双侧拉杆式口腔矫治器治疗OSAHS前后上气道容积变化及相关因素分析

Volume change of upper airway induced by mandibular advancement device in patients with obstructive sleep apnea hypopnea syndrome and analysis of relevant factors

目的 通过计算机体层摄影观察轻、中度阻塞型睡眠呼吸暂停、低通气综合征患者戴用双侧拉杆式口腔矫治器前后上气道形态变化及其相关因素分析.方法 经夜间多导睡眠仪监测确诊为OSAHS的男性患者9名,年龄25～43岁,平均37岁（中位数）,戴用口腔矫治器治疗有效.3个月后分别行CT扫描,三维重建后行定量分析.结果 所有患者戴用矫治器后上气道各段容积及总容积均增大.总容积的增加百分比与患者体重指数成负相关（r=-0.70,P=0.03）,与患者下颌平面角（MP-SN）没有显著相关性（r=-0.43,P=0.25）.上气道容积的增加与患者睡眠呼吸障碍的严重程度及改善程度无明显相关关系（r=0.30,P=0.43;r=0.39,P=0.29）.结论 双侧拉杆式口腔矫治器使OSAHS患者上气道大小、形态趋于正常.体重指数影响气道大小改善的程度.同时气道大小改善的程度与患者的睡眠呼吸状况改善并不一致.

Objective To investigate the morphologic change of upper airway induced by oral appliance（OA） of double-pull rods in obstructive sleep apnea and hypopnea syndrome（OSAHS） and analyze relevant factors, subsequently investigate treatment mechanism of OA for OSAHS. Methods Nine OSAHS patients （male, 25-43yeas old）, diagnosed by polysomnography, successfully treated with OA. After 3 months treatment, each patient received Helical computed tomography in central relation with and without OA respectively. Upper airway structures were reconstructed at threedimension and measured by VG Studio. Results The volume of the upper airway of all 9 patients were increased when patients with OA. A significant negative relationship was found between △volume and BMI（r=-0. 70,P=0. 03）. No significant relationship is found between△volume and FH-MP（r=-0. 43,P=0. 25）, between△volume and AHI （without OAs）（r=0. 30,P=0. 43）, and between△volume and△AHI（r= 0. 39, P=0. 29）. Conclusions OSAHS patients can be effectively treated with mandibular advancement devices （MAD）, with increased volume of upper airway which is influenced by BMI. The degree of volume increase is not consistent with improvement induced by treatment in patients with OSAHS.