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下顎前置裝置對阻塞型呼吸中止症的療效

下顎前置裝置對阻塞型呼吸中止症的療效.

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下顎前置裝置對阻塞型呼吸中止症的療效

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  1. 下顎前置裝置對阻塞型呼吸中止症的療效 自從1965年Gastaut於睡眠期間觀察到嚴重打鼾者所發生的呼吸中止現象 後，三十餘年來，證實呼吸中止症不但會影響病人的睡眠品質，更可能造 成威脅生命的疾病。目前對於打鼾及呼吸中止症的治療已成為胸腔科、耳 鼻喉科、神經科、精神科、牙科共同努力的目標。本實驗的目的在研究利 用下顎前置裝置做為治療工具，再以主、客觀的檢驗資料來評估打鼾及阻 塞型呼吸中止症的療效。本實驗對象為20名經多功能睡眠生理檢查證實為 阻塞型呼吸中止症病患（AHI>10），戴用下顎前置裝置23.3±14.14天後 ，再進行一夜檢查。本實驗另以Epworth睡眠量表(ESS)評估病人術前術後 白日嗜眠，以打鼾頻率量表(SFS)及打鼾強度量表(SIS)評估打鼾頻率及強 度的改變。結果顯示呼吸障礙指數（AHI）由30.00±14.94 降至11.09 ±11.71(p<0.05)，改善程度為63.33%, 成功率達70%（AHI<10）；若以 AHI<20且降低50%來評估，其成功率可達80%。呼吸中止指數（AI）由平 均16.12±16.83降至4.86±8.51，明顯的降低了70%。而缺氧指數由平 均16.67 ±17.55降至4.81±6.88(p<0.05)，改善幅度更高達71.2%。以線 性迴歸分析求取AHI與缺氧指數之相關性，術前及術後相關係數分別為 r=0.904與0.827，其前後差異所得相關係數亦達0.7523。而平均含氧量 由94.15% ±1.69%升為94.90% ±1.16%(p<0.05)，喚醒指數由9.62±7. 26降至7.96±5.67(p<0.05)。病人的主觀反應，以Epworth睡眠量表評估 病人白日嗜眠的情形，結果顯示由平均11.79 ±4.47降至6.62±3.06打鼾 頻率由4.73±6.56降至2.84±1.16(p<0.05) ，打鼾強度由4.58±0.61降 至2.26±0.45(p<0.05)。病人使用下顎前置裝置三個月後，調查病人對此 療法的接受度可達100%，無任何顳顎關節障礙或口腔顏面疼痛的問題。由 此實驗可證實下顎前置裝置可有效的改善病人的打鼾及阻塞型呼吸中止症 。

  2. Efficancy of a mandibular advancement device • 。The sleep apnea syndrome, first described by Gestaut since 1965, is a disorder associated with repetitive cessation of breathing during sleep. Not only does sleep apnea syndrome affect the sleep quality, but can be a manifestation of potentially life- threatening disorders. During the past 30 years, treatment of snoring and sleep apnea syndrome has become a team work of chest division, otolaryngology, neurology, psychiatry and dentistry. The objective of this study was to evaluate the efficacy of the mandibular advancement device(MAD) as a treatment modality for obstructive sleep apnea(OSA)patients with subjective and objective testing methods. Twenty adults with obstructive sleep apnea(OSA) diagnosed by polysomography (Apnea/Hypopnea Index, AHI>10) were used as subjects. Each subject received another polysomographic monitoring after 23. 3±14.14 days since MAD treatment. Epworth sleep scale (ESS) was used to evaluate excessive daytime sleepiness, snoring frequencyscale(SFS)and snoring intensity scale (ESS) were also used. The result exhibited a reduction of AHI by 63.33% (from 30.00±14.94 to 11.09±11. 71,p<0.05),the success rate was 70%(AHI<10). The success rate increased to 80% if AHI<20 yet reduction over 50% was defined as success. The desaturation index decreased from 16.67±17.55 to 4.81±6.88(p<0.05),and highly correlated with AHI before and after treatment (r=0.904,r=0.827 respectively). The mean saturation also increased from 94. 15%±1.69% to 94.90%±1.16%(p<0.05). The arousal index decreased from 9.62±7.26 to7.96±5.67(p<0.05). The subjective responses were improved. The ESS score decreased from 11.79±4.47 to 6.62±3.06 (p<0.05). The SFS score decreased from 4.73±6.56 to 2.84±1.16( p<0.05),SIS score decreased from 4.58±0.61 to 2.26±0.45 (p<0.05). A survey three months later since MAD treatment showed:100% of the patients were still using the MAD regularly, none has suffered temporomandibular disorders or orofacial pain. We concluded that the MAD can be an acceptable and effective treatment for snoring and obstructive sleep apnea.

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