两种阻鼾器治疗轻中度阻塞型睡眠呼吸暂停低通气综合征的比较研究

目的比较单纯下颌前伸阻鼾器和下颌前伸并左偏阻鼾器对轻中度阻塞型睡眠呼吸暂停低通气综合征（OSAHS）患者的疗效。方法41例轻中度OSAHS患者中，22例使用单纯下颌前伸阻鼾器（单纯前伸组），19例使用下颌前伸并左偏阻鼾器（左偏前伸组），1—3个月后复查Epworth嗜睡（ESS）评分和多导睡眠图，比较ESS评分和多导睡眠图各参数变化，并比较不良反应发生情况。结果两组患者使用阻鼾器后ESS评分和呼吸紊乱指数、最长呼吸暂停时间、平均呼吸暂停时间、氧减指数、最长氧减时间明显下降，最低血氧饱和度、平均血氧饱和度明显升高。在佩戴阻鼾器后，单纯前伸组与左偏前伸组比较，仅最长呼吸暂停时间分别为（35．5±6．9）、（31．3±6．0）s]和最长氧减时间分别为（41．0±18．9）、（29．9±9．3）s]两项指标改善差异有统计学意义。两组治疗后主要不良反应比较差异无统计学意义。结论下颌前伸阻鼾器治疗OSAHS疗效确切，加用下颌左偏可能对改善夜间呼吸暂停和缺氧时间有帮助，但需要进一步研究。

Comparison of two kinds of oral appliance in the treatment of mild or moderate obstructive sleep apnea-hypopnea syndrome

Objective To compare the mandibular advancement appliance（MAA） with mandibular advancement and left-leaning appliance （MALA） in the treatment of mild or moderate obstructive sleep apnea-hypopnea syndrome （OSAHS）. Methods Twenty-two cases of mild or moderate OSAHS were treated with MAA, and 19 cases with MALA. After 1-3 months, they were examined again with Epworth score and polysomnography （PSG）： Results After 1-3 months of the MAA or MALA treatment, the Epworth score was improved evidently. The apnea -hypopnea index, max apnea time, mean apnea time, oxygen desaturation index, and the longest time of oxygen desaturation were all lowered after the treatment, and the lowest SaO2 and the mean SaO2 were higher after the treatment. The differences were all distinctive （P〈 0.05 or 〈 0.01 ）. When patients treated with MAA were compared with those treated with MALA,only the max apnea time （35.5 ± 6.9）,（31.3 ± 6.0） s, respectively] and the longest time of oxygen desaturation （41.0 ± 18.9）, （29.9±9.3） s, respectively ] had significant difference. Conclusion MALA may be helpful for shortening max apnea time ＇and the longest time of oxygen desaturation, thus MAA is an effective alternative to patients of OSAHS. Further research should be done.