Clinical effect and airway changes of adjustable oral appliance in the treatment of adult obstructive sleep apnea hypopnea syndrome
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摘要: 目的:探讨可调节型阻鼾器治疗成人OSAHS的临床疗效并观察上气道改变及对颞颌关节的影响。方法:多导睡眠监测(PSG)确诊的40例成人OSAHS患者,使用可调节型阻鼾器治疗6个月后采用PSG评估睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2),并通过锥体束CT(CBCT)三维重建分析上气道大小形态的改变,初步观察颞颌关节前后隙的变化。结果:治疗后PSG结果显示,LSaO2均明显大于治疗前(P<0.01),AHI明显低于治疗前(P<0.01)。CBCT分析示口咽气道总容积、气道最小横截面积、最小矢状径、最小横径均明显大于治疗前(P<0.01)。颞下颌关节髁状突运动位置并未超过术前最大开口位生理运动范围,髁状突表面皮质骨形态与连续性未发现明显异常。结论:成人OSAHS采用可调节型阻鼾器治疗后,气道容积、横截面积、矢状及横向宽度增加,改善了通气,在保持舒适度的同时减少了对颞颌关节的影响,且初步观察未对颞下颌关节产生影响。
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关键词:
- 睡眠呼吸暂停低通气综合征 /
- 阻塞性 /
- 阻鼾器 /
- 上气道 /
- 颞颌关节
Abstract: Objective: To investigate the effect of adjustable oral appliance on airway changes and clinical effect in obstructive sleepApnea hypopnea syndrome,and to observe the effect of jaw joints.Method: Forty adult cases diagnosed as OSAHS by polysomnography(PSG),were treated with adjustable oral appliance.After six months,the sleep apnea hypoventilation index(AHI)and the lowest oxygen saturation(LSaO2) by PSG were evaluated.And three-dimensional cone beam computed tomography(CBCT) reconstruction was used to analyze the morphological changes of the upper airway,and the gap of jaw joint preliminarily.Result: After such treatment,LSaO2 level of all cases increased,and AHI reduced(P<0.01).The total volume and area of the upper airway increased significantly(P<0.01), There was no obvious anomalies found in jaw joints.Conclusion: The adjustable oral appliance applied to in adult OSAHS can increase the shape and size of the airway,improve the airway ventilation effectively,and have no affection to the jaw joints in initial observation.-
Key words:
- sleep apnea hypopnea syndrome /
- obstructive /
- oral appliance /
- upper airway /
- jaw joints
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[1] LI Z P,ZHONG Y,HUANG J Q, et al.The association of apnea hypopnea indices with body mass index in patients with OSAS[J].J Clin Pul Med,2008,13:971-972.
[2] 贾培增,傅民魁,曾祥龙.下颌前伸对阻塞性睡眠呼吸暂停综合征患者上气道形态的作用[J].北京大学学报(医学版),2003,35(6):663-667.
[3] ANIKA A,COLMAN M,URBAN H.Subjective effieacy of oral appliance design features in the management of obstructive sleep apnea:a systematic review[J].Am J Orthod Dentofac Orthop,2010,138:559-576.
[4] 李峰,蔡卓莺,武建潮.口腔矫治器治疗OSAHS疗效评价体系的研究进展[J].口腔医学,2011,31(7):431-433.
[5] 中华耳鼻咽喉头颈外科杂志编委会,中华医学会耳鼻咽喉科学分会.儿童阻塞性睡眠呼吸暂停低通气综合征诊疗指南草案(乌鲁木齐)[J].中华耳鼻咽喉头颈外科杂志,2007,42(2):83-84.
[6] 王瑞永,马绪臣,张万林. 健康成年人颞下颌关节间隙锥形束计算机体层摄影术测量分析[J]. 北京大学学报(医学版),2007,39(5):503-506.
[7] ALMEIDA F R,LOWE A A. Principles of oral appliance therapy forthe management of snoring and sleep disordered breathing[J]. Oral Maxillofac Surg Clin North Am,2009,21:413-420.
[8] 金煌,卢晓峰. 口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征及上气道形态的变化[J]. 上海口腔医学,2008,17(1):100-102.
[9] HOFFSTEIN V. Review of oral appliances for treatment of sleepdisorderedbreathing[J]. Sleep Breath,2007,11:1-22.
[10] PADMA A,NRAMAKRISHNAN V N. Management of obstructivesleep apnea:a dental perspective[J]. Indian J Dental Res,2007,18:201-209.
[11] LOWE A A,FLEETHAM J A,ADACHI S,et al.Cephalometric and computed tomographic predictors of obstructive sleep apnea severity[J].Am J Orthod Dentofac Orthop,1995,107:589-595.
[12] 张佐,杨红琴,王铁荣,等.自行调节式口腔矫治器治疗OSAHS的效果[J].宁夏医学杂志,2007,29(10):885-887.
[13] FLEURY B,RAKOTONAHARY D,PETELLE B,et al.Mandibular advancement titration for obstructive sleep apnea:optimization of the procedure by combining clinical and oximetric parameters[J].Chest,2004,125:1761-1767.
[14] DOFF M H,VELDHUIS S K,HOEKEMA A,et al. Long-term oralappliance therapy in obstructive sleep apnea syndrome:acontrolled study on temporomandibular side effects[J]. Clin Oral Investig,2012,16:689-697.
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