Upper-Airway Collapsibility and Loop Gain Predict the Response to Oral Appliance Therapy in Patients with Obstructive Sleep Apnea
Upper-Airway Collapsibility and Loop Gain Predict the Response to Oral Appliance Therapy in Patients with Obstructive Sleep Apnea
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DOI：
10.1164/rccm.201601-0099oc
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发表时间：
2016-12-01
影响因子：
24.7
通讯作者：
Wellman, Andrew
中科院分区：
文献类型：
--
作者：
Edwards, Bradley A.;Andara, Christopher;Wellman, Andrew
基本原理：口腔矫治器（OAs）通常用作阻塞性睡眠呼吸暂停（OSA）患者持续气道正压通气的替代治疗。然而，OA在降低呼吸暂停低通气指数（AHI）方面的成功率各不相同，预测应答者具有挑战性。了解这种变异性可能在于认识到OSA是一种多因素疾病，OA可能不仅仅影响上气道解剖结构/可操作性。目的：本研究的目的是确定OA如何改变AHI和四种表型性状（上呼吸道解剖结构/可操作性和肌肉功能、环路增益和唤醒阈值）以及患者从治疗中获得最大益处的基线预测因子。在一项随机交叉研究中，14名OSA患者参加了两项睡眠研究，有和没有他们的OA。在每个条件下，AHI和表型性状进行了评估。多元线性回归分析用于确定AHI降低的独立预测因素。测量和主要结果：OA治疗降低了AHI（30 +/- 5 vs. 11 +/- 2事件/h; P < 0.05），这是由被动下上气道解剖结构/可扩展性的改善驱动的。（1.9 +/- 0.7对4.7 +/- 0.6 L/min; P < 0.005）和活动条件（2.4 +/- 0.9对6.2 +/- 0.4 L/min; P < 0.001）。在肌肉功能、回路增益或唤醒阈值方面没有观察到变化。多变量分析显示，被动上气道通畅性和袢增益是AHI降低的独立预测因子（r（2）= 0.70; P = 0.001）。结论：OA治疗可改善被动和主动条件下的上气道通畅性。重要的是，在轻度解剖损伤和较低环路增益的患者中，对治疗的反应更大。
Rationale: Oral appliances (OAs) are commonly used as an alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea (OSA). However, OAs have variable success at reducing the apnea-hypopnea index (AHI), and predicting responders is challenging. Understanding this variability may lie with the recognition that OSA is a multifactorial disorder and that OAs may affect more than just upper-airway anatomy/collapsibility.Objectives: The objectives of this study were to determine how OA alters AHI and four phenotypic traits (upper-airway anatomy/collapsibility and muscle function, loop gain, and arousal threshold), and baseline predictors of which patients gain the greatest benefit from therapy.Methods: In a randomized crossover study, 14 patients with OSA attended two sleep studies with and without their OA. Under each condition, AHI and the phenotypic traits were assessed. Multiple linear regression was used to determine independent predictors of the reduction in AHI.Measurements and Main Results: OA therapy reduced the AHI (30 +/- 5 vs. 11 +/- 2 events/h; P < 0.05), which was driven by improvements in upper-airway anatomy/collapsibility under passive (1.9 +/- 0.7 vs. 4.7 +/- 0.6 L/min; P < 0.005) and active conditions (2.4 +/- 0.9 vs. 6.2 +/- 0.4 L/min; P < 0.001). No changes were seen in muscle function, loop gain, or the arousal threshold. Using multivariate analysis, baseline passive upper-airway collapsibility and loop gain were independent predictors of the reduction in AHI (r(2) = 0.70; P = 0.001).Conclusions: Our findings suggest that OA therapy improves the upper-airway collapsibility under passive and active conditions. Importantly, a greater response to therapy occurred in those patients with a mild anatomic compromise and a lower loop gain.