Dental appliance treatment for obstructive sleep apnea
Dental appliance treatment for obstructive sleep apnea
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DOI：
10.1378/chest.06-2038
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发表时间：
2007-08-01
期刊：
影响因子：
9.6
通讯作者：
Cistulli, Peter A.
中科院分区：
文献类型：
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作者：
Chan, Andrew S. L.;Lee, Richard W. W.;Cistulli, Peter A.
治疗阻塞性睡眠呼吸暂停(OSA)的口腔用具在睡眠时佩戴，通过增加上呼吸道的尺寸和减少其塌陷性来保持上呼吸道的通畅。口腔矫治器是持续气道正压(CPAP)的一种更简单的替代方案。在过去的十年里，支持使用口腔矫治器的证据基础有了显著的扩大，有力的研究证明了它们的有效性。这项工作的基础是认识到上呼吸道解剖在阻塞性睡眠呼吸暂停综合征的病理生理学中的重要性。美国睡眠医学学会最新的实践参数现在建议用于轻到中度OSA，或无法耐受CPAP或拒绝使用CPAP治疗的重度OSA患者。口腔矫治器已被证明对一些重要的临床终点有有益的影响，包括阻塞性睡眠呼吸暂停综合征的多导睡眠监测指数、嗜睡的主观和客观测量、血压、神经心理功能的方面和生活质量。口腔矫治器作用机制的阐明为预测治疗反应的因素提供了洞察力，并可能改善患者对这种治疗方式的选择。关于口腔矫治器使用的长期不良影响的纵向研究现在开始出现。虽然口腔矫治器的疗效不如CPAP，但在改善阻塞性睡眠呼吸暂停综合征的多导睡眠指标方面，口腔矫治器普遍受到患者的青睐。这有可能转化为更好的患者依从性，并可能提供同等的健康结果。
Oral appliances for the treatment of obstructive sleep apnea (OSA) are worn during sleep to maintain the patency of the upper airway by increasing its dimensions and reducing its collapsibility. Oral appliances are a simpler alternative to continuous positive airway pressure (CPAP). Over the last decade, there has been a significant expansion of the evidence base to support the use of oral appliances, with robust studies demonstrating their efficacy. This work has been underpinned by the recognition of the importance of upper airway anatomy in the pathophysiology of OSA. The updated practice parameters of the American Academy of Sleep Medicine now recommend their use for mild-to-moderate OSA, or for patients with severe OSA who are unable to tolerate CPAP or refuse treatment with CPAP. Oral appliances have been shown to have a beneficial impact on a number of important clinical end points, including the polysomnographic indexes of OSA, subjective and objective measures of sleepiness, BP, aspects of neuropsychological functioning, and quality of life. Elucidation of the mechanism of action of oral appliances has provided insight into the factors that predict treatment response and may improve the selection of patients for this treatment modality. Longitudinal studies to characterize the long-term adverse effects of oral appliance use are now beginning to emerge. Although less efficacious than CPAP, for improving the polysomnographic indexes of OSA, oral appliances are generally preferred by patients. This has the potential to translate to better patient adherence and may provide an equivalent health outcome.