Oral device therapy for the upper airway resistance syndrome patient.

摘要

Statement of Problem. Upper airway resistance syndrome (UARS) is characterized by repeated increases in resistance to airflow within the upper airway; this resistance results in arousal from sleep and excessive daytime sleepiness. There is no safe and efficacious therapy with good compliance for UARS. Purpose. The effects of an anterior mandibular positioning device on respiratory function and sleep quality were evaluated polysomnographically in patients with UARS. Material and Methods. Thirty-two patients (15 women, 17 men; mean age 38.4 +/- 6.4 years) were diagnosed with UARS based on a combination of clinical complaints. To be included in the study, all subjects had to demonstrate a score of <5 on the apnea-hypopnea index, a score of >10 on the Epworth sleepiness scale, and a score of >10 on an arousal index. An oral device was fabricated for each subject with copolyester foil and autopolymerizing resin. Subjects were scheduled for 2 separate overnight sleep stays, one before treatment with the oral device and one after a habituation period of 14 to 60 days. Respiratory function and sleep quality variables were recorded and compared before and after insertion of the device with the paired t test (P >.01) Results. Patient scores on the Epworth sleepiness scale (P<.0001), multiple sleep latency test (P<.0005), and arousal index (P<.0001) and recorded values for minimal oxygen saturation (P<.005) and sleep efficiency (P<.005) improved significantly after insertion of the device. No major side effects were noted with use of the oral device. Conclusion. Within the limitations of this study, the results suggest that an oral device may be an attractive initial treatment for UARS.