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Title: | 以舌支撐下顎前突口內裝置治療阻塞性睡眠呼吸中止症患者:成功與失敗病例之探討 The success and failure of using tongue-backing mandible andvancing device in treating obstructive sleep apnea patients |
Authors: | Sung-Ying Han 韓松穎 |
Advisor: | 陳韻之(Ynh-Jyi Chen) |
Keyword: | 阻塞性睡眠呼吸中止症,口內裝置,舌頭支撐設計,測顱分析, obstructive sleep apnea,oral appliance,tongue backing design,cephalometric analysis, |
Publication Year : | 2012 |
Degree: | 碩士 |
Abstract: | 中文摘要
目的: 本論文研究目的在於結合下顎前突裝置與舌頭固持裝置之概念,提供嶄新的設計─舌支撐下顎前突裝置(tongue-backing mandible advancement device, tMAD)。藉由多功能睡眠生理檢查評估其治療效果,並透過分析治療效果與患者之基礎生理指數、顱顏構造、睡眠評估指數及相關性,試圖找出臨床上舌支撐下顎前突裝置的適應症,以期精準的預估治療效果之成功率。 實驗材料與方法: 本實驗的對象為62位西元2010年11月至2011年12月間國立台大醫院睡眠中心特別門診就診病患中,具有OSA臨床症狀及經PSG測定之後,判定為輕度以上之OSA患者(AHI>5),並至台大醫院牙科部睡眠特別門診接受舌支撐下顎前突口內裝置之治療。上述患者於治療前紀錄其年齡,量取基礎生理指數包括身高、體重,計算身體質量指數;此外並拍攝側顱X光片進行測顱分析,並於口內裝置治療後三個月至睡眠中心回診,再度接受PSG之測定。 治療成功率之分類,是以治療前OSA嚴重度、AHI reduction的比例、以及治療後AHI作區分。 治療前OSA嚴重度定義如下:輕度(5≤AHI≤15)、中度(15≤AHI ≤30)、重度(30≤AHI≤50)、極重度(AHI≥50)。 不同成功定義區分如下: Criterion 1為:「治療後AHI改變比率大於50%」 Criterion 2為:「治療後AHI改變比率大於50%,且2nd AHI小於15/小時」 Criterion 3為:「治療後AHI改變比率大於50%,且2nd AHI小於10/小時」 Criterion 4為:「治療後AHI改變比率大於50%,且2nd AHI小於5/小時」 結果: 病患經由tMAD治療後的結果顯示,tMAD對於阻塞性睡眠呼吸中止症有顯著治療的效果,N1週期(p=0.019)、動眼期呼吸中止指數(p<0.001)、非動眼期呼吸中止指數(p<0.001)、呼吸中止指數(p<0.001)、呼吸中斷次數(p<0.001)、通氣減少(p=0.001)、氧氣飽和度小於90%之發生率(p<0.001)、及睡眠警醒指數(p<0.001)等項目治療後明顯減少,快速動眼期(p=0.005)、平均氧氣飽和濃度(p=0.002)、最低氧氣飽和濃度(p<0.001)等項目治療後明顯增加。 輕度之成功率依據criterion 1∼4皆為83.3%(5/6); 中度之成功率依據criterion 1、2為73.9%(17/23),依據criterion 3為69.6%(16/23),依據criterion 4為47.8%(11/23); 重度之成功率依據criterion 1、2為82.6%(19/23),依據criterion 3為65.2%(15/23),依據criterion 4為47.8%(11/23); 極重度之成功率依據criterion 1為50%(5/10),依據criterion 2為20%(2/10),依據criterion 3為10%(1/10);依據criterion 4為0%。 本實驗關於影響口內裝置效果之預測因子,使用tMAD治療成功的患者具有以下特徵:年紀較輕、∠SNA較小、overbite較大、H-Me間距離較大;依照嚴重度區分,中度OSA的患者baseline AHI越高,tMAD治療後成為responder的機會越高;重度OSA的患者BMI越低、舌頭高度(S-H)越高、帆咽部呼吸道(PNS-AA)越寬,tMAD治療後成為responder的機會越高。 總結: tMAD為臨床上治療阻塞性睡眠呼吸中止症之有效方式,而若干解剖特徵及PSG資料有助於治療前之篩選以及成功率之評估,可以更明確地選擇其應用範圍,如:口內裝置與CPAP之合併療法。 ABSTRACT Objectives: An innovative design of oral appliance, the tongue backing mandible advancing device (t-MAD) has been developed. The aim of this study was to report its treatment efficacy of obstructive sleep apnea (OSA); and to explore potential predictors of this new device. Materials and Methods: In this retrospective study (ranged from Jan 2010 to Dec 2011), 62 polysomnogram (PSG)-proved OSA patients (AHI≧5) were recruited. All were treated with t-MAD at the Clinic of Sleep Dentistry of NTUH. Baseline demographic and physiological data and lateral cephalometric images were collected before t-MAD delivery. PSG was used to evaluate its treatment outcomes 3 months after treatment. Various criteria in defining the so-called “response” by using AHI reduction and residual AHI have been used to evaluate treatment outcomes. Criterion 1: ≥ 50% reduction of AHI Criterion 2: ≥ 50% reduction of AHI and the residual AHI less than 15/h Criterion 3: ≥ 50% reduction of AHI and the residual AHI less than 10/h, and Criterion 4: ≥ 50% reduction of AHI and the residual AHI less than 5/h . Results: The using of t-MAD has resulted in significant improvement in many different aspects of sleep quality parameters, namely N1 percentage, AHI (at REM, NREM, and in total), obstruction apnea, hypopnea, average oxygen saturation, lowest oxygen saturation, saturation<90%, and arousal index (p<0.05). By using all 4 criteria, t-MAD could bring 83.3% of response rate in treating mild OSA patients. For moderate and OSA patients, the response rates were 73.9%/ 73.9%/ 69.6%/ 47.8%; and 82.6%/ 82.6%/ 65.2% / 47.8%, according to 4 different criterion, respectively. For some extremely severe OSA patients (AHI ≥ 50), the response rates were 50%/ 20%/ 10%/ 0, respectively. Age, ∠SNA, overbite, and H-Me distance were found to be significant predictors of tMAD treatment. For the modertate OSA patients, the baseline AHI was an important predictor. The BMI, hyoid bone level(S-H), and oropharyngeal airway space(PNS-AA) were the predictors of severe OSA patients. Conclusion: The tMAD is an effective appliance in treating OSA patients. Certain cephalometric measurements and PSG parameters can be used for patient selection. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/63603 |
Fulltext Rights: | 有償授權 |
Appears in Collections: | 臨床牙醫學研究所 |
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