1. The purpose of this study is to detect the differences of carotid atherosclerosis severity between patients with or without OSAHS(Obstructive Sleep Apnea and Hypopnea Syndrome) in a cross-sectional study in a large sample. 2. Then a longitudinal control study is conducted to observe the progress of the carotid atherosclerosis by vascular ultrasonography and the occurrence of cerebrovascular events after the intervention of the oral appliance for treating OSAHS，and finally explore the feasibility of using oral appliance to treat OSAHS in primary prevention of ischemic stroke.
1. the relevance of OSAHS and carotid atherosclerosis Patients are distributed questionnaire and recruited from neurology clinic，vascular ultrasonography clinic of Xuanwu Hospital if they match the inclusion criteria. After initial screening, carotid atherosclerosis patients with skeptical OSAHS are sent to sleep center for polysomnography examination to determine the severity of OSAHS. At least 50 patients for mild, moderate, severe OSAHS each are recruited for OSAHS Group. At least 100 patients without snoring from questionnaire and without OSAHS after PSG screening are recruited for non OSAHS Group. Vascular ultrasonography examination for carotid are done for the two groups. Data of carotid vascular plaque from two groups are collected. Statistics are done to detect differences of carotid atherosclerosis severity between patients with and without OSAHS, also the severity of OSAHS. 2. the relevance of the progress of carotid atherosclerosis and oral appliances intervention for treating OSAHS All carotid atherosclerosis patients with OSAHS are from patients of the first study. If they consent the treatment of oral appliances, they are recruited into this second study. At least 100 patients are recruited. They are divided into 2 groups by randomized block design by Evidence-based Medicine Center of Xuanwu Hospital. One group is oral appliance intervention group, the other group is no intervention group. The intervention group patients accept oral appliance treatment, and no intervention group patients do not accept OSAHS treatment. The two groups both accept anti-hypertension treatment or anti-diabetes treatment, or anti-hyperlipidemia treatment according to their own situation in neurology clinic. At timepoint of initial time, one month after oral appliance treatment, one and a half year after oral appliance treatment, the intervention group should accept PSG(Polysomnography) examination to monitor the treatment of OSAHS. At timepoint of initial time, one month after oral appliance treatment, one and a half year after oral appliance treatment, the two groups should accept breath holding test to monitor the cerebral vascular reserve. At timepoint of initial time, one and a half year after oral appliance treatment, the two groups should accept carotid vascular ultrasonography examination to monitor the progress of carotid atherosclerosis. Cerebrovascular events and death are recorded from initial time. Statistics are done to detect the influence of treatment of OSAHS on carotid atherosclerosis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
100
mandibular advancement device to enlarge pharyngeal airway space to get rid of apnea and hypopnea events
apnea hypopnea events 0 in Times
apnea and hypopnea times per hour
Time frame: initial time when patients are recruited
apnea hypopnea events 1 in Times
apnea and hypopnea times per hour
Time frame: one month after oral appliance treatment
apnea hypopnea events 2 in Times
apnea and hypopnea times per hour
Time frame: one and a half years after oral appliance treatment
longest apnea time 0 in Seconds
longest apnea or hypopnea time
Time frame: initial time when patients are recruited
longest apnea time 1 in Seconds
longest apnea or hypopnea time
Time frame: one month after oral appliance treatment
longest apnea time 2 in Seconds
longest apnea or hypopnea time
Time frame: one and a half years after oral appliance treatment
Blood oxygen saturation less than 90% of the total monitoring time percentage 0 in percentage
Blood oxygen saturation less than 90% of the total monitoring time percentage
Time frame: initial time when patients are recruited
Blood oxygen saturation less than 90% of the total monitoring time percentage 1 in percentage
Blood oxygen saturation less than 90% of the total monitoring time percentage
Time frame: one month after oral appliance treatment
Blood oxygen saturation less than 90% of the total monitoring time percentage 2 in percentage
Blood oxygen saturation less than 90% of the total monitoring time percentage
Time frame: one and a half years after oral appliance treatment
lowest Oxygen Saturation 0 in percentage
blood lowest oxygen saturation during the whole night
Time frame: initial time when patients are recruited
lowest Oxygen Saturation 1 in percentage
blood lowest oxygen saturation during the whole night
Time frame: one month after oral appliance treatment
lowest Oxygen Saturation 2 in percentage
blood lowest oxygen saturation during the whole night
Time frame: one and a half years after oral appliance treatment
atherosclerosis plaque thickness 0 in common carotid artery in milimetre
atherosclerosis plaque thickness is distance from the most convex point of plaque to carotid media
