Marklund M, Persson M, Franklin K A
Department of Orthodontics, Umeå University, Sweden.
Chest. 1998 Dec;114(6):1630-5. doi: 10.1378/chest.114.6.1630.
To evaluate the effect of a mandibular advancement device in patients with supine-dependent sleep apnea and patients with non-supine-dependent sleep apnea.
Prospective study.
Department of Respiratory Medicine, University Hospital, Umeå, Sweden.
Twenty-six patients with obstructive sleep apnea.
Individually fabricated and adjusted mandibular advancement devices.
Overnight polysomnographic sleep recordings with and without the device. Supine-dependent sleep apnea was defined when the supine apnea-hypopnea index was > or = 10, together with a lateral apnea-hypopnea index of < 10. Non-supine-dependent sleep apnea was considered when the lateral apnea-hypopnea index was > or = 10.
In 12 patients with supine-dependent sleep apnea, the device reduced the supine apnea-hypopnea index from a median of 41 (range, 16 to 70) to 5.9 (range, 0.0 to 15) (p < 0.01). In 14 patients with non-supine-dependent sleep apnea, the treatment reduced the supine apnea-hypopnea index from 44 (range, 1.8 to 73) to 21 (range, 6.3 to 60) (p < 0.05) and the lateral apnea-hypopnea index from 21 (range, 12 to 70) to 4.5 (range, 0.0 to 31) (p < 0.01). The odds ratio for a successful apnea reduction to an apnea-hypopnea index of < 10 in both the supine and the lateral positions was 30 for supine-dependent sleep apnea adjusted for age, obesity, mandibular advancement, and mandibular opening (p < 0.01).
Successful apnea reduction with a mandibular advancement device is highly related to supine-dependent sleep apnea.
评估下颌前移装置对仰卧位依赖型睡眠呼吸暂停患者和非仰卧位依赖型睡眠呼吸暂停患者的疗效。
前瞻性研究。
瑞典于默奥大学医院呼吸内科。
26例阻塞性睡眠呼吸暂停患者。
个体化制作并调整下颌前移装置。
使用和不使用该装置时的夜间多导睡眠图睡眠记录。仰卧位依赖型睡眠呼吸暂停定义为仰卧位呼吸暂停低通气指数≥10，同时侧卧位呼吸暂停低通气指数<10。当侧卧位呼吸暂停低通气指数≥10时，则考虑为非仰卧位依赖型睡眠呼吸暂停。
在12例仰卧位依赖型睡眠呼吸暂停患者中，该装置使仰卧位呼吸暂停低通气指数从中位数41（范围16至70）降至5.9（范围0.0至15）（p<0.01）。在14例非仰卧位依赖型睡眠呼吸暂停患者中，治疗使仰卧位呼吸暂停低通气指数从44（范围1.8至73）降至21（范围6.3至60）（p<0.05），侧卧位呼吸暂停低通气指数从21（范围12至70）降至4.5（范围0.0至31）（p<0.01）。在调整年龄、肥胖、下颌前移和下颌开口因素后，仰卧位依赖型睡眠呼吸暂停患者在仰卧位和侧卧位时成功将呼吸暂停降低至呼吸暂停低通气指数<10的比值比为30（p<0.01）。
使用下颌前移装置成功减少呼吸暂停与仰卧位依赖型睡眠呼吸暂停密切相关。
