Clinical cases of treating obstructive sleep apnea patients with tongue-raising mandibular advancement device: A pilot study

• Main Authors: Ming-Hsun Tsou, 鄒明勳
• Other Authors: Yunn-Jy Chen
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/78008441273964626389

碩士 === 國立臺灣大學 === 臨床牙醫學研究所 === 102 === Objectives: The aim of this study was to test the feasibility of a modification of the tongue-backing mandibular advancement device (t-MAD), by incorporating a design to raise the tongue (tr-MAD) in treating obstructive sleep apnea (OSA) patients. Materials and Methods: From Dec. 2013 to Apr. 2014 OSA patients (AHI≧5) managed in Clinic of Sleep Dentistry and met the following criteria were invited to this trial: 1. OSA patients responded well with t-MAD in term of AHI reduction, but still bothered with snoring. 2. New OSA patients either with hyoid bone located below C3 revealed by lateral cephalometric x-ray, or the dorsal surface of the tongue lower than occlusal plane during mouth light opening clinically. All subjects were given both t-MAD and tr-MAD for treatment. Subjectively comments and polysomnography was used to access the feasibility of the tr-MAD, and to compare their treatment outcomes. MRI was also used to evaluate their effects on the upper airway configuration. The OSA severity was classified into mild (5&;#8804; AHI<15), moderate (15&;#8804;AHI <30), severe (30&;#8804;AHI<50), and extremely severe (AHI &;#8805;50). The response to oral appliance was classified according to percentage of AHI reduction, and AHI after treatment: (1) True success(△AHI&;#8805;50% and 2nd AHI<15)(2) Success(△ AHI&;#8805;50% but 2nd AHI&;#8805;15)(3) Partial success(△AHI<50%)(4) Failure(△ AHI<0%). True success and success were defined as responder, meanwhile partial v &;#65532;success and failure were define as non-responder. Results: 17 patients have participated to this study. The treatment outcomes of t-MAD and tr-MAD were comparable, namely the success rates were 67% and 70.6%, respectively. PSG studies showed no different improvement brought by both t-MAD and tr-MAD. However, MRI scan showed tr-MAD can result in more upper airway configuration changes than those with t-MAD, including PNS level, anterior-posterior dimension, and medial-lateral dimension. For those who were still bothered by snoring while using the t-MAD, also reported snoring reduction with the newly designed tr-MAD. Conclusion: Incorporated a tongue raising mechanism within a tongue-backing mandibular advancement device seems to be a feasible modification indicated in certain OSA patients.