Adherence and efficacy of mandibular advancement splint treatment of sleep-disordered breathing during pregnancy: a pilot study,Sleep and Breathing

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Adherence and efficacy of mandibular advancement splint treatment of sleep-disordered breathing during pregnancy: a pilot study
Sleep and Breathing ( IF 2.1 ) Pub Date : 2022-07-13 , DOI: 10.1007/s11325-022-02681-4
Nelly Huynh ₁ , Léa Drouin-Gagné ₁ , Camille Gilbert ₁ , Jean-Patrick Arcache ₁ , Pierre Rompré ₁ , Anne-Maude Morency ₂ , Robert Gagnon ₂ , John Kimoff ₂ , Sushmita Pamidi ₂

Affiliation

Purpose

Sleep-disordered breathing (SDB) is common in pregnancy and is associated with adverse health consequences for both mother and child. Mandibular advancement splints (MAS) have been shown to improve sleep quality, daytime sleepiness and snoring in non-pregnant women. The effectiveness of MAS for treating SDB in pregnancy is unknown. This pilot study aimed to evaluate the efficacy and adherence to MAS in pregnant women with SDB.

Methods

Women with mild-moderate SDB (apnea–hypopnea index (AHI) 10–29/h) on level 2 polysomnography (PSG) performed at 22.0 ± 5.5 weeks’ gestation were treated with a MAS during pregnancy to 6 months postpartum. An embedded micro-recorder measured adherence. PSG was repeated while on titrated treatment, and off treatment in the postpartum period.

Results

Among 17 women completing the study, MAS was worn ≥ 4 h/night for 57.5 ± 36.7% of nights during the antepartum period. While using MAS, nightly snoring time decreased from 25.9 ± 24.5% at baseline to 6.4 ± 7.8% when treated during pregnancy (p = .003). AHI decreased from 17.6 ± 5.1 to 12.9 ± 6.3 (p = .02) and fell by ≥ 30% and below 15/h in 60% of participants. During the postpartum period, MAS was used for ≥ 4 h/night on 24.8 ± 27.9% of nights. Moreover, the mean AHI off MAS was 17.9 ± 13.1; 88% of women had persistent SDB (AHI ≥ 10).

Conclusions

In this cohort, treatment efficacy and objective adherence were variable. Device use was less frequent in the postpartum period even though a substantial number of women had persistent SDB after delivery.

Clinical trial registered with www.clinicaltrials.gov number: NCT03138291.

中文翻译：

下颌前移夹板治疗妊娠期睡眠呼吸障碍的依从性和疗效：初步研究

目的

睡眠呼吸障碍 (SDB) 在怀孕期间很常见，并且与母亲和孩子的不良健康后果有关。下颌前移夹板 (MAS) 已被证明可以改善非孕妇的睡眠质量、白天嗜睡和打鼾。MAS 治疗妊娠期 SDB 的有效性尚不清楚。这项初步研究旨在评估 SDB 孕妇对 MAS 的疗效和依从性。

方法

在妊娠 22.0 ± 5.5 周进行的 2 级多导睡眠图 (PSG) 中患有轻度中度 SDB（呼吸暂停低通气指数 (AHI) 10–29/h）的女性在怀孕期间至产后 6 个月接受 MAS 治疗。嵌入式微型记录器测量了依从性。在滴定治疗期间重复 PSG，并在产后期间停止治疗。

结果

在完成研究的 17 名女性中，产前期间 57.5 ± 36.7% 的夜晚佩戴 MAS ≥ 4 小时/晚。使用 MAS 时，夜间打鼾时间从基线时的 25.9 ± 24.5% 减少到怀孕期间接受治疗的 6.4 ± 7.8% ( p = .003)。AHI 从 17.6 ± 5.1 下降到 12.9 ± 6.3 ( p = .02)，并且在 60% 的参与者中下降了 ≥ 30% 并且低于 15/h。在产后期间，24.8 ± 27.9% 的夜晚使用 MAS ≥ 4 小时/晚。此外，MAS 的平均 AHI 为 17.9 ± 13.1；88% 的女性患有持续性 SDB（AHI ≥ 10）。