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

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。

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

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.