Marklund M, Franklin K A, Sahlin C, Lundgren R
Department of Orthodontics, Umeå University, Sweden.
Chest. 1998 Mar;113(3):707-13. doi: 10.1378/chest.113.3.707.
To evaluate the effects of a mandibular advancement device on apneas and sleep in mild, moderate, and severe obstructive sleep apnea.
Prospective study.
Forty-four of 47 patients included.
Individually adjusted mandibular advancement devices.
Polysomnographic sleep recordings for 1 night without the device and 1 night with it, with a median of 1 day and no changes in weight, medication, or sleep position between the recordings.
The device reduced the median obstructive apnea-hypopnea index from 11 (range, 7 to 19) to 5 (range, 0 to 17) (p<0.001) in 21 patients with mild sleep apnea, from 27 (range, 20 to 38) to 7 (range, 1 to 19) (p<0.001) in 15 patients with moderate sleep apnea, and from 53 (range, 44 to 66) to 14 (range, 2 to 32) (p<0.05) in 8 patients with severe sleep apnea. The arousal index decreased and the sleep stage patterns improved in all severity groups. Twenty-eight of 44 patients were successfully treated with an obstructive apnea-hypopnea index of below 10 and a subjective reduction in snoring. Nine of 16 patients with treatment failure still reported a reduction in snoring. The success rate correlated inversely to the disease severity (r=-0.41; p<0.01).
A mandibular advancement device reduces apneas and improves sleep quality in patients with obstructive sleep apnea, especially in those with mild and moderate disease. A follow-up sleep recording during treatment is necessary because of the risk of silent obstructive apneas without subjective snoring with the device.
评估下颌前移装置对轻、中、重度阻塞性睡眠呼吸暂停患者呼吸暂停及睡眠的影响。
前瞻性研究。
纳入47例患者中的44例。
个体化调整的下颌前移装置。
分别在不使用该装置及使用该装置的情况下进行1晚的多导睡眠图睡眠记录，两次记录间隔时间中位数为1天，且体重、用药情况及睡眠姿势均无变化。
在21例轻度睡眠呼吸暂停患者中，该装置使阻塞性呼吸暂停低通气指数中位数从11（范围7至19）降至5（范围0至17）（p<0.001）；在15例中度睡眠呼吸暂停患者中，从27（范围20至38）降至7（范围1至19）（p<0.001）；在8例重度睡眠呼吸暂停患者中，从53（范围44至66）降至14（范围2至32）（p<0.05）。所有严重程度组的觉醒指数均下降，睡眠阶段模式均得到改善。44例患者中有28例成功治疗，阻塞性呼吸暂停低通气指数低于10，打鼾主观症状减轻。16例治疗失败的患者中有9例仍报告打鼾减轻。成功率与疾病严重程度呈负相关（r=-0.41；p<0.01）。
下颌前移装置可减少阻塞性睡眠呼吸暂停患者的呼吸暂停并改善睡眠质量，尤其是轻、中度患者。由于使用该装置时存在无主观打鼾的隐匿性阻塞性呼吸暂停风险，因此治疗期间需要进行随访睡眠记录。
