Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome - Continuous positive airway pressure and mandibular repositioning splint
Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome - Continuous positive airway pressure and mandibular repositioning splint
复制标题
DOI：
10.1164/rccm.2109023
复制
发表时间：
2002-09-15
影响因子：
24.7
通讯作者：
Douglas, NJ
中科院分区：
文献类型：
--
作者：
Engleman, HM;McDonald, JP;Douglas, NJ
下颌复位夹板（MRSs）和持续气道正压通气（CPAP）用于治疗睡眠呼吸暂停/低通气综合征（SAHS）。有一些数据表明，症状较轻的患者更喜欢MRS，但很少有关于结果的比较数据。因此，我们对诊断为SAHS（呼吸暂停/低通气指数[AHI]大于等于5/小时，大于等于嗜睡等2种症状）的连续新门诊患者进行了8周CPAP和8周MRS治疗的随机交叉试验。四肢结束时的评估包括家庭睡眠研究，对治疗价值、困倦、症状和幸福感的主观评分，以及困倦和认知的客观测试。51名入选患者中有48名完成了试验（12名女性，年龄[平均+/- SD]， 46 +/- 9岁，Epworth 14 +/- 4岁，中位AHI为22/小时，四分位数比[IQR]， 11-43/小时）。在21个变量中，MRS和CPAP有7个变量（效应值为0.3-0.6 SDs）存在显著差异（p小于或等于0.01），均有利于CPAP，包括AHI（分别为15 +/- 16和8 +/- 6/小时）、有效性评分、症状、Epworth（分别为12 +/- 5和8 +/- 5）、困睡问卷功能结局、36健康问卷心理成分和健康过渡评分。客观嗜睡、认知表现和对治疗的偏好没有差异。在轻度综合征（AHI < 15, n = 18）的患者中，CPAP治疗的症状、治疗效果、满意度和主观嗜睡也优于MRS治疗（效应值为0.7-1.1 SDs）。这些结果不支持这些MRS设备作为SAHS嗜睡患者的一线治疗方法。
Mandibular repositioning splints (MRSs) and continuous positive airway pressure (CPAP) are used to treat the sleep apnea/hypopnea syndrome (SAHS). There are some data suggesting that patients with milder symptoms prefer MRS, but there are few comparative data on outcomes. Therefore, we performed a randomized crossover trial of 8 weeks of CPAP and 8 weeks of MRS treatment in consecutive new outpatients diagnosed with SAHS (apnea/hypopnea index [AHI] greater than or equal to 5/hour, and greater than or equal to 2 symptoms including sleepiness). Assessments at the end of both limbs comprised home sleep study, subjective ratings of treatment value, sleepiness, symptoms, and well-being, and objective tests of sleepiness and cognition. Forty-eight of 51 recruited patients completed the trial (12 women; age [mean +/- SD], 46 +/- 9 years; Epworth 14 +/- 4; median AHI, 22/ hour; interquartile ratio [IQR], 11-43/hour). Significant (p less than or equal to 0.01) differences between MRS and CPAP were observed for 7 of 21 variables (effect sizes, 0.3-0.6 SDs), all favoring CPAP, including AHI (15 +/- 16 and 8 +/- 6/hour, respectively), effectiveness rating, symptoms, Epworth (12 +/- 5 and 8 +/- 5, respectively), functional outcomes of sleepiness questionnaire, short-form 36 health survey mental component, and health transition scores. Objective sleepiness, cognitive performance, and preference for treatments were not different. In patients experiencing a mild form of the syndrome (AHI < 15, n = 18), symptoms, treatment efficacy and satisfaction, and subjective sleepiness were also better with CPAP than with MRS (effect sizes, 0.7-1.1 SDs). These results do not support these MRS devices as first-line treatment for sleepy patients with SAHS.