Mandibular advancement splint titration in obstructive sleep apnoea |
| |
Authors: | A J Campbell G Reynolds H Trengrove A M Neill |
| |
Institution: | (1) WellSleep, Department of Medicine, University of Otago, Wellington, P.O. Box 7343 Wellington South, New Zealand;(2) Department of Dentistry, Capital and Coast District Health Board, Private Bag 7902, Wellington South, New Zealand |
| |
Abstract: | Introduction Mandibular advancement splints (MAS) allowing self-adjustment may be better tolerated, but the optimum titration protocol
needs systematic study.
Aim The aims of the study are to assess the effectiveness of a titratable MAS device in consecutive patients with body mass index
(BMI) < 35 kg/m2 and obstructive sleep apnoea OSA, apnoea–hypopnoea index (AHI) 10–40/h] and compare two methods of adjustment self-adjustment
or adjustment after polysomnographic (PSG) feedback].
Materials and methods Twenty-eight patients (24 M, mean age 49 years, mean BMI 27.6 kg/m2) with symptomatic (Epworth Sleepiness score > 8/24, snoring, choking or poor sleep quality) OSA (mean AHI 25.7/h, range 10–46/h)
had a MAS set at 70% maximal protrusion and were randomised to subjective self-adjustment for 6 weeks (n = 16) or objective adjustment (n = 12; fixed position for 3 weeks, then PSG based feedback at 3 weeks with self-adjustment instructions). Primary outcome
variable (AHI) and OSA symptoms were compared by t tests and chi-squared tests at baseline and after 6 weeks. Resolution of apnoea was defined as AHI < 5/h; improvement was
defined as AHI decreased by >50% but still >5/h.
Results The groups had similar baseline demographics, OSA severity and occlusal type. MAS therapy improved or resolved OSA in 20 out
of 28 (71%) and was reportedly used nightly by 91% of the objective group and 63% of the subjective group (p = 0.04). MAS were used all night by 75% of the objective group and 69% of the subjective group (p > 0.05). MAS adjustment following PSG feedback did not lower AHI further from 3 weeks (baseline 26.5 ± 12.0/h, 3 weeks 15.3 ± 13.5/h
p = 0.01, 6 weeks 11.7 ± 10.0/h, p = 0.11). The overall improvement was similar to that achieved with subjective adjustment (baseline AHI 25.4 ± 7.4/h, 6 weeks
14.3 ± 10.7/h, p = 0.0002). Symptomatic benefit was reported by both groups.
Conclusion In selected patients, titratable MAS improved or resolved OSA in the majority of patients and was well tolerated. PSG-based
feedback at 3 weeks allowed objective confirmation of efficacy and increased device use but did not result in greater improvement
in AHI or symptoms. Neither titration method was significantly superior for us to provide firm endorsement. However, we recommend
a follow-up sleep study to confirm MAS efficacy. |
| |
Keywords: | Sleep apnoea Obstructive Mandibular advancement |
本文献已被 SpringerLink 等数据库收录! |
|