Review of oral appliances for treatment of sleep-disordered breathing.
Review of oral appliances for treatment of sleep-disordered breathing.
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DOI：
10.1007/s11325-006-0084-8
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发表时间：
2007-03
影响因子：
2.5
通讯作者：
Hoffstein, Victor
中科院分区：
文献类型：
--
作者：
Hoffstein, Victor
1982年至2006年间，有89篇不同的出版物涉及口腔矫治器治疗，共涉及3027名患者，报告了使用和不使用矫治器进行睡眠研究的结果。这些研究在方法学和患者群体方面构成了一个非常异质的群体，本文对这些研究进行了回顾并总结了结果。本综述主要关注以下结果：睡眠呼吸暂停（即呼吸暂停/低通气指数或呼吸障碍指数的降低）、口腔器械减少打鼾的能力、口腔器械对日间功能的影响、口腔器械与其他治疗方法（持续气道正压通气和手术）的比较、副作用、牙齿变化（复咬和复喷）以及长期依从性。我们发现，成功率（定义为口腔器械将呼吸暂停/低呼吸指数降低到10以下的能力）为54%。应答率为21%，定义为初始呼吸暂停/低呼吸指数至少降低50%（尽管仍高于10）。当只考虑随机、交叉、安慰剂对照研究的结果时，成功率和有效率分别为50%和14%。打鼾减少了45%。在比较口腔器械与持续气道正压通气（CPAP）或悬垂腭咽成形术（UPPP）的研究中，器械降低了42%的初始AHI， CPAP降低了75%，UPPP降低了30%。与CPAP相比，大多数患者更倾向于使用口腔矫治器。使用口腔辅助器具可在一定程度上改善日间功能；854名患者的Epworth嗜睡评分（ESS）从11.2降至7.8。对随访依从性数据的总结显示，在30个月时，56-68%的患者继续使用口腔矫治器。副作用相对较小，但频繁。最常见的是流涎过多和牙齿不适。疗效和副作用取决于矫治器的类型、突出程度、垂直开口和其他设置。我们的结论是，尽管口腔辅助器具在减少睡眠呼吸暂停、打鼾和改善白天功能方面不如CPAP有效，但在治疗打鼾和睡眠呼吸暂停方面具有明确的作用。
Between 1982 and 2006, there were 89 distinct publications dealing with oral appliance therapy involving a total of 3,027 patients, which reported results of sleep studies performed with and without the appliance. These studies, which constitute a very heterogeneous group in terms of methodology and patient population, are reviewed and the results summarized. This review focused on the following outcomes: sleep apnea (i.e. reduction in the apnea/hypopnea index or respiratory disturbance index), ability of oral appliances to reduce snoring, effect of oral appliances on daytime function, comparison of oral appliances with other treatments (continuous positive airway pressure and surgery), side effects, dental changes (overbite and overjet), and long-term compliance. We found that the success rate, defined as the ability of the oral appliances to reduce apnea/hypopnea index to less than 10, is 54%. The response rate, defined as at least 50% reduction in the initial apnea/hypopnea index (although it still remained above 10), is 21%. When only the results of randomized, crossover, placebo-controlled studies are considered, the success and response rates are 50% and 14%, respectively. Snoring was reduced by 45%. In the studies comparing oral appliances to continuous positive airway pressure (CPAP) or to uvulopalatopharyngoplasty (UPPP), an appliance reduced initial AHI by 42%, CPAP reduced it by 75%, and UPPP by 30%. The majority of patients prefer using oral appliance than CPAP. Use of oral appliances improves daytime function somewhat; the Epworth sleepiness score (ESS) dropped from 11.2 to 7.8 in 854 patients. A summary of the follow-up compliance data shows that at 30 months, 56–68% of patients continue to use oral appliance. Side effects are relatively minor but frequent. The most common ones are excessive salivation and teeth discomfort. Efficacy and side effects depend on the type of appliance, degree of protrusion, vertical opening, and other settings. We conclude that oral appliances, although not as effective as CPAP in reducing sleep apnea, snoring, and improving daytime function, have a definite role in the treatment of snoring and sleep apnea.
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DOI：
10.1164/rccm.2109023
发表时间：
2002-09-15
影响因子：
24.7
作者：
Engleman, HM;McDonald, JP;Douglas, NJ
通讯作者：
Douglas, NJ
DOI：
10.1164/rccm.200311-1571oc
发表时间：
2004-09-15
影响因子：
24.7
作者：
Barnes, M;McEvoy, RD;Pierce, RJ
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Pierce, RJ
DOI：
10.1164/ajrccm.162.1.9908112
发表时间：
2000-07-01
影响因子：
24.7
作者：
Bloch, KE;Iseli, A;Russi, EW
通讯作者：
Russi, EW
影响因子：
1.7
作者：
Battagel, JM;Johal, A;Kotecha, BT
通讯作者：
Kotecha, BT
DOI：
10.14219/jada.archive.2000.0275
发表时间：
2000-06-01
影响因子：
3.9
作者：
Clark, GT;Sohn, JW;Hong, CN
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Hong, CN