Leibovitz Shirley, Levi Shai, Hanut Aiham, Yanko Robert, Sharav Yair, Haviv Yaron
Department of Pediatric Dentistry, Barzilai Medical Center, Ashkelon, Israel.
The Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Sleep Breath. 2025 Jan 20;29(1):84. doi: 10.1007/s11325-025-03249-8.
The repeated airway obstructions in the common disorder Obstructive Sleep Apnea (OSA) cause health risks. Continuous Positive Airway Pressure (CPAP), the standard treatment, faces adherence challenges. Mandibular Advancement Devices (MADs) have been used successfully for mild to moderate OSA, as a good alternative for these patients.
to evaluate the effectiveness of MADs in reducing the Apnea-Hypopnea Index (AHI) and improving symptoms in patients with very severe OSA unable to tolerate CPAP.
This retrospective study included 22 patients with very severe OSA (AHI ≥ 50) treated with MADs. Baseline characteristics, including: age, sex, BMI, and AHI, were recorded, and changes in AHI following treatment were assessed. Adherence was monitored using patient-reported data. Unlike previous studies, this research focuses exclusively on the efficacy of MADs in treating patients with very severe OSA, a population often excluded from similar inspections.
median AHI significantly decreased from 60.0 (IQR: 57.0-65.0) to 15.0 (IQR: 10.0-24.0) after treatment (P < 0.001), with a mean reduction of 72.5% (± 14.3). Notably, 95.5% of patients achieved at least a 50% reduction in AHI. Symptom improvements, including reduced snoring and daytime tiredness, were reported by 72.7% of patients. BMI positively correlated with baseline AHI, and significant AHI reductions were observed across overweight and obese categories, although some patients remained in the severe AHI range post-treatment. Adherence varied, with 63.6% continuing to use the device.
MADs are effective in managing very severe OSA, providing significant reductions in AHI and symptom improvements. MADs may be a viable alternative for patients unable to tolerate CPAP. Further investigations into the long-term efficacy and impact on quality of life are needed.
常见的阻塞性睡眠呼吸暂停（OSA）疾病中反复出现的气道阻塞会带来健康风险。持续气道正压通气（CPAP）作为标准治疗方法，面临着患者依从性的挑战。下颌前移装置（MADs）已成功用于治疗轻度至中度OSA，是这些患者的良好替代方案。
评估MADs对无法耐受CPAP的极重度OSA患者降低呼吸暂停低通气指数（AHI）及改善症状的有效性。
这项回顾性研究纳入了22例接受MADs治疗的极重度OSA患者（AHI≥50）。记录了包括年龄、性别、体重指数（BMI）和AHI在内的基线特征，并评估了治疗后AHI的变化。使用患者报告的数据监测依从性。与以往研究不同的是，本研究专门关注MADs治疗极重度OSA患者的疗效，这类患者在类似研究中常被排除在外。
治疗后AHI中位数从60.0（四分位间距：57.0 - 65.0）显著降至15.0（四分位间距：10.0 - 24.0）（P < 0.001），平均降低72.5%（±14.3）。值得注意的是，95.5%的患者AHI至少降低了50%。72.7%的患者报告症状有所改善，包括打鼾减轻和白天疲劳感减轻。BMI与基线AHI呈正相关，尽管一些患者治疗后仍处于重度AHI范围，但超重和肥胖类别患者的AHI均有显著降低。依从性各不相同，63.6%的患者继续使用该装置。
MADs对治疗极重度OSA有效，可显著降低AHI并改善症状。对于无法耐受CPAP的患者，MADs可能是一种可行的替代方案。需要进一步研究其长期疗效及对生活质量的影响。
