两种口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征的疗效比较

目的在下颌前伸程度相同的情况下，比较两种不同设计类（分体式与整体式）口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征（obstructivesleepapnea／hypOpneasyndrome，OSAHS）成年男性患者的主客观疗效。方法采用随机交叉实验设计，16例OSAHS患者先后戴用分体式和整体式两种口腔矫治器，每副矫治器戴用3个月，患者戴用两种矫治器之间需停戴2周。在治疗前及戴用两种矫治器3个月时分别获取患者的主观疗效、多导睡眠监测（polysomnography，PSG）及上气道大小参数。采用单因素方差分析比较两者主客观疗效及上气道形态变化。结果两种口腔矫治器治疗OSAHS的主客观疗效显著（P〈O．05）。在呼吸指标方面，戴用分体式口腔矫治器的有效率为56．3％，整体式口腔矫治器的有效率为68．9％，两者无显著性差异（P〉0．05）。分体式在改善睡眠效率和深睡眠的比例方面不及整体式（P〈O．05）。两种口腔矫治器显著增大上气道各水平的前后径（P〈O．05），两者间无明显差别（P〉0．05）。结论两种口腔矫治器对OSAHS患者的主客观疗效大致相似，但整体式口腔矫治器在改善睡眠效率和主观依从性方面占优势。

Therapeutic Comparison of Two Oral Appliances on Obstructive Sleep Apnea/Hypopnea Syndrome

Objective To compare the objective and subjective effects of two oral appliances in patients with OSAHS.Methods A crossover design trial was carried out in 16 OSAHS patients who wore mono-block and two-piece appliances in turn.Each oral appliance needed to be worn for 3 months.There was a two-week washout period between appliance switch.The objective and subjective effects were assessed at the end of wearing oral appliance.One-way ANOVA was carried out to evaluate the parameters.Results Both oral appliances showed remarkable efficacy in OSAHS patients.But the mono-block appliance had less improvement in Sleep Efficiency(SE) and Percentage of Delta period( Delta％ )(P＜0.05).Both oral appliances could increase obviously the each segment of upper airway(P＜0.05).But there was no significant difference between the two oral appliances(P ＞0.05).Conclusions Both oral appliances had good efficacies in the treatment of OSAHS.Due to the different characteristics of each appliance,there were more alternatives for OSAHS patients.