阻塞性睡眠呼吸暂停患者及打鼾者的颌面结构分析(英文)

CEPHALOMETRIC ANALYSIS IN SNORERS AND PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

比较阻塞性睡眠呼吸暂停（Ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａ，ＯＳＡ）患者、打鼾者与正常对照的颌面结构，以探讨ＯＳＡ的发病过程及可能机制。研究对象为８６例男性ＯＳＡ患者、４５例男性打鼾者及３７例健康成年男性，均行多导睡眠仪检查证实或排除ＯＳＡ；数字化技术摄取头颅侧位片，应用ＮＩＨＩｍａｇｅ软件测定骨性结构、软组织结构、舌骨位置、咽气道口径参数２３项。ＯＳＡ患者、打鼾者的骨性结构、软组织结构、舌骨位置、咽气道口径均在异常，其中舌长度、口腔外舌面积、舌骨位置、腭水平气道口径在对照组、ＯＳＡ患者与打鼾者间均有显著差异，经身高体重指数（ＢＭＩ）校正后除舌长度、部分舌骨位置参数外结果基本不变．多元逐步回归分析提示胞胖程度、上颌骨缺陷、软腭舌接触线长度、咽长度对ＯＳＡ严重度影响较大。打鼾者与ＯＳＡ患者同样存在颌面结构异常，其中部分软组织相关参数介于ＯＳＡ患者和正常人之间，软组织的变化可能在ＯＳＡ发生发展中起重要作用。

To investigate the differences in craniofacial structure among obstructive sleep apnea (OSA) patients, snorers and normal subjects, and the possible mechanisms involved in the development from snoring to OSA. Eighty six male OSA patients, 45 male snorers and 37 healthy man were enrolled. All had completed one night polysomnographic examination and taken lateral cephalogram by digital image processing system. Cephalometric measurements were done by computer software (NIH Image), 23 variables were used concerning bone structure, soft tissue structure, hyoid bone position and upper airway dimension. Both OSA patients and snorers had abnormalities in craniofacial structure. The main differences among three groups were tongue length (TGL, control group: (83.4±7.0)mm; OSA group: (88.2±7.0)mm; snorer group: (85.4±7.2)mm), tongue area out of oral cavity (Ton2, control group: (575.4±221.5)mm 2; OSA group: (973.5±330.6)mm 2; snorer group: (851.3±236.1)mm 2), hyoid bone position (B/Me/H, control gruup: (104.3±11.7)°; OSA group: (122.0±13.7)°; snorer group: (114.1± 10.9)° ) and pharyngeal airway dimension (AWPP, control group:(25.0±5.1)mm; OSA group: (17.3±6.4)mm; snorer group:(20.1±6.0)mm). When the body mass index (BMI) was corrected, the results remained the same except for tongue length and a part of hyoid bone position parameters. BMI, maxillary defect, soft palate-tongue contact length and pharyngeal length were found to have relative greater influence on the apneic severity. Like OSA patients, snorers also have craniofacial structure abnormalities, and some soft tissue variables are between those of OSA patients and normal subjects. Soft tissue changes may play an important part in the development of OSA