Venza Nicolò, Malara Arianna, Liguori Claudio, Cozza Paola, Laganà Giuseppina
Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.
Sleep Medicine Centre, Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy.
J Clin Med. 2023 Aug 15;12(16):5315. doi: 10.3390/jcm12165315.
This study aimed to analyse the effectiveness of four different designs of the Mandibular Advancement Device (MAD) and the morphological changes on upper airway characteristics of Obstructive Sleep Apnea (OSA) patients inducted by each of them, detected by Cone Beam Computer Tomography (CBCT) 3D imaging. Twenty-two patients were recruited after an OSA diagnosis with PSG. Four different customised and titratable MADs were used and an initial CBCT scan was obtained for each patient. Six months after the end of the MAD titration phase, all the subjects performed a second PSG with the MAD in situ; the second PSG showed an Apnoea-Hypopnoea Index (AHI) of <5 or a decrease of 50% in AHI when compared with the initial AHI. Moreover, a second CBCT scan with the MAD in situ was performed. DICOM files were imported into the airway analysis software programme and the pharyngeal area around the oropharynx was highlighted. The area and volume of the oropharynx with and without the device was evaluated. A considerable improvement of the airway was observed (+33.76%), and a significant difference in the enlargement ratio between the posterior soft palate (+32.41%) and the posterior tongue (+36.96%) region was also found. The greatest increase in airway volume was achieved in patients treated with the MAD Forward and TAP (+42.77% and +41.63%, respectively). MAD therapy is effective to treat moderate to severe OSA with an increased upper airway volume. The design of the MAD can influence the effectiveness of the treatment.
本研究旨在分析四种不同设计的下颌前移装置（MAD）的有效性，以及通过锥形束计算机断层扫描（CBCT）3D成像检测到的每种装置对阻塞性睡眠呼吸暂停（OSA）患者上气道特征的形态学变化。22名经多导睡眠图（PSG）诊断为OSA的患者被招募。使用了四种不同的定制可滴定MAD，并为每位患者进行了初始CBCT扫描。在MAD滴定阶段结束6个月后，所有受试者佩戴MAD原位进行第二次PSG检查；第二次PSG显示呼吸暂停低通气指数（AHI）<5，或与初始AHI相比降低了50%。此外，还进行了一次MAD原位的第二次CBCT扫描。将DICOM文件导入气道分析软件程序，并突出显示口咽周围的咽部区域。评估了佩戴和不佩戴该装置时口咽的面积和体积。观察到气道有显著改善（+33.76%），并且还发现软腭后部（+32.41%）和舌根后部（+36.96%）区域的扩大率存在显著差异。使用MAD Forward和TAP治疗的患者气道体积增加最大（分别为+42.77%和+41.63%）。MAD疗法可有效治疗中度至重度OSA，并增加上气道体积。MAD的设计会影响治疗效果。