Time frame: initial time when patients are recruited
atherosclerosis plaque thickness 1 in common carotid artery in milimetre
atherosclerosis plaque thickness is distance from the most convex point of plaque to carotid media
Time frame: one and a half years after oral appliance treatment
atherosclerosis plaque length 0 in common carotid artery in milimetre
atherosclerosis plaque length is distance from the beginning to the end of a separate plaque
Time frame: initial time when patients are recruited
atherosclerosis plaque length 1 in common carotid artery in milimetre
atherosclerosis plaque length is distance from the beginning to the end of a separate plaqu
Time frame: one and a half years after oral appliance treatment
atherosclerosis plaque thickness 0 in internal carotid artery in milimetre
atherosclerosis plaque thickness is distance from the most convex point of plaque to carotid media
Time frame: initial time when patients are recruited
atherosclerosis plaque thickness 1 in internal carotid artery in milimetre
atherosclerosis plaque thickness is distance from the most convex point of plaque to carotid media
Time frame: one and a half years after oral appliance treatment
atherosclerosis plaque thickness 0 in carotid bulb in milimetre
atherosclerosis plaque thickness is distance from the most convex point of plaque to carotid media
Time frame: initial time when patients are recruited
atherosclerosis plaque thickness 1 in carotid bulb in milimetre
atherosclerosis plaque thickness is distance from the most convex point of plaque to carotid media
Time frame: one and a half years after oral appliance treatment
atherosclerosis plaque length 0 in internal carotid artery in milimetre
atherosclerosis plaque length is distance from the beginning to the end of a separate plaque
Time frame: initial time when patients are recruited
atherosclerosis plaque length 1 in internal carotid artery in milimetre
atherosclerosis plaque length is distance from the beginning to the end of a separate plaque
Time frame: one and a half years after oral appliance treatment
atherosclerosis plaque length 0 in carotid bolb in milimetre
atherosclerosis plaque length is distance from the beginning to the end of a separate plaque
Time frame: initial time when patients are recruited
atherosclerosis plaque length 1 in carotid bolb in milimetre
atherosclerosis plaque length is distance from the beginning to the end of a separate plaque
Time frame: one and a half years after oral appliance treatment
breath holding index 0 in percentage/seconds
breath holding index = (v2-v1)/v2\*100/t. v2 is average velocity of middle cerebral artery after breath holding, v1 is average velocity of middle cerebral artery before breath holding, t is time for breath holding.
Time frame: initial time when patients are recruited
breath holding index 0 in percentage/seconds
breath holding index = (v2-v1)/v2\*100/t. v2 is average velocity of middle cerebral artery after breath holding, v1 is average velocity of middle cerebral artery before breath holding, t is time for breath holding.
Time frame: one and a half years after oral appliance treatment
End systolic velocity of common carotid artery 0 in cm/s
the velocity of common carotid artery at the end of systolic period
Time frame: initial time when patients are recruited
End systolic velocity of common carotid artery 1 in cm/s
the velocity of common carotid artery at the end of systolic period
Time frame: one and a half years after oral appliance treatment
End systolic velocity of internal carotid artery 0 in cm/s
the velocity of internal carotid artery at the end of systolic period
Time frame: initial time when patients are recruited
End systolic velocity of internal carotid artery 1 in cm/s
the velocity of internal carotid artery at the end of systolic period
Time frame: one and a half years after oral appliance treatment
End systolic velocity of carotid bulb 0 in cm/s
the velocity of carotid bulb at the end of systolic period
Time frame: initial time when patients are recruited
End systolic velocity of carotid bulb 1 in cm/s
the velocity of carotid bulb at the end of systolic period
Time frame: one and a half years after oral appliance treatment
end diastolic velocity of common carotid artery 0 in cm/s
the velocity of common carotid artery at the end of diastolic period
Time frame: initial time when patients are recruited
end diastolic velocity of common carotid artery 1 in cm/s
the velocity of common carotid artery at the end of diastolic period
Time frame: one and a half years after oral appliance treatment
end diastolic velocity of internal carotid artery 0 in cm/s
the velocity of internal carotid artery at the end of diastolic period
Time frame: initial time when patients are recruited
end diastolic velocity of internal carotid artery 1 in cm/s
the velocity of internal carotid artery at the end of diastolic period
Time frame: one and a half years after oral appliance treatment
end diastolic velocity of carotid bulb 0 in cm/s
the velocity of carotid bulb at the end of diastolic period
Time frame: initial time when patients are recruited
end diastolic velocity of carotid bulb 1 in cm/s
the velocity of carotid bulb at the end of diastolic period
Time frame: one and a half years after oral appliance treatment
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