Mandibular Advancement Titration for Obstructive Sleep Apnea
| Autor: | Bernard Fleury, Bernard De Meyer, Boris Pételle, Bernard Lebeau, Gérard Vincent, Nathalie Pelletier Fleury, Dominique Rakotonanahary |
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| Rok vydání: | 2004 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.diagnostic_test Visual analogue scale business.industry Epworth Sleepiness Scale Oral appliance medicine.medical_treatment Sleep apnea Polysomnography Critical Care and Intensive Care Medicine medicine.disease Obstructive sleep apnea Apnea–hypopnea index Anesthesia medicine Continuous positive airway pressure Cardiology and Cardiovascular Medicine business |
| Zdroj: | Chest. 125:1761-1767 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.125.5.1761 |
| Popis: | Background Oral appliances (OAs) have been used for the treatment of obstructive sleep apnea syndrome (OSAS), with different degrees of effectiveness having been shown in previous studies. But, in the absence of a consensual recommendation, the method of the determination of effective mandibular advancement varies from one study to another. Study objective We prospectively evaluated an OA titration protocol based on a combined analysis of symptomatic benefit and oximetric recording to guide the progressive mandibular advancement. Setting University hospital sleep disorders center. Patients Forty patients with OSAS (mean [±SD] apnea-hypopnea index [AHI], 46 ± 21 events per hour) found on baseline polysomnography, who were intolerant of nasal continuous positive airway pressure, completed all aspects of the study. Methods Two acrylic appliances connected by Herbst attachments were constructed. The mandible was advanced 1 mm every week until there was a resolution of the symptoms and a reduction in the oxygen desaturation index ( ie , the number of desaturations yielding a > 3% fall in pulse oximetric saturation per hour of recording) [ODI] of Results A complete response ( ie , mean AHI, 5 ± 3 events per hour; mean snoring reduction [SR], 91 ± 13%; mean Epworth sleepiness scale [ESS] score, 5 ± 3) was obtained in 63.6% of patients, and a limited response ( ie , mean AHI, 21 ± 11 events per hour; mean SR, 88 ± 15%; mean ESS, 6 ± 3) was obtained in 18.2% of patients. Twenty-five percent of mandibular advancements were motivated by an abnormal ODI ( ie , 21 ± 10 events per hour) despite resolution of the symptoms, while 20% were motivated by persistent symptoms with a normal ODI ( ie , 6 ± 2 events per hour). After a mean duration of 17 ± 4 months, 34 patients declared that they had used the OA 5 ± 2 days a week for 89 ± 19% of their sleep time. Conclusions A combination of the patient's subjective evaluation and oximetric score improves the effectiveness of the OA titration procedure. |
| Databáze: | OpenAIRE |
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