Drug-induced sleep endoscopy as a selection tool for mandibular advancement therapy by oral device in patients with mild to moderate obstructive sleep apnoea.
Drug-induced sleep endoscopy as a selection tool for mandibular advancement therapy by oral device in patients with mild to moderate obstructive sleep apnoea.
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DOI：
10.14639/0392-100x-959
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发表时间：
2015-12
期刊：
影响因子：
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通讯作者：
Scarano E
中科院分区：
文献类型：
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作者：
De Corso E;Bastanza G;Della Marca G;Grippaudo C;Rizzotto G;Marchese MR;Fiorita A;Sergi B;Meucci D;Di Nardo W;Paludetti G;Scarano E
如今，口腔矫治器治疗被认为是许多原发性打鼾和轻度至中度阻塞性睡眠呼吸暂停（OSA）患者以及无法耐受气道正压通气（PAP）治疗的更严重阻塞性睡眠呼吸暂停（OSA）患者的有效治疗方法。出于这个原因，重要的是要关注客观标准，以表明哪些受试者可能受益于下颌前移装置（MAD）的治疗。在文献中已经描述了各种人体测量和多导睡眠图预测因子，然而关于药物诱导睡眠内窥镜检查（DISE）和推进双手操作作为口服器械治疗结果的预测因子的作用仍存在争议。本文报告应用DISE口腔矫治器治疗轻中度阻塞性睡眠呼吸暂停综合征的经验。我们对一组连续的轻度中度阻塞性睡眠呼吸暂停综合征患者进行了一项单一机构的纵向前瞻性评价，这些患者接受了DISE。在睡眠内窥镜检查期间，进行下颌前移小于5 mm的温和操作。65例患者中有30例（46.2%）的气道通畅性改善不成功，而65例患者中有35例（53.8%）的气道通畅性改善成功，认为患者适合使用口腔器械。由于35例患者中有7例因干扰口腔矫治器治疗而被排除，我们最终治疗了28例患者。治疗3个月后，我们观察到埃普沃思中位指数显著改善。（7.35 ± 2.8对比4.1 ± 2.2（p < 0.05））]，平均AHI [（21.4 ± 6）次/h vs（8.85 ± 6.9）次/h（p < 0.05）]和平均ODI [（18.6 ± 8）次/h vs（7 ± 5.8）次/h（p < 0.05）]。我们观察到，71.4%的患者在DISE后选择MAD治疗，呼吸暂停/呼吸不足指数（AHI）较基线改善高达50%。在本研究中，下颌前移夹板治疗不仅根据受试者的初始AHI确定的疾病严重程度，而且还根据DISE结果结合温和下颌前移操作的结果成功处方，从而直接观察下颌前移对阻塞部位呼吸空间的影响，并显示出良好的口腔器械治疗患者选择优化。
Nowadays oral appliance therapy is recognised as an effective therapy for many patients with primary snoring and mild to moderate obstructive sleep apnoea (OSA), as well as those with more severe OSA who cannot tolerate positive airway pressure (PAP) therapies. For this reason, it is important to focus on objective criteria to indicate which subjects may benefit from treatment with a mandibular advancement device (MAD). Various anthropometric and polysomnographic predictors have been described in the literature, whereas there are still controversies about the role of drug-induced sleep endoscopy (DISE) and advancement bimanual manoeuvre as predictor factors of treatment outcome by oral device. Herein, we report our experience in treatment of mild moderate OSA by oral appliance selected by DISE. We performed a single institution, longitudinal prospective evaluation of a consecutive group of mild moderate patients with obstructive sleep apnoea syndrome who underwent DISE. During sleep endoscopy, gentle manoeuvre of mandibular advancement less than 5 mm was performed. In 30 of 65 patients (46.2%) we obtained an unsuccessful improvement of airway patency whereas in 35 of 65 patients (53.8%) the improvement was successful and patients were considered suitable for oral device application. Because 7 of 35 patients were excluded due to conditions interfering with oral appliance therapy, we finally treated 28 patients. After 3 months of treatment, we observed a significant improvement in the Epworth medium index [(7.35 ± 2.8 versus 4.1 ± 2.2 (p < 0.05)], in mean AHI [(21.4 ± 6 events per hour versus 8.85 ± 6.9 (p < 0.05)] and in mean ODI [(18.6 ± 8 events per hour to 7 ± 5.8 (p < 0.05)]. We observed that the apnoea/hypopnoea index (AHI) improved by up to 50% from baseline in 71.4% of patients selected after DISE for MAD therapy. In the current study, mandibular advancement splint therapy was successfully prescribed on the basis not only of severity of disease, as determined by the subject's initial AHI, but also by DISE findings combined with results of gentle mandibular advancement manoeuvre allowing direct view of the effects of mandibular protrusion on breathing spaces in obstruction sites, and showing good optimisation of selection of patients for oral device treatment.