Lisätietoa aiheesta

Apneakiskon lyhyt- ja pitkäaikaiset haittavaikutukset

Lisätietoa aiheesta
23.1.2017
Riitta Pahkala

Uniapnean hoidossa käytetyt suun sisäiset kojeet ovat pääsääntöisesti akryylimuovista valmistettuja yksi- tai kaksiosaisia hammasteknisiä kojeita (apneakisko), jotka "sitovat" ylä- ja alahammaskaaren kojeeseen. Kiskon avulla alaleuka asemoidaan nukkuessa eteenpäin yläleukaan nähden. Alaleuan eteenpäin tuonnin määrä voi olla joko kojeen valmistusvaiheessa määritetty (protruusioastetta ei voi muuttaa) tai säädeltävissä (protruusioastetta voidaan tarpeen mukaan lisätä tai vähentää). Kojeet valmistetaan yksilöllisesti hammaslääkärin vastaanotolla hammaskaarista otettujen muottien ja leuan eteenpäin tuonnin määrää määrittävän purentaindeksin avulla.

Apneakojeilla on usein suhteellisen lieviä, mutta lyhytaikaisia haittavaikutuksia. Tavallisimpia ovat lisääntynyt syljeneritys kojeen ollessa suussa sekä hampaiden ja leukanivelalueiden arkuus lähinnä aamuisin kojeen käytön jälkeen (ks. taulukko « Apneakiskon lyhyt- ja pitkäaikaiset haittavaikutukset»1). Pitkäaikaisella kojeen käytöllä voi olla vaikutusta etuhampaiden ylipurentoihin ja purentakontakteihin sivualueilla hampaiden kallistumisen vuoksi. Ylipurennat yleensä pienenevät. Purentasuhteiden muutoksia on myös raportoitu, mutta ne ovat verraten vähäisiä. Haittavaikutusten määrä riippuu kiskon protruusioasteesta, kojemallista sekä kiskon käytön määrästä ja käytön pituudesta.

