insight into the prevalence of TECSA with MAD therapy.

METHODS

This retrospective study includes a total of 129 patients with moderate to severe obstructive sleep apnea who were treated with a custom-made titratable MAD. Baseline and follow-up sleep studies were compared to identify patients with TECSA. Since different diagnostic criteria to define TECSA are used in literature, prevalence was calculated according to three definitions (TECSA-1, -2, and -3). Demographics, MAD treatment variables, and findings of the diagnostic polysomnography were compared between TECSA and non-TECSA patients to identify possible predictors.

RESULTS

Depending on the definition used, TECSA was found in 3.1%-7.8% of patients undergoing MAD therapy. TECSA patients had a higher apnea index (9.2 vs 2.0 events/h, = .042), central apnea-hypopnea index (4.1 vs 0.2 events/h, = .045) and oxygen desaturation index (23.9 vs 16.3 events/h, = .018) at baseline compared to non-TECSA patients. No differences were found in demographics and treatment variables.

CONCLUSIONS

These findings demonstrate that TECSA also occurs in patients starting MAD treatment. Patients with TECSA had a higher apnea index, central apnea-hypopnea index, and oxygen desaturation index at baseline compared to non-TECSA patients.

CITATION

Hellemans S, Van de Perck E, Braem MJ, Verbraecken J, Dieltjens M, Vanderveken OM. The prevalence of treatment-emergent central sleep apnea with mandibular advancement device therapy. . 2023;19(12):2035-2041.

摘要

研究目的

治疗中出现的中枢性睡眠呼吸暂停（TECSA）是指在阻塞性睡眠呼吸暂停治疗过程中出现或持续存在中枢性睡眠呼吸暂停。在持续气道正压通气治疗中，TECSA 已得到充分研究，其患病率估计为 8%。基于少数病例报告，下颌前伸装置（MAD）也可能引发 TECSA。本研究旨在深入了解 MAD 治疗中 TECSA 的患病率。

方法

这项回顾性研究共纳入 129 例中重度阻塞性睡眠呼吸暂停患者，均接受定制可滴定 MAD 治疗。比较基线和随访睡眠研究以识别 TECSA 患者。由于文献中使用了不同的诊断 TECSA 的标准，因此根据三种定义（TECSA-1、-2 和-3）计算患病率。比较 TECSA 和非 TECSA 患者的人口统计学、MAD 治疗变量和诊断多导睡眠图结果，以确定可能的预测因素。

结果

根据使用的定义，MAD 治疗中 TECSA 的患病率为 3.1%-7.8%。与非 TECSA 患者相比，TECSA 患者的呼吸暂停指数（9.2 比 2.0 次/小时，P =.042）、中枢性呼吸暂停低通气指数（4.1 比 0.2 次/小时，P =.045）和氧减饱和度指数（23.9 比 16.3 次/小时，P =.018）更高。在人口统计学和治疗变量方面没有差异。