Oropharyngeal Crowding and Obesity as Predictors of Oral Appliance Treatment Response to Moderate Obstructive Sleep Apnea
Oropharyngeal Crowding and Obesity as Predictors of Oral Appliance Treatment Response to Moderate Obstructive Sleep Apnea
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DOI：
10.1378/chest.12-2609
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发表时间：
2013-08-01
期刊：
影响因子：
9.6
通讯作者：
Inoue, Yuichi
中科院分区：
文献类型：
--
作者：
Tsuiki, Satoru;Ito, Eiki;Inoue, Yuichi
背景：越来越多的中度阻塞性睡眠呼吸暂停（OSA）患者使用口腔矫治器代替鼻CPAP。然而，口腔矫治器的功效差异很大。我们假设，口腔用具是无效的中度OSA患者肥胖与口咽crowding.Methods：日本中度OSA患者进行了前瞻性和连续招募。使用Mallampati评分（MS）作为口咽拥挤的估计值。在调整后的口腔矫治器就位的情况下进行随访多导睡眠图。应答者被定义为受试者谁表现出后续的呼吸暂停低通气指数（MIT）的基线MIT.Results减少50%：平均基线AHI减少与口腔矫治器从21 +/- 4至9.8 +/- 8在95名受试者。35例患者被视为应答者。Logistic回归分析显示，MS和BMI可以单独预测治疗结果。当根据受试者工作特征曲线将BMI的临界值确定为24 kg/m2时，53名肥胖患者（即BMI >24 kg/m2），MS为4级，提示治疗失败，阴性预测值高（92），阴性似然比低结论：我们得出的结论是，中度阻塞性睡眠呼吸暂停合并口咽拥挤的肥胖患者不太可能对口腔矫治器治疗有反应。这种简单的预测可以在诊断OSA后立即应用，而不需要任何繁琐的工具。
Background: Oral appliances are increasingly prescribed for patients with moderate obstructive sleep apnea (OSA) instead of nasal CPAP. However, the efficacy of oral appliances varies greatly. We hypothesized that oral appliances were not efficacious in patients with moderate OSA who were obese with oropharyngeal crowding.Methods: Japanese patients with moderate OSA were prospectively and consecutively recruited. The Mallampati score (MS) was used as an estimate of oropharyngeal crowding. Follow-up polysomnography was performed with the adjusted oral appliance in place. Responders were defined as subjects who showed a follow-up apnea-hypopnea index (MIT) of 50% reduction in baseline MIT.Results: The mean baseline AHI was reduced with an oral appliance from 21 +/- 4 to 9.8 +/- 8 in 95 subjects. Thirty-five patients were regarded as responders. Logistic regression analyses revealed that both MS and BMI could individually predict the treatment outcome. When the cutoff value of BMI was determined to be 24 kg/m(2) based on a receiver operating characteristic curve, 53 obese patients (ie, BMI >24 kg/m(2)) with an MS of class 4 were indicative of treatment failure with a high negative predictive value (92) and a low negative likelihood ratio (0.28).Conclusions: We conclude that patients with moderate OSA who are obese with oropharyngeal crowding are unlikely to respond to oral appliance treatment. This simple prediction can be applied without the need for any cumbersome tools immediately after the diagnosis of OSA.