磁悬浮弹力下颌托对轻中度阻塞性睡眠呼吸暂停患者的疗效

Efficacy of magnetic levitation elastic mandibular elevator in treatment of mild or moderate obstructive sleep apnea

目的探讨磁悬浮弹力下颌托(MLEME)对轻中度阻塞性睡眠呼吸暂停(OSA)的疗效。方法选择21例2016年6月至2017年6月在南京医科大学第一附属医院经多导睡眠监测(PSG)诊断轻中度OSA的患者,比较治疗前和磁悬浮下颌托治疗中两夜间PSG参数及Epworth嗜睡量表(ESS)评分所反映的日间嗜睡程度的变化,并观察治疗中有无不适反应。结果与治疗前相比,治疗中的夜间呼吸暂停低通气指数[(9.3±6.2)比(15.6±7.8)次/h]、微觉醒指数[(6.2±3.4)比(10.3±5.4)次/h]、睡眠期间脉氧饱和度(SpO2)<90%时间占总睡眠时间的百分比(3.9%±2.7%比9.8%±3.5%)及日间ESS评分[(6.3±2.3)比(11.2±2.8)分]均显著降低(均P<0.05),而平均SpO2(97.2%±0.9%比94.7%±1.1%)和最低SpO2(87.6%±2.8%比81.7%±4.6%)均显著增加(均P<0.05)。患者治疗中无明显不适主诉,头颈部侧位X线片显示佩戴MLEME中悬雍垂顶点至咽后壁的水平距离较未佩戴时明显增宽[(11.9±1.8)比(9.6±1.5)mm,P<0.05]。结论MLEME对于改善OSA患者的睡眠呼吸参数和日间嗜睡具有较明显的疗效,且无明显不良反应。其远期疗效尚有待观察。

Objectives To investigate the clinical efficacy of magnetic levitation elastic mandibular elevator (MLEME) in treatment of mild obstructive sleep apnea (OSA). Methods Twenty one patients with mild or moderate OSA confirmed by polysomnographic (PSG) examination were recruited from the First Affiliated Hospital with Nanjing Medical University between June of 2016 and June of 2017. Their PSG parameters, daytime Epworth sleepiness score (ESS) were compared before and on treatment of MLEME. In addition, any side effects and discomfort were observed during MLEME treatment. Results Comparison of parameters during and before MLEME treatment revealed a significant decrease (all P<0.05) in apnea hypopnea index [(9.3±6.2) vs (15.6±7.8)/h], arousal index [(6.2±3.4) vs (10.3±5.4)/h], percentage of sleep time with less than 90% oxygen saturation (3.9%±2.7% vs 9.8%±3.5%), daytime ESS (6.3±2.3 vs 11.2±2.8);but a remarkable increase (all P<0.05) in mean and minimal pulse oxygen saturation (97.2%±0.9% vs 94.7%±1.1% and 87.6%±2.8% vs 81.7%±4.6% respectively). All patients could tolerate MLEME treatment well with no complain of discomfort. Following wearing of MLEME, X-ray lateral film of head and neck revealed a significantly longer distance than that before MLEME treatment from tip of uvula to posterior pharyngeal wall [(11.9±1.8) vs (9.6±1.5) mm](P<0.05). Conclusions MLEME could significantly improve sleep respiratory parameters and daytime sleepiness of OSA without side effects. Its long-term efficacy for OSA remains to be further explored.