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Practical considerations for effective oral appliance use in the treatment of obstructive sleep apnea: a clinical review

机译：有效使用口腔矫治器治疗阻塞性睡眠呼吸暂停的实际考虑：临床回顾

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Oral appliance (OA) therapy is a promising alternative to continuous positive airway pressure (CPAP) for patients with obstructive sleep apnea (OSA). By holding the mandible in a forward position, an OA keeps the airway open and prevents collapse. The recently revised practice parameters of the American Academy of Sleep Medicine extend the indications for OA therapy, recommending that “sleep physicians consider prescription of an OA for adult patients with OSA who are intolerant of CPAP therapy or prefer alternative therapy.” This manuscript reviews the practical considerations for effective OA therapy with a discussion of three factors: patient eligibility for OA therapy, device features, and requirements for OA providers. Identification of patients who are eligible for OA therapy is a key factor because the overall success rate of OA therapy is lower than that of CPAP. Conventional predictive variables have low sensitivity and specificity; however, new tools such as drug-induced sleep endoscopy and single-night polysomnographic OA titration have been developed. Other factors to consider when determining the indications for OA include the patient’s oral health, evidence of inadequate treatment for older populations, and the risk of long-term dentofacial side effects. For the second factor, customization of OA features is a key component of treatment success, and no single OA design most effectively improves every situation. Although adjustment of the mandibular position is much more important than device selection, the adjustment procedure has not been standardized. Additionally, a pitfall that tends to be forgotten is the relationship between application of the mandibular position and device selection. Promising new technology has become commercially available in the clinical setting to provide objective adherence monitoring. Finally, the third factor is the availability of enough qualified dentists because sleep medicine is a relatively new and highly multidisciplinary field. Because OSA treatments such as CPAP and OA therapy are generally considered for continuous use, treatments should be carefully planned with attention to multiple aspects. Additionally, because OA therapy requires the cooperation of professionals with different areas of expertise, such as dentists and physicians with various specialties, everyone involved in OA therapy must understand it well.
机译：对于阻塞性睡眠呼吸暂停（OSA）患者，口服矫治器（OA）治疗是一种有希望的替代持续气道正压（CPAP）的方法。通过将下颌骨保持在向前位置，OA可以保持呼吸道开放并防止塌陷。美国睡眠医学研究院最近修订的实践参数扩展了OA治疗的适应症，建议“睡眠医生考虑对CPAP治疗不耐受或倾向于替代治疗的OSA成年患者开OA处方。”该手稿讨论了有效的OA治疗的实际考虑因素，并讨论了三个因素：患者是否适合OA治疗，设备功能以及对OA提供者的要求。鉴定有资格进行OA治疗的患者是关键因素，因为OA治疗的总体成功率低于CPAP。常规预测变量的敏感性和特异性较低;但是，已经开发了新的工具，例如药物诱发的睡眠内窥镜检查和单夜多导睡眠图OA滴定。确定OA适应症时还需要考虑的其他因素包括患者的口腔健康状况，对老年人群治疗不充分的证据以及长期的牙颌副作用的风险。第二个因素，OA功能的自定义是治疗成功的关键，并且没有一个OA设计能够最有效地改善每种情况。尽管下颌位置的调整比设备选择更为重要，但调整程序尚未标准化。此外，下颌位置的应用和器械选择之间的关系往往会被遗忘。有前途的新技术已在临床上商业化，可提供客观的依从性监测。最后，第三个因素是有足够的合格牙医，因为睡眠医学是一个相对较新且高度多学科的领域。由于通常考虑将OSA治疗（例如CPAP和OA治疗）连续使用，因此应仔细计划治疗方案，并注意多个方面。另外，由于OA治疗需要具有不同专业领域的专业人员（例如具有各种专长的牙医和医生）的合作，因此涉及OA治疗的每个人都必须对此有所了解。

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