Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Treatment Outcome of Mandibular Advancement Device in Obstructive Sleep Apnea Patients- Polysomnographic and Cephalometric analyses

수면무호흡증 환자에서 수면다원검사와 두부규격방사선사진을 이용한 하악전방이동장치의 치료효과에 관한 연구

  • Chung, Jin-Woo (Department of Oral Medicine and Oral Diagnosis School of Dentistry, Seoul National University) ;
  • Kim, Ebee (Department of Oral Medicine and Oral Diagnosis School of Dentistry, Seoul National University) ;
  • Kim, Sung-Hun (Department of Oral Medicine and Oral Diagnosis School of Dentistry, Seoul National University)
  • 김성헌 (서울대학교 치의학대학원 구강내과진단학교실) ;
  • 김이비 (서울대학교 치의학대학원 구강내과진단학교실) ;
  • 정진우 (서울대학교 치의학대학원 구강내과진단학교실)
  • Received : 2013.03.18
  • Accepted : 2013.04.15
  • Published : 2013.06.30
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Abstract

Objecives : The purpose of the study was to evaluate treatment outcome of mandibular advancement device(MAD) in obstructive sleep apnea (OSA) patients using full night polysomnography and cephalometry. Methods : Twenty-seven OSA patients were confirmed by full night, lab-attended polysomnography. Cephalometric examinations were conducted to obtain SNA, ANB, $AH{\bot}MP$, AH-C3, SPT, PNS-U, NAS, SOAS, MOAS, and HAS. Mandibular advancement devices (MADs) were fabricated and delivered for all subjects. After acclimation period of MAD, the second polysomnographic examinations were conducted in the same manner. Polysomnographic variables were compared between before and after MAD placement. Also, correlation coefficients were calculated between apnea-hypopnea index (AHI) and each item of cephalometric parameters. Results : There were significant improvements in total AHI, lowest $SpO_2$, and total arousal index after MAD therapy. Also, there were significant improvements in NREM $SpO_2$ and NREM AHI, but not in REM $SpO_2$ and REM AHI with MAD. Stratifying the sleep stage, there were significant decrease in stage I and significant increases in stage II and REM, but change in stage III was not significant. SNA and SOAS were significantly correlated with total AHI and NAS was significantly correlated with supine AHI. ANB was significantly associate with the effect of MAD. Conclusions : MAD is an effective treatment in OSA patients comparing polysomnographic variables before and after treatment. Cephalometric examination can be useful to evaluate OSA patients and predict treatment outcome of MAD.

본 연구의 목적은 폐쇄성수면무호흡증 환자의 표준 수면다원검사와 두부규격방사선사진 분석을 이용하여 하악전방이동 장치의 치료 효과에 영향을 주는 요소들을 분석하는데 있다. 서울대학교치과병원 구강내과에 내원한 27명의 수면무호흡증 환자들을 대상으로 측두두부규격방사선사진 촬영 및 계측점을 이용하여 SNA, ANB, $AH{\bot}MP$, AH-C3, SPT, PNS-U, NAS, SOAS, MOAS, HAS 등을 분석하였으며, 하악전방이동장치를 제작하여 장치 장착 전후 수면다원검사를 시행하였다. 장치 장착 전후 수면무호흡지수, 산소포화도, 각성지수 등을 비교하였고 무호흡-저호흡지수와 두부규격방사선사진 계측치와의 상관관계를 분석하였다. 하악전방이동장치 장착 전후 전체 수면무호흡지수, 최소 산소포화도 및 전체 각성지수에서 통계적으로 유의한 개선이 있었다. 또한 장치 장착 전후 NREM수면에서 산소분압과 무호흡지수에서 통계적으로 유의한 개선이 있었던 반면 REM수면에서는 산소분압과 무호흡지수에서 통계적으로 유의한 개선이 없었다. 장치 장착 전후 수면의 단계에서 stage I의 유의한 감소, stage II와 REM수면의 유의한 증가가 관찰되었으나 stage III의 변화는 유의하지 않았다. 두부규격방사선사진 계측치중 SNA와 SOAS가 전체 수면무호흡지수와 유의한 상관관계가 관찰되었으며 NAS는 앙와위 수면무호흡지수와 유의한 상관관계가 관찰되었다. 하악전방이동장치의 효과는 환자의 ANB 각도가 클수록 유의하게 높게 나타났다. 표준 수면다원검사를 이용하여 하악전방이동장치 장착 전후를 비교해 보았을 때 하악전방이동장치는 수면무호흡증 치료에 효과적인 치료법이며 두부규격방사선사진 분석은 수면무호흡증 환자를 평가하고 치료 결과를 예측하는 데 유용할 수 있다.

