治疗阻塞性睡眠呼吸暂停综合征有效的口腔矫治器戴入后上气道及周围结构的变化

Changes of upper airway volume and around its structure in patients with obstructive apnea / hypopnea syndrome who were treated effectively with the oral appliances

目的了解阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者戴入治疗成功的口腔矫治器后上气道结构的变化。方法选取22例口腔矫治器治疗成功的OSAHS患者及22例无鼾正常牙合配对组,摄取病例治疗前、戴用口腔矫治器时及配对组的X线头颅定位侧位片,测量并分析三组上气道及周围结构16项测量项目的差别。选用配对样本t检验及单因素方差分析的统计学方法。结果①82%患者治疗后睡眠指标达正常标准;②与配对组相比OSAHS患者上气道后间隙及悬雍垂尖至咽后壁距较窄,舌骨至下颌平面距较大,舌较短;③戴入口腔矫治器后患者舌体下降,舌变短而平坦,舌骨上移,下颌骨前下方移位,上气道后间隙扩大,与配对组比较,除舌体下移外其它测量项目值差异无显著性。结论成功治疗OSAHS患者的口腔矫治器戴入后使患者上气道结构趋于正常。

Objective To investigate the differences of upper airway volume and around its structure in patients with obstructive sleep apnea / hypopnea syndrome （OSAHS） after effective oral appliances treatment. Methods 22 OSAHS patients who were treated successfully with mandibular advancement oral appliances and 22 control subjects being nonsnore and normal occlusion were involved in the research. Each patient underwent cephalometric film and polysomonography （PSG） before and after oral appliance therapy. Each control subject was also taken cephalometric film. Sleep parameters and sixteen cephalometric items were analyzed. Statistic paired - sample T test and one -way ANOVA analyses were performed. Results ①Of 82% OSAHS patients＇ sleep indices were normal after the oral appliance therapy;②Compared to the control group, the patients with OSAHS had narrower upper- posterior airway volume and shorter distance from tip of the uvula to the posterior pharyngeal wall and lower positioned hyold bone and shorter tongue before treatment; ③Compared to before treatment, the OSAHS patients after therapy had lower positioned and shorter and flatter tongue, the upper hyoid bone, more anterior and downward mandibular and wider upper- posterior airway volume. In comparison to control subjects, the indices were almost the same except for the lower positioned tongue Conclusion The sagittal dimension of upper airway in OSAHS patients wearing oral appliance effectively is similar to the normals＇.