폐쇄성수면무호흡증의 표현형에 따른 구강내장치치료의 장기 유효성
Differences in Long-term Efficacy of Oral Appliance Therapy for Obstructive Sleep Apnea According to Polysomnographic Phenotypes
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Purpose: The purpose of this study is to evaluate the efficacy of oral appliance therapy for the treatment of obstructive sleep apnea (OSA) according to distinct polysomnographic phenotypes. Material and Methods: Forty four patients with OSA were evaluated before and after oral appliance therapy through polysomnography along with clinical and radiological examination. Treatment efficacy and change in respiratory parameters were evaluated according to polysomnographic phenotypes based on OSA severity, sleep position dependency and REM sleep relatedness. Results: Mean age of the patients was 49.8±11.3 years. The apnea-hypopnea index (AHI) value at baseline was 29.0±21.8/h. After a mean treatment duration of 56.6±42.0 months using an oral appliance, the overall AHI had reduced by 44.3±35.4%. Treatment efficacy of oral appliance for OSA was 47.7% with AHI < 10 and 40.9% for AHI >50% reduction. Results were similar regardless of OSA severity. The reduction of AHI and increase of oxygen saturation level was significantly greater in patients with positional OSA than in those with nonpositional OSA. Not-REM-related OSA patients showed significantly greater reduction of AHI and increase in oxygen saturation compared to those with REM-related OSA. Conclusion: Oral appliance therapy was effective in approximately half of the patients with OSA during a long-term follow-up period. Positional and not-REM-related OSA patients showed higher treatment efficacy and improvement with oral appliance therapy.
Abstract
Purpose: The purpose of this study is to evaluate the efficacy of oral appliance therapy for the treatment of obstructive sleep apnea (OSA) according to distinct polysomnographic phenotypes. Material and Methods: Forty four patients with OSA were evaluated before and after oral appliance therapy through polysomnography along with clinical and radiological examination. Treatment efficacy and change in respiratory parameters were evaluated according to polysomnographic phenotypes based on OSA severity, sleep position dependency and REM sleep relatedness. Results: Mean age of the patients was 49.8±11.3 years. The apnea-hypopnea index (AHI) value at baseline was 29.0±21.8/h. After a mean treatment duration of 56.6±42.0 months using an oral appliance, the overall AHI had reduced by 44.3±35.4%. Treatment efficacy of oral appliance for OSA was 47.7% with AHI < 10 and 40.9% for AHI >50% reduction. Results were similar regardless of OSA severity. The reduction of AHI and increase of oxygen saturation level was significantly greater in patients with positional OSA than in those with nonpositional OSA. Not-REM-related OSA patients showed significantly greater reduction of AHI and increase in oxygen saturation compared to those with REM-related OSA. Conclusion: Oral appliance therapy was effective in approximately half of the patients with OSA during a long-term follow-up period. Positional and not-REM-related OSA patients showed higher treatment efficacy and improvement with oral appliance therapy.
참고문헌 (28)
- Nieto FJ, "Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study", Sleep Heart Health Study, 283, pp.1829~1836 (2000)
- Grunstein, RR, "Sleep-related breathing disorders. 5. Nasal continuous positive airway pressure treatment for obstructive sleep apnoea", Thorax, 50, pp.1106~1113 (1995)
- Chan AS, "Non-positive airway pressure modalities : mandibular advancement devices", positional therapy, 2008, pp.5, 179~184
- Padma A, "Management of obstructive sleep apnea : A dental perspective", Indian J Dent Res, 18, pp.201~209 (2007)
- 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)
- 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)
- Cartwright RD, "Effect of sleep position on sleep apnea severity", Sleep, 7, pp.110~114 (1984)
- Oksenberg A, "Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data", Chest, 112, pp.629~639 (1997)
- Koo BB, "Rapid eye movementrelated sleep-disordered breathing : influence of age and gender", Chest, 134, pp.1156~1161 (2008)
- Berry RB, "Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine", J Clin Sleep Med, 8, pp.597~619 (2012)
- Brown DL, "Do apneas and hypopneas best reflect risk for poor outcomes after stroke?", Sleep Med, 63, pp.14~17 (2019)
- Andren A, "Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension : a randomized clinical trial", Sleep Breath, 17, pp.705~712 (2013)
- Gotsopoulos H, "Oral appliance therapy improves symptoms in obstructive sleep apnea:a randomized, controlled trial", Am J Respir Crit Care Med, 166, pp.743~748 (2002)
- Mehta A, "A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea", Am J Respir Crit Care Med, 163, pp.1457~1461 (2001)
- Lam B, "The efficacy of oral appliances in the treatment of severe obstructive sleep apnea", Sleep Breath, 15, pp.195~201 (2011)
- Haviv Y, "A 2-year mean follow-up of oral appliance therapy for severe obstructive sleep apnea : a cohort study", Oral Dis, 21, pp.386~392 (2015)
- Sutherland K, "Oral appliance treatment response and polysomnographic phenotypes of obstructive sleep apnea", J Clin Sleep Med, 11, pp.861~868 (2015)
- 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)
- Marklund M, "Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring : tolerability and predictors of treatment success", Chest, 125, pp.1270~1278 (2004)
- Oksenberg A, "Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data", Chest, 112, pp.629~639 (1997)
- Jung-Hwan Jo, "Comparison of polysomnographic and cephalometric parameters based on positional and rapid eye movement sleep dependency in obstructive sleep apnea", Scientific Reports, 12(1) (2022), Springer Science and Business Media LLC[DOI]
- Chan AS, "The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea", Thorax, 65, pp.726~732 (2010)
- Nishio Y, "Treatment outcome of oral appliance in patients with REM-related obstructive sleep apnea", Sleep Breath, 24, pp.1339~1347 (2020)
- Oksenberg A, "REMrelated obstructive sleep apnea : the effect of body position", J Clin Sleep Med, 6, pp.343~348 (2010)
- Yamauchi M, "Nonrapid eye movement-predominant obstructive sleep apnea : detection and mechanism", J Clin Sleep Med, 11, pp.987~993 (2015)
- de Almeida FR, "Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome", J Clin Sleep Med, 1, pp.143~152 (2005)