目的:前瞻性验证药物诱导的睡眠内窥镜检查与下颌前移动作作为口腔矫治器治疗(OAT)治疗成功的预测工具。
方法:纳入诊断为中度阻塞性睡眠呼吸暂停的77例患者,并接受药物诱导睡眠内镜检查。使用VOTE分类评估上呼吸道塌陷。此外,进行了三次下颌前移操作以预测OAT的治疗成功。如果机动是否定的,根据VOTE分类描述了持续崩溃的水平、程度和配置。所有患者均接受OAT治疗,并完成了原位OAT的随访睡眠研究,而不考虑他们对治疗的预期反应。
结果:64例患者完成了6个月的随访。积极的颚推力动作被证明与良好的OAT反应显着相关,而下巴提升机动和垂直下巴提升机动则没有。此外,进行下颌前移操作时,持续的口咽外侧塌陷与OAT反应不良显著相关.
结论:目前的研究结果表明,在预测OAT反应方面,下颌推力动作应优于下巴提升动作。具有积极的下颌推力动作的患者应被告知OAT反应良好,而那些持续口咽外侧塌陷的患者应被告知OAT不良反应的可能性。负下颌推力动作并不能证明是对OAT不利反应的重要预测指标。因此,仅为了预测OAT的疗效而进行药物诱导的睡眠内窥镜检查的合理性存在不确定性。然而,当前研究的结果可能受到呼吸参数评估中的异质性的影响,下颌前移动作表现的变异性,以及推注技术镇静的不稳定性。
背景:注册:荷兰试验注册;名称:药物诱导的睡眠内窥镜检查:口腔矫正器治疗成功率的预测工具;标识符:NL8425;URL:https://www。onderzoekmetmensen.nl/en/审判/20741。
背景:VeugenCCAFM,KantE,KelderJC,SchipperA,StokroosRJ,铜MP。药物诱导睡眠内窥镜检查期间下颌前移动作对阻塞性睡眠呼吸暂停口腔矫治器治疗成功的预测价值:一项前瞻性研究。JClinSleepMed.2024;20(3):353-361。
OBJECTIVE: To prospectively validate drug-induced sleep endoscopy with mandibular advancement maneuvers as a prediction tool for treatment success of oral appliance treatment (OAT).
METHODS: Seventy-seven patients diagnosed with moderate obstructive sleep apnea were included and underwent drug-induced sleep endoscopy. The upper airway collapse was assessed using the VOTE classification. Additionally, three mandibular advancement maneuvers were performed to predict treatment success of OAT. If the maneuver was negative, the level and degree and configuration of the persistent collapse was described according to the VOTE classification. All patients were treated with OAT and completed a follow-up sleep study with OAT in situ without regard to their anticipated response to treatment.
RESULTS: Sixty-four patients completed 6-month follow up. A positive jaw thrust maneuver proved to be significantly associated with favorable OAT response, whereas the chin lift maneuver and the vertical chin lift maneuver were not. Additionally, a persistent lateral oropharyngeal collapse when performing any mandibular advancement maneuver was significantly associated with unfavorable OAT response.
CONCLUSIONS: The current findings suggest that a jaw thrust maneuver should be preferred over the chin lift maneuver for predicting OAT response. Patients with a positive jaw thrust maneuver should be counseled toward favorable OAT response, whereas those with persistent lateral oropharyngeal collapse should be advised about the likelihood of unfavorable OAT response. A negative jaw thrust maneuver did not prove to be a significant predictor for unfavorable response to OAT. Consequently, uncertainties arise regarding the justification of performing drug-induced sleep endoscopy solely for predicting the efficacy of OAT. However, the results of the current study could be influenced by heterogeneity in the assessment of respiratory parameters, variability in the performance of the mandibular advancement maneuvers, and the instability of bolus technique sedation.
BACKGROUND: Registry: Netherlands Trial Register; Name: Drug-induced Sleep Endoscopy: a prediction tool for success rate of oral appliance treatment; Identifier: NL8425; URL: https://www.onderzoekmetmensen.nl/en/trial/20741.
BACKGROUND: Veugen CCAFM, Kant E, Kelder JC, Schipper A, Stokroos RJ, Copper MP. The predictive value of mandibular advancement maneuvers during drug-induced sleep endoscopy for treatment success of oral appliance treatment in obstructive sleep apnea: a prospective study. J Clin Sleep Med. 2024;20(3): 353-361.