Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea
Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea
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DOI：
10.1164/rccm.200311-1571oc
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发表时间：
2004-09-15
影响因子：
24.7
通讯作者：
Pierce, RJ
中科院分区：
文献类型：
--
作者：
Barnes, M;McEvoy, RD;Pierce, RJ
目前推荐的治疗方法在轻度至中度阻塞性睡眠呼吸暂停（呼吸暂停低通气指数[AHI]，5-30）患者中的疗效尚不确定。一组114名AHI为5-30的睡眠诊所患者参加了一项随机对照交叉试验，分别使用鼻持续气道正压通气（CPAP）、下颌前移夹板和安慰剂片剂治疗3个月。结果为睡眠碎片和低氧血症、日间嗜睡、生活质量、神经行为功能和血压。两种积极治疗都改善了睡眠结果，但气道正压通气的效果更好。两种治疗组的生活质量、症状和主观而非客观的嗜睡改善程度相似;然而，在神经心理功能和情绪方面观察到的许多改善并不比安慰剂效果好。夜间血压的某些方面与夹板改善，但没有与CPAP。这项研究表明，虽然CPAP和下颌前移夹板有效地治疗睡眠呼吸障碍和嗜睡，预期的神经行为功能的反应是不完整的。这可能是由于夹板的治疗效果较差，CPAP的耐受性较差，因此在该患者组中使用较少。
The efficacy of currently recommended treatments is uncertain in patients with mild to moderate obstructive sleep apnea (apnea-hypopnea index [AHI], 5-30). A group of 114 sleep clinic patients with an AHI of 5-30 have participated in a randomized controlled crossover trial of 3 months of treatment with each of nasal continuous positive airway pressure (CPAP), a mandibular advancement splint, and a placebo tablet. Outcomes were sleep fragmentation and hypoxemia, daytime sleepiness, quality of life, neurobehavioral function, and blood pressure. Both active treatments improved sleep outcomes, but positive airway pressure had a greater effect. The quality of life, symptoms, and subjective but not objective sleepiness improved to a similar degree with both treatments; however, many of the improvements seen in neuropsychologic function and mood were not better than the placebo effect. Some aspects of nocturnal blood pressure were improved with the splint but not with CPAP. This study has shown that although both CPAP and mandibular advancement splint effectively treated sleep-disordered breathing and sleepiness, the expected response in neurobehavioral function was incomplete. This may be due to the splint having a lesser therapeutic effect and CPAP being poorly tolerated and therefore used less in this patient group.