可调节型阻鼾器治疗成人OSAHS的临床疗效研究

Clinical effect and airway changes of adjustable oral appliance in the treatment of adult obstructive sleep apnea hypopnea syndrome

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。

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.