Keywords

References

  1. Chae KY. Physiology of sleep. Korean J Pediatr 2007;50:711-7. https://doi.org/10.3345/kjp.2007.50.8.711
  2. Hoffstein V, Viner S, Mateika S, Conway J. Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. Am Rev Rspir Dis 1992;145:841-5. https://doi.org/10.1164/ajrccm/145.4_Pt_1.841
  3. Riolfe I, Olson LG, Saunders NA. Long-term acceptance of continuous positive airway pressure in obstructive sleep apnea. Am Rev Respir Dis 1991; 144:1130-3. https://doi.org/10.1164/ajrccm/144.5.1130
  4. Miljeteig H, Mateika S, Haight JS. Subjective and objective assessment of uvulopalatopharyngoplasty for treatment of snoring and obstructive sleep apnea. Am J Respir Crit Care Med 1994;150:1286-90. https://doi.org/10.1164/ajrccm.150.5.7952554
  5. Wilhelmsson B, Tegelberg A, Walker-Engstrom ML, Ringqvist M, Andersson L, Krekmanov L, Ringqvist IA. A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea. Acta Otolaryngol 1999;119:503-9. https://doi.org/10.1080/00016489950181071
  6. Clark GT, Blumenfeld I, Yoffe N, Peled E, Lavie P. A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibulat positioning devices on patients with obstructive sleep apnea. Chest 1996;109:1477-83. https://doi.org/10.1378/chest.109.6.1477
  7. Ferguson KA, Ono T, Lowe AA, al-Majed S, Love LL, Fleetham JA. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnea. Thorax 1997;52: 362-8. https://doi.org/10.1136/thx.52.4.362
  8. Aber WR, Block AJ, Hellard DW, Webb WB. Consistency of respiratory measurements from night to night during the sleep of elderly men. Chest 1989;96:747-51. https://doi.org/10.1378/chest.96.4.747
  9. Chediak AD, Acevedo-Crespo JC, Seiden DJ, Kim HH, Kiel MH. Night variability in the indices of sleep-disordered breathing in men being evaluated for impotence with consecutive night polysomnograms. Sleep 1996;19:589-92.
  10. Keenan SP, Anderson B, Wiggs B, Ryan CF, Fleetham JA. The predictive accuracy of home oximetry in patients with suspective obstructive sleep apnea. Sleep 1993;16:133-4.
  11. Manser RL, Rochford P, Naughton MT, et al. Measurement variability in sleep disorders medicine: the Victorian experience. Intern Med J 2002;32: 386-93. https://doi.org/10.1046/j.1445-5994.2002.00256.x
  12. Littner M. Polysomnography in the diagnosis of the obstructive sleep apnea-hypopnea syndrome: where do we draw the line? Chest 2000;118:286-8. https://doi.org/10.1378/chest.118.2.286
  13. Meyer TJ, Eveloff SE, Kline LR, Millman RP. One negative polysomnogram does not exclude obstructive sleep apnea. Chest 1993;103:756-60. https://doi.org/10.1378/chest.103.3.756
  14. Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: An update for 2005. Sleep 2005;28:499-519.
  15. Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep 1995;18:501-10.
  16. Clark GT, Arand D, Chung E, Tong D. Effect of anterior mandibular positioning on obstructive sleep apnea. Am Rev Respir Dis 1993;147:624-9. https://doi.org/10.1164/ajrccm/147.3.624
  17. Marklund M, Franklin kA, Sahlin C, Lundgren R. The effect of a mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea. Chest 1998;113:707-13. https://doi.org/10.1378/chest.113.3.707
  18. Mehta A, Qian J, Petocz P, Daredeliler MA, Cistulli PA. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 2001;163:1457-61. https://doi.org/10.1164/ajrccm.163.6.2004213
  19. Tsuiki S, Lowe AA, Almeida FR, Kawahata N, Fleetham JA. Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity. Eur Respir J 2004;23:263-8. https://doi.org/10.1183/09031936.04.00094304
  20. Chung JW, Enciso R, Levendowski DJ, Morgan TD, Westbrook PR, Clark GT. Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:724-31. https://doi.org/10.1016/j.tripleo.2009.11.031
  21. Yoshida K. Influence of sleep posture on response to oral appliance therapy for sleep apnea syndrome. 2001 Aug1;24(5):538-544.
  22. Haba-Rubio J, Janssens JP, Rochat T, Sforza E. Rapid eye movement-related disordered breathingclinical and polysomnographic features. Chest 2005;128:3350-7. https://doi.org/10.1378/chest.128.5.3350
  23. Umemoto G, Yoshimura C, Aoyagi N, Toyoshima H, Matsumoto T, Watanabe K, Maki H, Kikuta T. Treatment outcome of the two-part semi-rigid oral appliance in obstructive sleep apnea. Oral Science Int 2012;9:49-54. https://doi.org/10.1016/S1348-8643(12)00028-6
  24. Choi JK, Choi JM, Ahn HJ. Cephalometric characteristics and their relationship to Respiratory Disturbance Indices in snorer and patients with Obstructive Sleep Apnea. Korean J Oral Med 2001; 26: 369-76.
  25. Chang ET, Shiao GM. Craniofacial abnormalities in Chinese patients with obstructive and positional sleep apnea. Sleep Med 2008;9:403-10. https://doi.org/10.1016/j.sleep.2007.04.024
  26. Liu Y, Lowe AA, Fleetham JA, Park Y-C. Cephalometric and physiologic predictors of the efficacy of an adjustable oral appliance for treating obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2001;120:639-47. https://doi.org/10.1067/mod.2001.118782
  27. Sforza E, Bacon W, Weiss T, et al. Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. Am J Respir Crit Care Med 2000; 161: 347-52. https://doi.org/10.1164/ajrccm.161.2.9810091