Changes Of Sleep Parameters In Patients With Different Severity Of OSA After Oral Appliance Treatment

Objective:（1）To compare the changes of sleep parameters and respiratory parameters in patients with obstructive sleep apnea（OSA）of different severity before and after treatment with mandibular advancement appliance.（2）Objective to investigate the correlation between the efficacy parameters of oral appliances and the changes of sleep parameters before and after treatment.（3）Objective to investigate the difference of sleep structure between OSA patients before and after oral appliance treatment and simple snoring patients.Methods:（1）87 patients with OSA（62 males and 25 females）were selected according to the criteria of inclusion.According to the severity of the disease,87 patients were divided into three groups,including 21 mild,26 moderate and 40 severe.The changes of sleep parameters and respiratory parameters were monitored by multi-channel sleep map before and after the mandible anterior oral appliance was compared in each group.The correlation between the therapeutic parameters and the changes before and after the treatment was analyzed,and the mechanism of sleep structure change was discussed.（2）17 patients with snore（8 males and 9 females）were used as control group to remove body mass in OSA patients The results showed that the PSG parameters of OSA patients were 18 mild,18moderate and 20 severe.The PSG parameters before and after treatment were compared with17 patients with snoring before and after treatment in the control group,and the improvement effect of appliance on sleep poor in OSA patients was understood.Results and analysis:（1）The effective rate of oral appliance for mild OSA patients was81%,moderate 88%,and severe 80%,and the difference between the three groups was not statistically significant（P>0.05）.（2）（1）the results of sleep parameters comparison between OSA patients with different severity showed that the percentage of S3 stage（deep sleep stage）after treatment in mild group was（4.72±6.02）%increased to（8.73±7.92）The arousal index of the moderate group was（1.17±0.96）times/hour reduced to（0.81±0.68）The difference was statistically significant（P<0.05）,and there was no significant difference in sleep parameters before and after treatment in severe group（P>0.05）.（2）The results of comparison of respiratory parameters before and after treatment showed that the lowest oxygen saturation in night increased in OSA patients with different severity,AI（apnea index）,HI（low ventilation index）,AHI（apnea hypopnea index）,and the longest pause time were all decreased compared with those before treatment,there was no significant difference between the two groups（P>0.05）.（3）The results showed that（the changes were before treatment cut after treatment）:（1）The duration of hypopnea and duration of hypoventilation were negatively correlated with the total sleep time and S2（shallow sleep phase 2）respectively（r=-0.509,-0.593,-0.467,-0.519）,the duration of hypoventilation before treatment was positively correlated with the change of S1（shallow sleep phase 1）,and there was no significant correlation between the changes of ASp O₂（mean blood oxygen saturation）,LSp O₂（minimum nocturnal oxygen saturation）,and the changes of ASp O₂and LSp O₂before and after treatment（P>0.05）.It shows that the more serious the disease before treatment,the more the total sleep time after treatment,the less the shallow sleep time,and the better the effect.The degree of hypoxemia in mild patients is relatively light,so there is no correlation between oxygen saturation and sleep parameter.（2）The changes of HI（hypopnea）and S3,HI（hypopnea）and sleep latency,AHI（apnea hypopnea index）and S3（deep sleep）were negatively correlated with the changes of sleep latency in the moderate group（r=-0.424,-0.500,-0.430,-0.497）.It shows that the more serious the disease is,the better the effect of oral appliance treatment,the longer the sleep latency after treatment,the closer to normal,and the percentage of S3 period of deep sleep increases.（3）The changes of HI（hypopnea index）and S3（deep sleep period）,HI（hypopnea index）and total sleep time before treatment,the change of the longest pause time,the total sleep time,sleep efficiency,S2（shallow sleep phase 2）,duration of hypopnea and S3（deep sleep period）before treatment were observed,Before treatment,ASp O₂（mean blood oxygen saturation）was positively correlated with the change of sleep latency of REM（r=0.340,0.353,0.444,0.378,0.352,0.363,0.359）;The change of the longest pause time was negatively correlated with the change of sleep latency and S1（shallow sleep phase 1）respectively（r=-0.363,-0.403）.It shows that the higher HI（hypopnea index）before treatment,the better the curative effect,the greater the percentage of S3（deep sleep period）before treatment,the lower the percentage of S3 stage（deep sleep period）and the decrease of total sleep time,which is the manifestation of improvement of disease severity.Severe patients often have more or less drowsiness,the total sleep time becomes longer,after the treatment of appliance,the sleep quality is improved,the sleep latency is prolonged,REM（rapid eye movement）sleep latency is shortened,sleep time is shortened.（4）The results of correlation analysis between the therapeutic parameters before and after treatment showed that the percentage of sleep latency of pre treatment HI and REM（rapid eye movement）,ASp O₂（mean blood oxygen saturation）before treatment,sleep latency after treatment and S3（deep sleep period）after treatment were all the same,The longest pause time before treatment was positively correlated with the percentage of REM（rapid eye movement）after treatment（r=0.230,0.245,0.249,0.242）;AI（apnea index）before treatment was negatively correlated with the sleep latency after treatment,and the longest time before and after treatment was negatively correlated with the percentage of S2 stage（shallow sleep phase 2）after treatment（r=-0.218,-0.249）.The results show that the more serious the disease before treatment,the better the curative effect of appliance,shorter sleep latency,less shallow sleep time and deep sleep after treatment The time of S3 period increased.（4）Compared with OSA patients with different severity before treatment,there was no significant difference between sleep parameters before treatment and those with simple snoring（P>0.05）.The proportion of S1 stage（shallow sleep phase 1）in light and moderate patients was higher than that of the patients with simple snoring.AI,HI,AHI,longest pause time were observed in patients with OSA The longest duration of hypopnea was higher than that of snoring patients,and aspo2 and lspco2 were lower than those of snoring patients（P<0.05）.There was no statistical difference in sleep parameters between the patients with simple snore and after treatment（P>0.05）,which indicated that the sleep state of OSA patients was similar to that of the patients with snore.The duration of AI,HI,AHI and the longest duration of hypopnea in patients with severe respiratory parameters was still higher than that of snoring patients,LSp O₂was lower than that of snoring patients（P<0.05）.Conclusion:（1）Oral appliance has good effect on patients with different severity of OSA.（2）Oral appliance treatment can promote sleep improvement in patients with mild to moderate OSA.After treatment,the proportion of deep sleep in patients with mild OSA increases,while the sleep wake index in patients with moderate OSA decreases.After treatment,the respiratory parameters of patients with different severity of OSA are improved.（3）After oral appliance treatment,AI,HI,AHI and other therapeutic parameters of patients with different severity of OSA are correlated with the changes of sleep parameters before and after treatment,which indicates that the better the curative effect of oral appliance is,the better the sleep improvement before treatment effect of patients with OSA is,the sleep structure of patients with severe OSA was similar to that of patients with simple snoring,while the sleep structure of patients with mild and moderate OSA was disordered,and the percentage of patients with shallow sleep stage S1 was higher than that of patients with simple snoring.（4）Before treatment,the sleep structure of patients with severe OSA was similar to that of patients with simple snoring,while the sleep structure of patients with mild and moderate OSA was disordered,and the percentage of patients with shallow sleep stage S1 was higher than that of patients with simple snoring.After oral appliance treatment,the sleep structure of patients with mild and moderate OSA was improved,similar to that of patients with simple snoring,close to normal.The respiratory parameters of the severe group were different from those of the simple snoring group,and some severe patients did not reach the normal effect after treatment.