口腔矫治器联合改良UPPP术治疗伴下颌后缩的中-重度OSAHS

Therapeutic analysis of oral appliance combined with M-UPPP in treating moderate and severe OSAHS accompanied with mandibular retrusion

目的 :分析口腔矫治器联合改良悬雍垂腭咽成形术(modified-uvulopalatopharyngoplasty, M-UPPP)治疗伴下颌后缩的中-重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)的疗效。方法:经多导睡眠描记法(polysomnography, PSG)诊断为中-重度OSAHS患者36例,且存在腭咽平面狭窄伴下颌后缩,行M-UPPP术。术后1个月按个人意愿分为两组:A组20例,接受手术并佩戴口腔矫治器;B组16例,单纯接受M-UPPP术。所有患者分别于术前、术后1个月、术后6个月行PSG监测,记录呼吸暂停低通气指数(apnea hypopnea index, AHI)、最低血氧饱和度(lowest oxygen saturation, LSaO2)值,X线头影测量舌后气道间隙(posterior airway space, PAS)值,并采用Epworth嗜睡量表(Epworth sleepness scale, ESS)及鼾声视觉模拟评分(visual analogue scale, VAS)评价患者的主观症状。结果:所有患者术后1个月AHI、LSaO2、ESS评分及鼾声VAS评分与术前相比差异均有统计学意义(均P<0.05);术后1个月两组AHI、LSaO2、ESS评分、VAS评分及X线头影测量PAS值差异无统计学意义(P>0.05);术后6个月A组患者PAS值及LSaO2较B组升高,AHI、ESS评分及VAS评分均较B组降低(均P<0.05)。结论:对于明确为腭咽平面狭窄并伴下颌后缩的中-重度OSAHS患者,在患者有较好依从性的情况下,采用M-UPPP术联合佩戴个性化口腔矫治器的综合治疗,可取得较好疗效。

Objective:To investigate the efficacy of oral appliance combined with modified-uvulopalatopharyngoplasty(M-UPPP)in the treatment of moderate and severe obstructive sleep apnea-hypopnea syndrome(OSAHS)accompanied with mandibular retrusion.Methods:Thirty-six patients were diagnosed as moderate or severe OSAHS accompanied with mandibular retrusion whose obstructive plane was in the oropharynx measured by polysomnography(PSG)and X-ray cephalometrics.All patients were treated with M-UPPP and classified into two groups as their own wishes.Twenty patients in group A received oral appliance one month after M-UPPP,while sixteen patients in group B only received M-UPPP.Apnea hypopnea index(AHI)and lowest oxygen saturation(LSaO2)were collected by PSG and posterior airway space(PAS)was determined by X-ray cephalometrics.Epworth sleepness scale(ESS)and visual analogue scale(VAS)were used to evaluate the subjective symptoms of patients.Results:One-month postoperative monitoring showed AHI,LSaO2,ESS and VAS were improved significantly after surgery(P<0.05).However,there was no significant difference between group A and group B(P>0.05).In the 6th month after operation,LSaO2 score of snore and PAS in group A were signicantly increased in group A compared to group B(P<0.05).While six-month postoperative VAS score and AHI score of snore were significantly reduced in group A compared to group B(P<0.05).Conclusion:For those patients got OSAHS with mandibular retrusion and the obstruction plane were in oropharynx,when patients with good compliance,the methods of oral appliance union M-UPPP had good therapeutic effect.Oral appliance combined with M-UPPP has a good therapeutic effect for the patients with OSAHS accompanied with mandibular retrusion whose obstructive plane is in the oropharynx in case of good compliance.