Minimizing the mandibular advancement in an oral appliance for the treatment of obstructive sleep apnea
Minimizing the mandibular advancement in an oral appliance for the treatment of obstructive sleep apnea
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DOI：
10.1016/j.sleep.2016.12.019
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发表时间：
2017-06-01
期刊：
影响因子：
4.8
通讯作者：
Hamdan Alkhraisat, Mohammad
中科院分区：
文献类型：
--
作者：
Anitua, Eduardo;Duran-Cantolla, Joaquin;Hamdan Alkhraisat, Mohammad
目的：在口腔矫治器治疗阻塞性睡眠呼吸暂停(OSA)中，微调下颌前移尚无金标准方法。本研究旨在分析下颌前移的渐进性增加对睡眠呼吸暂停低通气指数(AHI)演变的影响。所有的治疗都是从口腔矫治器开始的，而不是下颌前移。两周后，用呼吸多导描记评估AHI。以1 mm的步长开始下颌前移，并评估AHI的演变。靶点突出是AHI减少率最高、副作用最小的一种。获得人体测量学数据、睡眠问卷和Epworth嗜睡量表评分。结果：36例患者(22名男性)参与了本次研究。患者平均年龄57±12岁，体重指数25.4±4.1 kg/m(2)。口腔矫治器治疗后呼吸暂停指数由20.8±12.9/h降至8.4+/-5.1/h(P=0.000)。在26例AHI下降50%的患者中，10例(39%)为零进展。在72%的患者中，下颌骨平均前移1.7+/-1.5 mm，达到AHI减少50%的效果。27名患者发生了AHI
Objective: In the treatment of obstructive sleep apnea (OSA) with an oral appliance (OA), there is no gold standard method to fine-tune the mandibular advancement. This study aimed to analyze the effect of gradual increment of mandibular advancement on the evolution of the apnea hypopnea index (AHI).Methods: OSA patients were recruited from a sleep unit. All treatments started with an oral appliance without mandibular advancement. After two weeks, the AHI was assessed with respiratory polygraphy. Mandibular advancement was initiated with a step size of 1 mm and evolution in the AHI was assessed. The target protrusion was the one that achieved the highest reduction in AHI and the least side effects. Anthropometric data, sleep questionnaire and Epworth sleepiness scale score were obtained.Results: Thirty six patients (22 men) participated in this study. The patient's mean age was 57 +/- 12 years and the body mass index was 25.4 +/- 4.1 kg/m(2). The oral appliance reduced the AHI from 20.8 +/- 12.9/h to 8.4 +/- 5.1/h (P = 0.000). Ten of the 26 patients with >= 50% reduction in AHI (39%) had zero advancement. The mean mandibular advancement was 1.7 +/- 1.5 mm achieving >= 50% reduction in AHI in 72% of the patients. Twenty seven patients had an AHI