睡眠阻塞性呼吸中止對舌癌病患手術治療後的影響及Silent Nite®口內裝置對睡眠阻塞性呼吸中止的療效

Abstract

Objective：This research is about OSA which consists of 2 studies. The first study is to determine the prevalence of obstructive sleep apnea (OSA) in patients with squamous cell carcinoma (SSC) of the tongue after primary surgical resection and to correlate the presence of OSA with the occurrence of obstructive apnea in this patient population. The second study aims to evaluate the efficacy of mandibular advancement appliance (Silent NiteR) in the treatment of snoring and obstructive sleep apnea. Methods and materials: A retrospective study was done to determine the prevalence of obstructive sleep apnea (OSA) among 26 Taiwanese patients, 24 males and 2 females, aged 37~71 years after surgical resection of SSC of the tongue. Patients who had a follow-up after treatment of 6 months to 11 years were eligible for inclusion. During the post-treatment period, the occurrence of OSA was determined in these patients. Overnight polysomnography (PSG) was also used to determine the apnea-hypopnea index (AHI). Patients were considered to have OSA if the AHI value was more than 5 events per hour. Another retrospective study was done to evaluate the efficacy of Silent NiteR oral appliance in the treatment of snoring and obstructive sleep apnea among 43 Taiwanese patients with obstructive sleep apnea. An overnight polysomnography was used to determine the apnea-hypopnea index (AHI) and other parameters. Patients were considered to have OSA if the AHI value is more than 5. Complete response was defined as a resolution of symptoms with reduction in AHI to less than 5 events per hour. Partial response was defined as improved symptoms of 50% reduction in AHI with remaining 5 events per hour or more. Results: The results of oral cancer study showed that in patients with an AHI value of 5, there was a mean BMI of 26.3 kg/m2. The BMI distribution between patients with AHI value of 5 was statistically significant (p = 0.018). Using the definition of clinically significant sleep apnea as AHI > 5, 14 of 26 patients (53.85%) had clinical OSA. The OSA and non-OSA groups showed no statistical significance in terms of age, tumor size, tongue ablation, radical and suprahyoid neck dissection, or wound reconstruction methods. The results of Silent NiteR oral appliance study showed that there was no statistical difference in terms of age, gender, BMI, and central apnea. For the entire group, the oral device reduced the mean of AHI from 16.24 ± 2.45 events/h to 8.37 ± 0.01 events/h with statistical significance (p 5 events/h). Conclusions: The incidence of OSA in the patient population with SSC of the tongue was found to be significantly higher than that of the general population which compared with other published articles. The limitations of this study were the patient sample size. Moreover, there was no pre-surgical PSG record obtained from the patients to compare the sleep quality before and after cancer therapy. Silent NiteR oral appliance, despite its limitations presented in this study, may be an alternative and effective method for treatment of OSA patients especially for those who were unwilling/unable to use nasal continuous positive airway pressure (nCPAP) or for patients who were of high surgical risks.