2种下颌前移器治疗重度睡眠呼吸暂停低通气综合征患者的疗效评价

上海口腔医学 ›› 2014, Vol. 23 ›› Issue (6): 713-717.

2种下颌前移器治疗重度睡眠呼吸暂停低通气综合征患者的疗效评价

王岚¹, 刘业海²

1.合肥市口腔医院口腔正畸科,安徽合肥 230011; 2.安徽医科大学第一附属医院耳鼻咽喉头颈外科,安徽合肥 230007

收稿日期:2013-12-06 修回日期:2014-03-12 出版日期:2014-12-20 发布日期:2015-01-08
通讯作者: 刘业海,Tel:0551-62922114,E-mail:yehailiu2003@yahoo.com.cn E-mail:wwk147@sina.com
作者简介:王岚（1974-）,女,学士,Tel:0551-62630175
基金资助:
合肥市2010年度第一批科技计划项目（074）

Comparison of the efficacy of 2 types of mandibular advancement device in severe obstructive sleep apnea hypopnea syndrome

WANG Lan, LIU Ye-hai

1.Department of Orthodontics, Stomatological Hospital of Hefei City. Hefei 230011;
2. Department of Otorthinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University. Hefei 230007, Anhui Province, China

Received:2013-12-06 Revised:2014-03-12 Online:2014-12-20 Published:2015-01-08
Supported by:
The First Round of Science and Technology Projects of Hefei City in 2010 (074)

摘要/Abstract

摘要： 目的：探讨拒绝持续正压通气（continuous positive airway pressure, CPAP）或不耐受CPAP治疗的重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome, OSAHS）患者,采用2种下颌前移器分别干预治疗6周的效果。方法：采用随机交叉试验,22例男性重度OSAHS患者,分别辅以2种下颌前移器（mandibular advancement devices, MADs）干预治疗（拉杆式和可控式),试验周期为14周,每种戴用6周,间隔停用2周,分析2种下颌前移器干预前与戴用6周的多导睡眠图监测(polysomnography, PSG）指标间差异,同时进行问卷调查（Epworth嗜睡量表、SCL-90症状自评量表）,并评估下颌前移器的固位性、不良反应及主观症状等参数。采用SPSS19.0软件包对数据进行统计学分析。结果：与干预治疗前呼吸暂停低通气指数AHI（48.16±13.99次/h）相比,拉杆式前移器组AHI（19.16±2.74次/h）、可控式前移器组AHI（18.93±2.57次/h）均较干预前下降>50%。其余指标表明,2种前移器均具有显著疗效（P<0.01）,SCL-90各项因子指标均有不同程度下降。躯体化、人际敏感、焦虑与干预前相比,差异具有统计学意义(P<0.05)。代表依从性的固位情况和咬合舒适性指标,2组之间差异显著（P均<0.05）。结论：2种下颌前移器不仅客观疗效明显,同时有助患者身心健康。在依从性方面,可控式前移器具有明显优势,但长期影响需进一步研究。

关键词: 阻塞性睡眠呼吸暂停低通气综合征, 下颌前移器, 拉杆式矫治器, 可控式矫治器, 身心健康

Abstract: PURPOSE: To evaluate the efficacy of 2 mandibular advancement devices in 6-week treatment of patient with severe obstructive sleep apnea hypopnea syndrome (OSAHS) who refused to CPAP or CPAP therapy. METHODS: A randomized cross-over study was designed and conducted. Twenty-two male patients with severe OSAHS were included for treatment. Rod type and controllable type mandibular advancement devices (MADs) were used respectively in 6 weeks with 2-week interval, while the whole experimental duration was 14 weeks. The differences of the indexes of the polysomnography (PSG) were analyzed, which were gained before the intervention and 6 weeks after use of 2 types of MADs. Questionnaires with Epworth sleep and SCL-90 symptoms self evaluation scales were proceeded. Meanwhile, the parameters such as the stability of the MADs、the adverse reaction and the subjective symptom relief were assessed. The result was statistically analyzed by SPSS19.0 software package. RESULTS: Compared with the apnea hypopnea index (AHI) before the intervention (48.16±13.99 times/hr), both the AHI of the rod type (19.16±2.74 times/hr) and the controllable type (18.93±2.57 times/hr) were reduced by 50%. The remaining parameters showed that both types of MADs had a significant effect on mandibular advancement. There was significant different decrease in each index of the SCL-90(P<0.01), while significant differences were found in somatization, interpersonal sensitivity and anxiety compared with those before intervention(P<0.05). At the same time, there were significant differences in the indexes of stability and results occlusive comfort between the rod type and the controllable MADs (P<0.05). CONCLUSIONS: The objective results and the patients’ physical and mental health are improved obviously by using the 2 types of MADs. Controllable MADs have more advantages in compliance; however, further research should be conducted for long-time outcome.

Key words: Obstructive sleep apnoea/hypopnea syndrome, Mandibular advancement devices, Rod type appliance, Controllable appliance, Physical and mental health

中图分类号:

R782.2

王岚, 刘业海. 2种下颌前移器治疗重度睡眠呼吸暂停低通气综合征患者的疗效评价[J]. 上海口腔医学, 2014, 23(6): 713-717.

WANG Lan¹, LIU Ye-hai². Comparison of the efficacy of 2 types of mandibular advancement device in severe obstructive sleep apnea hypopnea syndrome[J]. Shanghai Journal of Stomatology, 2014, 23(6): 713-717.

参考文献

[1] Olson EJ, Park JG, Morgenthaler TI. Obstructive sleep apnea-hypopnea syndrome [J]. Prim Care, 2005, 32(2): 329-359.
[2] 刘月华, 王飞, 兰庭超, 等. 口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征—计算机辅助下颌前伸定位 [J]. 实用口腔医学杂志, 2007, 23(5): 611-615.
[3] Bonham PE, Currier GF, Orr WC, et al. The effect of modified functional appliance on obstructive sleep apnea [J]. Am J Orthod Dentofacial Orthop, 1988, 94(5): 384-392.
[4] 中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案) [J].中华结核和呼吸杂志, 2002, 25(4): 195-198.
[5] 唐秋萍, 程灶火, 袁爱华, 等. SCL-90在中国的应用与分析 [J]. 中国临床心理学杂志, 1999, 7(1): 16-20.
[6] Inoko Y, Morita O. Relationship between mandibular position and oropharyngeal space in obstructive sleep apnea syndrome patients with dental oral appliance [J]. Prosthodont Res Pract, 2007, 6(3): 194-199.
[7] Barthlen GM, Brown LK, Wiland MR, et al. Comparison of three oral appliances for treatment of severe obstructive sleep apnea syndrome [J]. Sleep, 2000, 1(4): 299-305.
[8] Lam B, Sam K, Lam JC, et al. The efficacy of oral appliances in treatment of severe obstructive sleep apnea [J]. Sleep Breath, 2011, 15(2): 195-201.
[9] Lowe AA, Sjöholm TT, Ryan CF, et al. Treatment, airway and compliance effects of a titratable oral appliance [J]. Sleep, 2000, 23(Suppl 4): S172-178.
[10] Lee CH, Mo JH, Choi IJ, et al. The mandibular advancement device and patient selection in the treatment obstructive sleep apnea[J]. Arch Otolaryngol Head Neck Surg,2009,135(5):439-444.
[11] Engleman HM, Wild MR. Improving CPAP use by patients with the sleep apnea/hypopnea syndrome (SAHS) [J]. Sleep Med Rev, 2003, 7(1): 81-99.
[12] 中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版) [J]. 中华结核和呼吸杂志, 2012, 35(1): 9-12