不同疗程戴用口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征的疗效对比

Efficacy of oral appliance therapy of obstructive sleep apnea and hypopnea syndrome in different periods of treatment

目的:观察阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者戴用不同疗程的口腔矫治器后,治疗效果的持续情况。方法:55例经多导睡眠监测诊断为OSAHS的患者,使用下颌前移型口腔矫治器治疗,下颌前伸量为患者下颌最大前伸量的60%~70%,下颌张口量为前牙切端间距4~5mm,患者每周戴用5~7 d,每天戴用6~8 h。对疗效进行回顾,根据戴用时间长短,分为4个时间组(1年以下组、1~2年组、2~6年组和6~9年组)进行比较,观察睡眠呼吸暂停及低通气指数(apnea-hypopnea index,AHI)、最长呼吸暂停时间、最低血氧饱和度(lowest oxygen saturation,LSa O_2)治疗前后的变化。结果:AHI(次/h)在1年以下组[24.50(14.65,54.05)vs.7.40(2.12,10.00),P<0.001]、1~2年组[19.50(12.15,39.23)vs.1.80(0.70,6.58),P=0.001]、2~6年组[25.00(11.41,42.60)vs.4.50(1.35,7.90),P=0.001]和6~9年组[26.2(16.95,47.45)vs.4.00(1.90,26.70),P=0.043]治疗前后差异均有统计学意义;最长呼吸暂停时间在6年以下的3个组均有降低,1年以下组由57.00(37.70,61.50)s降至25.00(15.90,33.50)s(P<0.001),1~2年组由41.00(25.50,62.26)s降至13.10(0.00,22.10)s(P=0.001),2~6年组由42.50(30.35,58.15)s降至15.60(0.00,28.10)s(P=0.003);最低血氧饱和度LSa O_2在1年以下组及2~6年组有所升高,1年以下组由初始的74.18%±7.96%升至84.06%±7.67%(P=0.001),2~6年组由76.71%±10.98%升至84.06%±4.64%(P=0.006),而在1~2年组及6~9年组差异无统计学意义。在组间比较中,Kruskal-Wallis检验示4组患者经矫治器治疗后,各项睡眠呼吸指数差异均无统计学意义(P>0.05)。结论:口腔矫治器是一种长期治疗OSAHS的比较有效的方法,但是医生应加强对患者的疗效追踪,督促患者复诊检查,以确保疗效的持续性,并及时根据需要更换矫治器。

Objective： To investigate the long-term efficacy of oral appliance treating of obstructive sleep apnea and hypopnea syndrome （OSAHS） in different periods of treatment. Methods： A total of 55 patients were included in the study. Patients were all diagnosed with OSAHS by overnight polysomnography and all received oral appliance （OA） as the therapy. The OA positioned the mandible at 60% - 70% of the maximal mandible advancement position and created a 4 - 5 mm incisor separation. The patients were instructed to wear the appliance during sleep, 6 -8 hours per day, for 5 -7 days per week. They were divided into four groups by the period of treatment, including less than 1 year group; 1 -2 years group ; 2 - 6 years group and 6 - 9 years group. The polysomnographic study was used to investigate the efficacy of the four groups. The outcome measures included the score on the apnea-hypopnea index （AHI）, the longest apnea time and the lowest oxygen saturation （LSaO2 ） levels during an overnight sleep. Results： The AHI decreased significantly in all the four groups. The less than 1 year group decreased from 24.50 （ 14.65, 54.05 ） to 7.40 （2.12,10.00） events/h （ P 〈 0. 001 ） ; The 1 - 2 years group decreased from 19.50 （ 12.15, 39.23） to 1.80 （0.70, 6.58） events/h （P =0. 001 ） ; The 2 -6 years group decreased from 25.00 （11.41,42.60） to 4.50 （ 1.35, 7.90） events/h （P =0. 001 ） ; The 6-9 years group decreased from 26.2 （16.95, 47.45） to 4.00 （1.90, 26.70） events/h （P = 0. 043 ）. The longest apnea decreased significantly in less than 1 year group, 1 -2 years group and 2 - 6 years group. The longest apnea decreased from 57.00 （37.70, 61.50） to 25.00 （ 15.90, 33.50） seconds （P 〈0. 001） in the less than 1 year group, from 41.00 （25.50, 62.26） to 13. 10 （0.00, 22.10） seconds （P =0. 001 ） in the 1 -2 year group and from 42.50 （30.35,58.15） to 15.60 （0.00, 28.10） seconds （ P = 0.003 ） in the 2 - 6 year group. The LSaO2 levels increased significantly in the less than 1 year group and 2 -6 years group. The LSaO2 levels rose significantly in the less than 1 year group, from 74.18% -＋7.96% to 84.06% -＋7.67% （P =0.001）, and in the 2 -6 years group, from 76.71% ± 10.98% to 84.06% ±4.64% （P =0. 006）, The LSaO2 levels did not increase significantly in the 1 -2 years and 6 -9 years groups. Kruskal-Wallis test showed that there were no statistically significant differences in the AHI, longest apnea time and LSaO2 in 4 the groups. Conclusion： The oral appliance is an effective therapy for patients with OSAHS in the long-term treatment. However, it＇ s recommended to make appointments with patients as a follow-up supervision whether there is any efficacy decrease. And the oral appliance should be replaced if necessary.