Taulukko 1. Apneakiskon lyhyt- ja pitkäaikaiset haittavaikutukset
OireetSeuranta-aika(kk)Tutkimushenkilöt (n)Osuus tutkituista (%)Kirjallisuusviitteet
Lisääntynyt syljeneritys1–6,5
14–58
64		16–48
15
155		19–68
39–67
34		 «Lam B, Sam K, Mok WY ym. Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax 2007;62:354-9 »1, «Engleman HM, McDonald JP, Graham D ym. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Res»2, «Lawton HM, Battagel JM, Kotecha B. A comparison of the Twin Block and Herbst mandibular advancement splints in the treatment of patients with obstructive sleep apnoea: a prospective study. Eur J Ortho»4
«Martínez-Gomis J, Willaert E, Nogues L ym. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010;80:30-6 »6
«Marklund M, Franklin KA. Long-term effects of mandibular repositioning appliances on symptoms of sleep apnoea. J Sleep Res 2007;16:414-20 »5
Suun/kurkun kuivuus1–2,5
14–58
64		16–34
15
155		33–63
7–28
30		 «Lam B, Sam K, Mok WY ym. Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax 2007;62:354-9 »1, «Engleman HM, McDonald JP, Graham D ym. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Res»2, «Lawton HM, Battagel JM, Kotecha B. A comparison of the Twin Block and Herbst mandibular advancement splints in the treatment of patients with obstructive sleep apnoea: a prospective study. Eur J Ortho»4
«Martínez-Gomis J, Willaert E, Nogues L ym. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010;80:30-6 »6
«Marklund M, Franklin KA. Long-term effects of mandibular repositioning appliances on symptoms of sleep apnoea. J Sleep Res 2007;16:414-20 »5
Leuan epämukavuus, kipu1–2,5
6,5
14–58		16–34
16
15		13–38
25
0–27		 «Lam B, Sam K, Mok WY ym. Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax 2007;62:354-9 »1, «Lawton HM, Battagel JM, Kotecha B. A comparison of the Twin Block and Herbst mandibular advancement splints in the treatment of patients with obstructive sleep apnoea: a prospective study. Eur J Ortho»4
«Zhou J, Liu YH. A randomised titrated crossover study comparing two oral appliances in the treatment for mild to moderate obstructive sleep apnoea/hypopnoea syndrome. J Oral Rehabil 2012;39:914-22 »7
«Martínez-Gomis J, Willaert E, Nogues L ym. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010;80:30-6 »6
Hampaiden aristus2,5–6,5
14–58		16–34
15		25–33
13–67		 «Lam B, Sam K, Mok WY ym. Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax 2007;62:354-9 »1, «Zhou J, Liu YH. A randomised titrated crossover study comparing two oral appliances in the treatment for mild to moderate obstructive sleep apnoea/hypopnoea syndrome. J Oral Rehabil 2012;39:914-22 »7
«Martínez-Gomis J, Willaert E, Nogues L ym. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010;80:30-6 »6
Niveläänet (TMJ)14–58
64		15
155		0–7
11		 «Martínez-Gomis J, Willaert E, Nogues L ym. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010;80:30-6 »6
«Marklund M, Franklin KA. Long-term effects of mandibular repositioning appliances on symptoms of sleep apnoea. J Sleep Res 2007;16:414-20 »5
Puremalihasten arkuus1–6,5
14–58		16
15		19–25
7–13		 «Lawton HM, Battagel JM, Kotecha B. A comparison of the Twin Block and Herbst mandibular advancement splints in the treatment of patients with obstructive sleep apnoea: a prospective study. Eur J Ortho»4, «Zhou J, Liu YH. A randomised titrated crossover study comparing two oral appliances in the treatment for mild to moderate obstructive sleep apnoea/hypopnoea syndrome. J Oral Rehabil 2012;39:914-22 »7
«Martínez-Gomis J, Willaert E, Nogues L ym. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010;80:30-6 »6
Limakalvoärsytys14–58157–40 «Martínez-Gomis J, Willaert E, Nogues L ym. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010;80:30-6 »6
Ulseraatiot6,51612,5 «Zhou J, Liu YH. A randomised titrated crossover study comparing two oral appliances in the treatment for mild to moderate obstructive sleep apnoea/hypopnoea syndrome. J Oral Rehabil 2012;39:914-22 »7
Kuivat huulet6415522 «Marklund M, Franklin KA. Long-term effects of mandibular repositioning appliances on symptoms of sleep apnoea. J Sleep Res 2007;16:414-20 »5
Paha maku6415532 «Marklund M, Franklin KA. Long-term effects of mandibular repositioning appliances on symptoms of sleep apnoea. J Sleep Res 2007;16:414-20 »5
Hampaan kruunun rikkoontuminen2486 «Engleman HM, McDonald JP, Graham D ym. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Res»2
Koje irtoaa/potilas irrottaa kojeen suusta yöllä24840 «Engleman HM, McDonald JP, Graham D ym. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Res»2
Unen keskeytyminen24825 «Engleman HM, McDonald JP, Graham D ym. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Res»2
Lyhytaikainen purennan muutos1–1,51625–56 «Lawton HM, Battagel JM, Kotecha B. A comparison of the Twin Block and Herbst mandibular advancement splints in the treatment of patients with obstructive sleep apnoea: a prospective study. Eur J Ortho»4
Purennan muutokset (vain merkitsevät muutokset)Seuranta-aikaTutkimushenkilöt (n)MuutosKirjallisuusviitteet
Vertikaalisen ylipurennan pieneneminen (mm)11,1 ± 2,8 v
21 kk
24 kk		77
15
29		2,3 ± 1,6
0,72
1,2 ± 1,1		 «Pliska BT, Nam H, Chen H ym. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med 2014;10:128»3
«Martínez-Gomis J, Willaert E, Nogues L ym. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010;80:30-6 »6
«Doff MH, Finnema KJ, Hoekema A ym. Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects. Clin Oral Investig 2013;17:475-82 »8
Horisontaalisen ylipurennan pieneneminen (mm)11,1 ± 2,8 v
21 kk
24 kk		77
15
29		1,9 ± 1,9
0,85
1,5 ± 1,5		 «Pliska BT, Nam H, Chen H ym. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med 2014;10:128»3
«Martínez-Gomis J, Willaert E, Nogues L ym. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010;80:30-6 »6
«Doff MH, Finnema KJ, Hoekema A ym. Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects. Clin Oral Investig 2013;17:475-82 »8
Alahammaskaaren aukkoisuuden lisääntyminen (mm)11,1 ± 2,8 v771,3 ± 1,8 «Pliska BT, Nam H, Chen H ym. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med 2014;10:128»3
Alakulmahampaiden välin leveneminen (mm)11,1 ± 2,8 v770,7 ± 1,5 «Pliska BT, Nam H, Chen H ym. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med 2014;10:128»3
Alaposkihampaiden välin leveneminen (mm)11,1 ± 2,8 v771,1 ± 1,4 «Pliska BT, Nam H, Chen H ym. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med 2014;10:128»3
Poskihampaiden purentakontaktien väheneminen11,1 ± 2,8 v
21 kk
24 kk		77
15
29		1,9 ± 2,1
1,5
1,3 ± 1,5		 «Pliska BT, Nam H, Chen H ym. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med 2014;10:128»3
«Martínez-Gomis J, Willaert E, Nogues L ym. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010;80:30-6 »6
«Doff MH, Finnema KJ, Hoekema A ym. Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects. Clin Oral Investig 2013;17:475-82 »8
Purentasuhteen sagittaalinen muutos (mm)24 kk291,3 ± 1,5 «Doff MH, Finnema KJ, Hoekema A ym. Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects. Clin Oral Investig 2013;17:475-82 »8
Pysyvä purennan muutos14–58 kk
64 kk		15
155		7–17
18		 «Martínez-Gomis J, Willaert E, Nogues L ym. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010;80:30-6 »6
«Marklund M, Franklin KA. Long-term effects of mandibular repositioning appliances on symptoms of sleep apnoea. J Sleep Res 2007;16:414-20 »5

