Der therapeutisch notwendige CPAP-Wert als Prädiktor der Wirksamkeit von Unterkieferprotrusionsschienen in der Therapie schlafbezogener obstruktiver Atmungsstörungen

Zusammenfassung

Hintergrund: Unterkieferprotrusionsschienen werden seit vielen Jahren zur Therapie schlafbezogener obstruktiver Atmungsstörungen eingesetzt. Es wurde verglichen, ob die Höhe des therapeutisch notwendigen CPAP-Wertes ein Prädiktor der Wirksamkeit von Unterkieferprotrusionsschienen ist.

Methode und Patienten: Es wurden retrospektiv die polysomnografischen Messergebnisse von 67 Patienten (8 Frauen und 59 Männer) im Alter von (Mittelwert/Standardabweichung) 54,2 ± 12,3 Jahren, einem Body-Mass-Index von 28,6 ± 4,3 kg/m² und einem Apnoe-Hypopnoe-Index ohne Therapie von 21,9 ± 12,3/h analysiert. Alle Patienten waren auf eine CPAP-Therapie eingestellt worden, hatten sich aber aufgrund von Problemen der Durchführung der Druckatmungstherapie eine zweiteilige verstellbare Unterkieferprotrusionsschiene nach Maß anfertigen lassen.

Ergebnisse: Der Apnoe-Hypopnoe-Index nahm im Mittel unter CPAP signifikant von 21,9 ± 12,3/h auf 3,4 ± 4,6/h ab, unter Nutzung der Unterkieferprotrusionsschiene auf 9,7 ± 11,6/h ab. Die detaillierte Analyse der Verminderung des Apnoe-Hypopnoe-Indexes unter Berücksichtigung des therapeutisch notwendigen CPAP-Wertes ergab, dass mit ansteigendem CPAP-Wert die Wirkung der Unterkieferprotrusionsschienen deutlich abnahm: Der Apnoe-Hypopnoe-Index lag in der Subgruppe der Patienten mit einem CPAP-Wert von 4 mbar (cmH₂O) unter Nutzung der Unterkieferprotrusionsschiene bei 6,1 ± 8,7/h und in der Gruppe mit einem CPAP-Wert von mehr als 8 mbar bei 23 ± 9,6/h. Bei CPAP-Werten oberhalb von 8 mbar war die Therapie mit einer Unterkieferprotrusionsschiene signifikant geringer wirksam als bei geringeren Drucken.

Schlussfolgerungen: Der therapeutisch notwendige CPAP-Wert ist ein guter Prädiktor für die Wirksamkeit von zweiteiligen verstellbaren Unterkieferprotrusionsschienen.

Abstract

Background: Mandibular advancement devices are used for the therapy of obstructive sleep apnea. We investigated whether the therapeutically necessary CPAP value is a useful predictor of the efficacy of oral devices.

Methods and Patients: We retrospectively compared polysomnography data from 67 patients, 8 women and 59 men, (age mean/standard deviation: 54.2 ± 12.3 years; BMI: 28.6 ± 4.3 kg/m²; apnea-hypopnea index: 21.9 ± 12.3/h). All patients were initially treated with CPAP. Due to problems with the CPAP mask, they switched to a mandibular advancement device.

Results: Under the use of CPAP, the apnea-hypopnea index decreased from 21.9 ± 12.3 to 3.4 ± 4.6/h, with the mandibular advancement device to 9.7 ± 11.6/h. The apnea-hypopnea index while using an oral device was remarkably different when the therapeutically necessary CPAP value was taken into consideration: in the patient group with a pressure of 4 mbar, it was 6.1 ± 8.7 and in the group with values > 8 mbar, it was 23 ± 9.6/h. Thus, the efficacy was signficantly different for CPAP values above 8 mbar.

Conclusions: The therapeutically necessary CPAP value is a valuable predictor for the efficacy of mandibular advancement devices.

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