Efficacy of Oral Appliance Therapy as a First-Line Treatment for Moderate or Severe Obstructive Sleep Apnea: A Korean Prospective Multicenter Observational Study
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Purpose Responses to oral appliances (OAs) in obstructive sleep apnea (OSA) vary, and have not been fully evaluated in Korean patients. In this study we aimed to determine the efficacy of OAs for the first-line treatment of Korean patients with moderate or severe OSA. Methods This multicenter prospective observational study included 45 patients with moderate or severe OSA that had been newly diagnosed between March 2017 and May 2018 and who underwent OA treatment for 1 month. Questionnaires were completed and polysomnography (PSG) was performed before and after OA treatment. The primary outcome measures were improvement in the absolute apnea-hypopnea index (AHI) and the percentage reduction in the AHI. The secondary outcomes were improvements in the questionnaire scores related to sleep-associated symptoms and PSG parameters. Results The patients were aged 47.4±12.1 years (mean±SD), only two of them were female, and their AHI at baseline was 29.7±10.9/h. After OA treatment the AHI had reduced by 63.9± 25.8%, with the reduction was similar between the patients with moderate OSA and those with severe OSA. Overall 31.1% of the patients achieved a normal AHI (<5/h), and 64.4% had an AHI of ≤10/h after the treatment. The body mass index (BMI) was the most reliable factor for predicting the percentage reduction in the AHI. The OAs also improved the sleep architecture and subjective sleep-related symptoms. Conclusions The OAs were effective in patients with moderate or severe OSA. The OAs reduced the mean AHI to 63.9% of the baseline value, and this reduction was influenced by the BMI.
Abstract
Background and Purpose Responses to oral appliances (OAs) in obstructive sleep apnea (OSA) vary, and have not been fully evaluated in Korean patients. In this study we aimed to determine the efficacy of OAs for the first-line treatment of Korean patients with moderate or severe OSA. Methods This multicenter prospective observational study included 45 patients with moderate or severe OSA that had been newly diagnosed between March 2017 and May 2018 and who underwent OA treatment for 1 month. Questionnaires were completed and polysomnography (PSG) was performed before and after OA treatment. The primary outcome measures were improvement in the absolute apnea-hypopnea index (AHI) and the percentage reduction in the AHI. The secondary outcomes were improvements in the questionnaire scores related to sleep-associated symptoms and PSG parameters. Results The patients were aged 47.4±12.1 years (mean±SD), only two of them were female, and their AHI at baseline was 29.7±10.9/h. After OA treatment the AHI had reduced by 63.9± 25.8%, with the reduction was similar between the patients with moderate OSA and those with severe OSA. Overall 31.1% of the patients achieved a normal AHI (<5/h), and 64.4% had an AHI of ≤10/h after the treatment. The body mass index (BMI) was the most reliable factor for predicting the percentage reduction in the AHI. The OAs also improved the sleep architecture and subjective sleep-related symptoms. Conclusions The OAs were effective in patients with moderate or severe OSA. The OAs reduced the mean AHI to 63.9% of the baseline value, and this reduction was influenced by the BMI.
