Obstructive sleep apnea therapy
Obstructive sleep apnea therapy
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DOI：
10.1177/154405910808700917
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发表时间：
2008-09-01
影响因子：
7.6
通讯作者：
de Bont, L. G. M.
中科院分区：
文献类型：
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作者：
Hoekema, A.;Stegenga, B.;de Bont, L. G. M.
在临床实践中，口腔矫治器主要用于对持续正压通气(CPAP)治疗无效的阻塞性睡眠呼吸暂停患者。我们假设口腔矫治器在有效治疗阻塞性睡眠呼吸暂停方面不逊于CPAP。我们随机将103名受试者分为口腔矫治器组和CPAP组。8-12周多导睡眠图显示，51名使用口腔矫治器的患者中有39名有效(76.5%)，52名使用CPAP的患者中有43名有效(82.7%)。对于有效性的差异，计算了95%的双侧可信区间。当这一区间的下限超过-25%时，口腔矫治器治疗的非劣势被认为是成立的。可信区间下限为-21.7%，表明口腔矫治器治疗阻塞性睡眠呼吸暂停疗效不逊于CPAP。然而，亚组分析显示，口腔矫治器治疗对患有严重疾病(呼吸暂停低通气指数30)的个体效果较差。由于这些人可能有特别的心血管风险，初级口腔矫治器治疗似乎只支持那些患有非严重呼吸暂停的人。缩写：CI=可信区间，CPAP=持续正压。
In clinical practice, oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure (CPAP) therapy. We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively. We randomly assigned 103 individuals to oral-appliance or CPAP therapy. Polysomnography after 8-12 weeks indicated that treatment was effective for 39 of 51 persons using the oral appliance (76.5%) and for 43 of 52 persons using CPAP (82.7%). For the difference in effectiveness, a 95% two-sided confidence interval was calculated. Non-inferiority of oral-appliance therapy was considered to be established when the lower boundary of this interval exceeded -25%. The lower boundary of the confidence interval was -21.7%, indicating that oral-appliance therapy was not inferior to CPAP for effective treatment of obstructive sleep apnea. However, subgroup analysis revealed that oral-appliance therapy was less effective in individuals with severe disease (apnea-hypopnea index > 30). Since these people could be at particular cardiovascular risk, primary oral-appliance therapy appears to be supported only for those with non-severe apnea. Abbreviations: CI = confidence interval, CPAP = continuous positive airway pressure.