| Summary: | 碩士 === 國立臺灣大學 === 臨床牙醫學研究所 === 99 === Objectives：
The aim of the study is to combine the concept of mandible advancement device and tongue retaining device, provide an innovative design and manufacturing process ─Tongue backing mandible advancement device (TMAD). The effect of TMAD in treating obstructive sleep apnea(OSA) was assessed by use of polysomnogram and questionnaires, and the effect of TMAD in OSA patients in relation to their basic medical condition, craniofacial features, polysomnographic data and the improvement of self-estimated symptoms was also analyzed. We hope to illustrate the indication of TMAD in treating OSA and effective method for predicting treatment response of oral appliance.
Materials and Methods:
A crossover study design was used, using TMAD as the experimental group and monoblock, without design of tongue backing, as the control grouph. A total of 51 subjects received TMAD for OSA, and 22 subjects completed the randomized-crossover clinical trial.
Subjects who had related clinical symtoms and signs, diagnosed as OSAS (AHI≧5) by polysomnography were included from 2010.01 to 2011.02. They were arranged for mandibular advancement oral appliance therapy in Special Clinic of Oral Appliance in Dental Department of NTU. Pre-treatment age, height and weight were recored, so the BMI were derived. Besides, baseline cephalometry was performed on each subject. One month after treatment, patients came back to Sleep Center for follow-ups and received post-treatment polysomnography. In the meanwhile, patients were asked to answer the questionnaire of Epworth sleep sacle and Fatigue severity sore before treatment and one month after treatment to assess the self-estimated responses of the treatment. The subjects were divided into two groups on the basis of the degree of changes in AHI: responders (AHI reduction>50%) and non-responders (AHI reduction<50%).
Results:
51 subjects had received TMAD treatment. There were significant improvement in AHI（p<0.0001）、oxygen desaturation events（p<0.0001）、average oxygen saturation（p=0.0039）、lowest oxygen saturation（p<0.0001）、saturation<90%（p=0.0021）and arousal index(p=0.0039) with TMAD, compared with the baseline。
22 subjects completed the protocol of randomized crossover trial, comparison of Monoblock and TMAD. There was significant improvement in AHI at the REM sleep (p=0.0037) with TMAD, compared with the baseline; but no significant change (p=0.0514)with Monoblock, compared with the baseline. Furthermore, there were also singnificant improvement in lowest oxygen saturation with TMAD(p<0.0001) and Monoblock(p=0.0002), compared with with the baseline；there was a significant increase in lowest oxygen saturation with TMAD(p=0.0019), compared with the Monoblock.
The responder(48.88 years old) of Monoblock group was found to be significantly younger than the non-responder(58.69 years old); the responder of TMAD group(40.59 mm) was found to have significantly lower tongue height than the non-responder(44.33). Furthermore, there was significantly greater decrease in AHI in TMAD group without asthma(70.72%), compared with the group with asthma(43.17%).
The PSG data predictors of monoblock responders were IAS <7mm and age <57 years old , the success rate of patient with IAS>7mm was about eleven times to patients >7mm, and the success rate of paient younger than 57 y/o was fifteen times to patients older than 57 y/o. The predictors of TMAD were N_Ba(>110mm) and ANS_PNS(110 mm), the success rate of patient with N_Ba<110mm was about fifteen times to patients >110mm, and the success rate of paient with ANS_PNS<110 mm was 14 times to patients with ANS_PNS>110 mm.
The greater difference between the success rate of Monoblock and TMAD was found in subjects with smaller N_Ba and S_N. Furthermore, the greater difference between the decrease in AHI of Monoblock and TMAD was found in older subjects or subjects with larger <N-S-Ba, larger S_Ba, smaller tongue height and wider diameter of retropalatal airway space.
Conclusion：
TMAD is an effective treatment in patients with OSA, had a significantly greater decerease in lowest oxygen saturation, compared with the Monoblock(without tongue backing). The predicators of TMAD responders were N_Ba <110mmand length of maxilla <56 mm. Use TMAD in treating OSA was recommended for the older patient and patients with lager <N-S-Ba,smaller S_Ba, lower tongue height and wider diameter of retropalatal airway space.
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