Oral Appliance療法におけるタイトレーションの試み

抄録

This study evaluated the effect of titration in oral appliance therapy for obstructive sleep apnea syndrome (OSAS), and examined problems with this test. However, the method of predicting the appropriate mandible position has not yet been established. In this study, titration was attempted in order to predict appropriate mandible position prior to wearing an oral appliance.
Twenty-three male patients diagnosed as OSAS by a physician participated in this study. The mandible was protruded by a titratable splint (TS) until apneic and hypopneic signs had disappeared. Moreover, polisomnography (PSG) was used to monitor brain wave patterns, eye movement, muscle tone, body movement and breathing.
Sleep study was performed by a portable sleep monitoring device before and after examination wearing titrated oral appliance (OA), and the effect of therapy was evaluated.
The results obtained were as follows.
1. In the Apnea Hypopnea Index (AHI), Apnea Hypopnea density (AH density), lowest SpO₂, Oxygen Desaturation Index (ODI), there was a statistically significant improvement. The mean AHI reduced from 13.8 to 4.7 (p<0.001) . The mean AH density reduced from 12.0 to 3.5 (p<0.001) . The mean lowest SpO₂ increased from 78.7 to 84.7 (p<0.0001) . The mean ODI reduced from 15.7 to 6.1 (p<0.001) .
2. The average proportion of protrusive distance for movable distance was 71.7%.
3. Only one patient complained of discomfort in the maxillofacial region, however, this discomfort disappeared after adjustment of OA.
Therefore, it is suggested that titration for OA is a very useful examination for OSAS therapy.