The Use of Remotely Controlled Mandibular Positioner as a Predictive Screening Tool for Mandibular Advancement Device Therapy in Patients with Obstructive Sleep Apnea through Single-Night Progressive Titration of the Mandible: A Systematic Review

被引:21
作者
Kastoer, Chloe [1 ,4 ]
Dieltjens, Marijke [1 ,2 ,4 ]
Oorts, Eline [1 ]
Hamans, Evert [4 ]
Braem, Marc J. [2 ,4 ]
Van de Heyning, Paul H. [1 ,3 ,4 ]
Vanderveken, Olivier M. [1 ,3 ,4 ]
机构
[1] Univ Antwerp Hosp, Dept ENT Head & Neck Surg, Wilrijkstr 10, B-2650 Antwerp, Belgium
[2] Univ Antwerp Hosp, Dept Special Dent Care, Antwerp, Belgium
[3] Univ Antwerp Hosp, Multidisciplinary Sleep Disorders Ctr, Antwerp, Belgium
[4] Univ Antwerp, Fac Med & Hlth Sci, Antwerp, Belgium
来源
JOURNAL OF CLINICAL SLEEP MEDICINE | 2016年 / 12卷 / 10期
关键词
device; mandibular advancement; mandibular positioner; mandibular protrusion; obstructive sleep apnea; oral appliances; overnight; prediction; remotely controlled; single-night; titration; ORAL APPLIANCE THERAPY; COMPUTATIONAL FLUID-DYNAMICS; UPPER AIRWAY; TREATMENT SUCCESS; OBJECTIVE MEASUREMENT; CLINICAL-PRACTICE; HEAD ROTATION; PRESSURE; ENDOSCOPY; NASENDOSCOPY;
D O I
10.5664/jcsm.6202
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Objectives: To perform a review of the current evidence regarding the use of a remotely controlled mandibular positioner (RCMP) and to analyze the efficacy of RCMP as a predictive selection tool in the treatment of obstructive sleep apnea (OSA) with oral appliances that protrude the mandible (OAm), exclusively relying on single-night RCMP titration. Methods: An extensive literature search is performed through PubMed. com, Thecochranelibrary. com (CENTRAL only), Embase. com, and recent conference meeting abstracts in the field. Results: A total of 254 OSA patients from four full-text articles and 5 conference meeting abstracts contribute data to the review. Criteria for successful RCMP test and success with OAm differed between studies. Study populations were not fully comparable due to range-difference in baseline apneahypopnea index (AHI). However, in all studies elimination of airway obstruction events during sleep by RCMP titration predicted OAm therapy success by the determination of the most effective target protrusive position (ETPP). A statistically significant association is found between mean AHI predicted outcome with RCMP and treatment outcome with OAm on polysomnographic or portable sleep monitoring evaluation (p < 0.05). Conclusions: The existing evidence regarding the use of RCMP in patients with OSA indicates that it might be possible to protrude the mandible progressively during sleep under poly(somno) graphic observation by RCMP until respiratory events are eliminated without disturbing sleep or arousing the patient. ETPP as measured by the use of RCMP was significantly associated with success of OAm therapy in the reported studies. RCMP might be a promising instrument for predicting OAm treatment outcome and targeting the degree of mandibular advancement needed.
引用
收藏
页码:1411 / 1421
页数:11
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