Kirjallisuutta

  1. Lam B, Sam K, Mok WY ym. Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax 2007;62:354-9 «PMID: 17121868»PubMed
  2. Engleman HM, McDonald JP, Graham D ym. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Respir Crit Care Med 2002;166:855-9 «PMID: 12231497»PubMed
  3. Pliska BT, Nam H, Chen H ym. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med 2014;10:1285-91 «PMID: 25325593»PubMed
  4. Lawton HM, Battagel JM, Kotecha B. A comparison of the Twin Block and Herbst mandibular advancement splints in the treatment of patients with obstructive sleep apnoea: a prospective study. Eur J Orthod 2005;27:82-90 «PMID: 15743867»PubMed
  5. Marklund M, Franklin KA. Long-term effects of mandibular repositioning appliances on symptoms of sleep apnoea. J Sleep Res 2007;16:414-20 «PMID: 18036087»PubMed
  6. Martínez-Gomis J, Willaert E, Nogues L ym. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010;80:30-6 «PMID: 19852636»PubMed
  7. Zhou J, Liu YH. A randomised titrated crossover study comparing two oral appliances in the treatment for mild to moderate obstructive sleep apnoea/hypopnoea syndrome. J Oral Rehabil 2012;39:914-22 «PMID: 23016888»PubMed
  8. Doff MH, Finnema KJ, Hoekema A ym. Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects. Clin Oral Investig 2013;17:475-82 «PMID: 22562077»PubMed