口腔矫治器治疗颈动脉粥样硬化伴OSAHS患者对脑血流储备力的影响

Effect of oral appliance treatment on cerebrovascular reserve in patients with carotid atherosclerosis and OSAHS

目的探讨口腔矫治器干预治疗颈动脉粥样硬化伴阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea and hypopnea syndrome,OSAHS)患者时对其脑血流储备力的影响。方法选择2016年7月至2017年12月在本院收治的46例经颈动脉超声检查和多导睡眠监测(polysomnography,PSG)确诊的颈动脉粥样硬化伴OSAHS患者,在口腔矫治器治疗前和治疗1个月后进行屏气试验,比较其屏气指数(breath-holding index,BHI)的变化,同时行PSG监测复查疗效,比较治疗前后PSG指标的变化,并进行PSG指标与BHI变化的相关性分析。结果 46例OSAHS患者中,41例治疗有效,有效率达89%。与治疗前比较,口腔矫治器治疗1个月后,呼吸暂停低通气指数降低,最长呼吸暂停时间减少,氧减百分时间降低,最低血氧饱和度升高,深睡眠期及快动眼期睡眠时间百分比增加,BHI也明显增加,差异均有显著性(P<0.05;P<0.01);且口腔矫治器治疗后BHI变化与氧减百分时间的变化呈正相关(P<0.05)。5例治疗无效的患者体重指数明显高于41例有效患者,且其治疗前后BHI未见明显变化。结论口腔矫治器治疗能在短期内显著提高颈动脉粥样硬化伴OSAHS患者的脑血流储备力。

Objective To investigate the treatment effect of cerebrovascular reserve（CVR）with Silensor IL appliance for carotid atherosclerosis with OSAHS patients. Method 46 patients with carotid atherosclerosis and OSAHS were recruited in and diagnosed with carotid artery ultrasound and polysomnography. All the 46 patients, before treated with Silensor IL appliance and after one month treatment, were accepted Breath holding test with transcranial cerebral doppler（TCD）. The changes of PSG index before and after one month treatment were compared to evaluate the therapeutic effect, and the change of BHI was also compared to evaluate cerebrovascular reserve ability, then the correlation analysis were made between the changes of BHI and PSG index value. Result Of the 46 patients, 41 patients respond positively to the one month treatment and the effective rate is 89%. To compare the indicators of polysomnography before and after treatment in positive treatment patients, the minimum blood oxygen saturation increased significantly; the longest apnea time decreased significantly; the percentage of blood oxygen saturation below 90% decreased significantly; all the index mentioned above showed statistical differences（P〈0.05）; and the percentage of deep sleep stage and rapid eye movement stage increased（P〈0.05）. After 1 month continuous wearing Silensor IL appliance, the average BHI of 41 OSAHS patients, who are positive response to appliance treatment, increased significantly and indicated the elevation of cerebrovascular reserve（P〈0.01）. The BHI of 5 OSAHS patients, who are no response to oral appliance treatment, did not show significant difference. The change of BHI index was positively correlated with the change value of percentage of blood oxygen saturation below 90% after one month treatment. Conclusion The Silensor IL appliance can effectively treat OSAHS. The cerebrovascular reserve of Patients with OSAHS and carotid atherosclerosis could be elevated by application of oral appliance in short time.