口腔矫治对阻塞性睡眠呼吸暂停低通气综合征患者睡眠呼吸功能增龄变化的影响

Effect of oral appliance treatment on age-related changes of sleep respiratory function in patients with obstructive sleep apnea hypopnea syndrome

目的探索口腔矫治器(oral appliance,0A)治疗能否减缓阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患考的增龄性改变。方法本研究为回顾性研究,筛选出1995—2005年在北京大学口腔医学院正畸科接诊的15例(12男,3女)使用0A治疗的OSAHS患者作为治疗组,平均年龄(47.44±10.00)岁,初始体质量指数(BMI)为(26.31±3.33)kg/m^2,复诊间隔54[22, 100]个月。筛选19例(13男,6女)未经治疗的OSAHS患者作为对照组,平均年龄(45.00±9.26)岁.初始BMI(25.53±2.58) kg/m^2,复诊间隔35[26, 63]个月。两组患者在性别、年龄、初始BMI、呼吸暂停低通气指数(apnea hypopneaindex,AHI)及复诊间隔差异无统计学意义。对两组患者整夜多道睡眠监测(PSG)资料进行比较,通过秩和检验(Wilcoxon配对法)观察两组患者睡眠呼吸功能随年龄变化的情况。结果复诊时,治疗组及对照组BMI差异均无统计学意义[治疗组:(26.31±3.33) kg/m^2比(25.67±3.65) kg/m^2,Z=-1.223,P=0.221;对照组:(25.53±2.58) kg/m^2比(25.12±2.72) kg/m^2,Z=-1.193,P=0.233]。治疗组AHI变化差异无统计学意义(26.20[ 11.50,52.98]次/h 比23.10[16.00,45.00]次,Z=-0.284,P=0.776);对照组 AHI复诊时较初诊时升高(15.00[10.72,28.90]次/h 比31.10[13.00,41.80]次/h,Z=-3.481 ,P<0.001 )。最长呼吸暂停时间,治疗组差异无统计学意义(60.00[56.40,74.00] s比63.00[52.00,77.00] s,Z=-0.345,P=0.730);对照组较初诊时升高(42.00[34.00,56.70]s比46.00[37.00,62.00] s,Z=-2.274,P=0.023)。最低动脉血氧饱和度在治疗组及对照组前后差异均无统计学意义(治疗组:72.47%±12.69%比72.73%±17.59%,Z=-0.597,P=0.550;对照组:78.21 %±9.30%比76.42%±12.17%,/=-0.153.P=0.879)。结论OSAHS患者睡眠呼吸暂停症状有随年龄增大而加重的趋势,口腔矫治器治疗可能具有减缓这种增龄性恶化的作用。

Objective The severity of obstructive sleep apnea hypopnea syndrome (OSAHS) has a tendency to in crease with age. The purpose of this study was to explore whether oral appliance (OA) treatment can block this age-related change. Methods This study was a retrospective study. Fifteen patients (12 males,3 females) of OSAHS treated with OA were selected as treatment group.with an average age of (47.44± 10.00) years and initial body mass index (BMI) of (26.31 ±3.33) kg/m^2. The follow-up length was 54 [22, 100| months. Nineteen patients (13 males,6 fenuiles) with untreated OSAHS sened as controls, with an average age of (45.00±9.26) years and initial BMI of (25.53±2.58) kg/m^2,and the follow-up length was 35 [26,63] months. There were nt) significant differences in tenns of gender.age,initial BMI. apnea hypopnea index(AHI). and follow-up length between the two groups. Polysomnography(PSG) data for the two groups were compared to observe the sleep respiratory function changes as aging l)y Wilcoxon test. Results Therewas no significant difference in BM1 of the treatment group and the control group at the time of follow-up, with BM1 of treatment group from (26.31 ±3.33) kg/nr to (25.67±3.65) kg/m^2,Z=-1.223,P=0.221;and BMI of control group from (25.53±2.58) kg/m^2 to (25.12±2.72) kg/m^2,Z=-1.193,P=0.233. There was no significant difference in the change of AHI within the treatment group, from 26.20 [11.50,52.98]/h to 23.10 [16.00, 45.00]/h,Z=-0.284,P=0.776;AHI in the control group was higher than that at the first visit,and the AHI increased from 15.00 110.72, 28.90]/h to 31.10 [13.00, 41.80]/h,Z=- 3.481, P<0.001. The longest apnea duration was not statistically different in the treatment group, from 60.00 [56.40,74.00]s to 63.00 [52.00, 77.00] s,Z=-0.345.P=0.730;the longest apnea duration in the control group increased from 42.00 [34.00, 56.70]s to 46.00 [37.00,62.00]s,Z=-2.274,P=0.023. There was no significant difference in the lowest blood oxygen saturation of the treatment group and the control group, with the treatment group from 72.47%±12.69% to 72.73%± 17.59%,Z=-0.597,P=0.550;and the control group from 78.21%±9.30% to 76.42%± 12.17%,Z=-0.153,P=0.879. Conclusion Symptoms of sleep apnea in OSAHS patients tend to increase with age,and oral appliance treatment may have the effect of slowing down this age-related worsening effect.