tailieunhanh - Obstructive Sleep Apnea Diagnosis and Treatment - part 6

Cho rằng mục đích của điều trị là để giải quyết OSA, điều quan trọng là định nghĩa nghiêm ngặt hơn về kết quả điều trị được sử dụng. Về các thông số độ bão hòa oxy, các nghiên cứu đã xác định những cải tiến trong độ bão hòa oxy tối thiểu, nhưng hiếm khi mức bình thường. | Oral Appliances 221 reducing the number of obstructive breathing events and arousals and improving arterial oxygen saturation particularly in the mild-to-moderate OSA range. The overall success rate is dependent on the definition used with almost 70 of patients achieving a greater than 50 reduction in the apnea-hypopnea index AHI 19 and up to 50 achieving an AHI 5 hour 12 13 21 . Given that the aim of treatment is to resolve OSA it is important that the more stringent definition of treatment outcome be used. With regards to oxygen saturation parameters studies have identified improvements in the minimum oxygen saturation but rarely to normal levels. This is not surprising as unlike CPAP oral appliances do no inflate the lungs. With regards to sleep architecture and arousals the data are less consistent with only some studies reporting an increase in rapid eye movement sleep and reductions in the arousal index 12 13 21 . Less is known regarding the efficacy of TRD. Modest reductions in AHI 22 and improvements in minimum oxygen saturation and oxygen desaturation index 23 have been reported. Limited data suggest that supine-dependent OSA and absence of obesity are associated with a more favorable outcome 22 . Hypersomnolence Whilst there has been a consistent observation across studies that subjective daytime sleepiness improves with oral appliances randomized controlled trials using inactive control devices suggest that at least part of this improvement could be a placebo effect 12 13 similar to that identified with sham CPAP and oral tablet placebo 24 25 . With regards to objective sleepiness there are indications of a small improvement although more work is required in this area. In one study the mean sleep latency on the multiple sleep latency test after four weeks of MAS treatment was significantly improved compared with an inactive control oral device but the mean increase was relatively small minutes 13 . Two studies compared oral appliances to CPAP over 8