分体式口腔矫治器治疗OSAHS患者前后上呼吸道形态CBCT分析

Morphological changes of upper airway in OSAHS patients after treatment with oral appliance: a cone beam computed tomography evaluation

目的观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者戴用分体式口腔矫治器前后呼吸功能及上呼吸道形态的变化,探讨口腔矫治器治疗OSAHS的机制。方法对15例经多导睡眠仪监测确诊为轻、中度OSAHS患者,戴用口腔矫治器前及戴用矫治器3个月后的上呼吸道行CBCT扫描,运用MIMICS 10.01和AutoCAD2010对上气道各段的矢状径、横径、截面积以及容积等指标进行测量分析,并比较治疗前后OSAHS患者呼吸暂停指数(AI)、低通气指数(HI)、呼吸紊乱指数(AHI)和最低血氧饱和度(SaO2)等指标的变化。结果戴用口腔矫治器治疗后,OSAHS患者上呼吸道腭咽和舌咽区域的矢状径、横径、横截面积和体积均明显增大(P<0.05),而鼻咽区域变化不明显。戴用口腔矫治器后呼吸暂停指数(AI)、低通气指数(HI)、呼吸紊乱指数(AHI)明显降低(P<0.05),最低血氧饱和度(SaO2)显著提高(P<0.05)。结论 OSAHS患者戴用口腔矫治器后,可通过扩大上气道腭咽和舌咽区域,保持上气道气流通畅,改善患者的呼吸功能而达到治疗目的。

Objective To investigate the morphological changes of the upper airway in OSAHS （obstructive sleep apnea-hypopnea syndrome） patients after treatment with split oral appliance and the mechanism of the treatment. Methods Fifteen patients with OSAHS were included and received split oral appliance treatment. Three months after treatment, the morphological changes of the upper airway, including sagittal diameter, transverse diameter, cross-sectional area and volume were evaluated by CBCT. The apnea index （AI）, hypopnea index （HI）, apnea hypopnea index （AHI）and SaO2 were compared before and after treatment. Results After treatment with split oral appliance, the sagittal diameter, transverse diameter, cross-sectional area and volume significantly increased （ P 〈 0.05 ） , but the nasopharynx area had no obvious change. The AI, HI and AHI decreased significantly （ P 〈 0.05 ）. SaO2 increased significantly （ P 〈 0. 05 ）. Conchlsion The size of upper airway of OSAHS patients was enlarged significantly after treatment with split oral appliance which maintained the patency of the airflow in upper airway.