참고문헌 (30)
- Flemons WW, "Clinical practice. Obstructive sleep apnea", N Engl J Med, 347, pp.498~504 (2002)
- Sutherland K, "Oral appliance treatment for obstructive sleep apnea : an update", J Clin Sleep Med, 10, pp.215~227 (2014)
- Ramar K, "Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy : an update for 2015", J Clin Sleep Med, 11, pp.773~827 (2015)
- Sutherland K, "Oral appliance treatment response and polysomnographic phenotypes of obstructive sleep apnea", J Clin Sleep Med, 11, pp.861~868 (2015)
- Doff MHJ, "Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome : a 2-year follow-up", Sleep, 36, pp.1289~1296 (2013)
- Li KK, "Obstructive sleep apnea syndrome : a comparison between Far-East Asian and white men", Laryngoscope, 110, pp.1689~1693 (2000)
- Lee RWW, "Differences in respiratory arousal threshold in Caucasian and Chinese patients with obstructive sleep apnoea", Respirology, 22, pp.1015~1021 (2017)
- Park P, "Therapeutic outcomes of mandibular advancement devices as an initial treatment modality for obstructive sleep apnea", Medicine(Baltimore), 95, pp.e5265~ (2016)
- Lee CH, "The mandibular advancement device and patient selection in the treatment of obstructive sleep apnea", Arch Otolaryngol Head Neck Surg, 135, pp.439~444 (2009)
- Banhiran W, "Adjustable thermoplastic mandibular advancement device for obstructive sleep apnea : outcomes and practicability", Laryngoscope, 124, pp.2427~2432 (2014)
- Okuno K, "Prediction of oral appliance treatment outcomes in obstructive sleep apnea : a systematic review", Sleep Med Rev, 30, pp.25~33 (2016)
- Ng JH, "Oral appliances in the management of obstructive sleep apnea", Sleep Med Clin, 14, pp.109~118 (2019)
- Shin W, "Tailored treatment strategies for obstructive sleep apnea", Respir Investig, 54, pp.2~7 (2016)
- Edwards BA, "Upper-airway collapsibility and loop gain predict the response to oral appliance therapy in patients with obstructive sleep apnea", Am J Respir Crit Care Med, 194, pp.1413~1422 (2016)
- Berry RB, "The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, version 2.2" (2015), American Academy of Sleep Medicine
- Park P, "Therapeutic outcomes of mandibular advancement devices as an initial treatment modality for obstructive sleep apnea", Medicine(Baltimore), 95, pp.e5265~ (2016)
- Fukuda T, "Selection of response criteria affects the success rate of oral appliance treatment for obstructive sleep apnea", Sleep Med, 15, pp.367~370 (2014)
- Lam B, "The efficacy of oral appliances in the treatment of severe obstructive sleep apnea", Sleep Breath, 15, pp.195~201 (2011)
- Ng ATM, "Cephalometry and prediction of oral appliance treatment outcome", Sleep Breath, 16, pp.47~58 (2012)
- Dieltjens M, "Determinants of objective compliance during oral appliance therapy in patients with sleep-disordered breathing: a prospective clinical trial", JAMA Otolaryngol Head Neck Surg, 141, pp.894~900 (2015)
- Ingman T, "Predicting compliance for mandible advancement splint therapy in 96 obstructive sleep apnea patients", Eur J Orthod, 35, pp.752~757 (2013)
- Ahrens A, "Subjective efficacy of oral appliance design features in the management of obstructive sleep apnea : a systematic review", Am J Orthod Dentofacial Orthop, 138, pp.559~576 (2010)
- Zhao M, "Computational fluid dynamics for the assessment of upper airway response to oral appliance treatment in obstructive sleep apnea", J Biomech, 46, pp.142~150 (2013)
- Chung JW, "Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients", Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 109, pp.724~731 (2010)
- Farré R, "Static and dynamic upper airway obstruction in sleep apnea : role of the breathing gas properties", Am J Respir Crit Care Med, 168, pp.659~663 (2003)
- Zeng B, "Influence of nasal resistance on oral appliance treatment outcome in obstructive sleep apnea", Sleep, 31, pp.543~547 (2008)
- Hoekema A, "Predictors of obstructive sleep apnea-hypopnea treatment outcome", J Dent Res, 86, pp.1181~1186 (2007)
- Sands SA, "Enhanced upper-airway muscle responsiveness is a distinct feature of overweight", obese individuals without sleep apnea, 2014, pp.190, 930~937
- Edwards BA, "Clinical predictors of the respiratory arousal threshold in patients with obstructive sleep apnea", Am J Respir Crit Care Med, 190, pp.1293~1300 (2014)
- Tham KW, "Weight management in obstructive sleep apnea : medical and surgical options", Sleep Med Clin, 14, pp.143~153 (2019)