下颌适度前移矫治器治疗对阻塞性睡眠呼吸暂停及上气道容积的影响

Impact of Oral Appliance Treatment for Moderate Mandibular Advancement on Obstructive Sleep Apnea Syndrome and Upper Airway Volume

目的:研究下颌适度前移矫治器(mandibular advancement device,MAD)治疗对阻塞性睡眠呼吸暂停(obstructive sleep apnea syndrome,OSAS)及上气道容积的影响。方法:选择2017年6月~2018年9月经河南省中医院收治的阻塞性睡眠呼吸暂停综合征患者57例进行下颌适度前移矫治器治疗。比较治疗前与治疗6个月后患者症状与体征指标;记录鼻阻力、气道容积和原位横截面积。根据呼吸暂停低通气指数(apnea hypopnea index,AHI)降低,治疗反应分为完全、部分或非完全。分析MAD治疗后6个月影响因素及MAD上咽气道通畅性与鼻腔阻力,并采用多元性分析原位MAD增加上呼吸道总容积的预测因素。使用SPSS20.0软件包对数据进行统计分析。结果:男性平均年龄小于女性,男性已婚人数占比及大专以上教育程度占比高于女性(P<0.05);完全响应组年龄、治疗后AHI低于部分/不完全反应组,存在位置AHI、覆牙合高于部分/非完全响应组(P<0.05);治疗结束后/原位MAD AHI、仰卧性AHI、动脉血氧饱和度(Percutaneous oxygen saturation,SaO2)<90%、打鼾、打鼾症状、睡量、平均总鼻呼吸阻力低于无原位MAD,口咽面积、口咽、下咽、鼻咽最小横截面积、总咽气道容积高于无原位MAD(P<0.05);凸面型轮廓呈正相关,下面部高度增加、咽喉反流与上呼吸道容积增大呈负相关(P<0.05),其余因素无显著相关性(P>0.05)。结论:多数患者适宜下颌中度前移,MAD疗效显著。下颌前移后,凸面型轮廓患者咽气道容积增加更为明显,下面部高度偏大与咽喉反流是限制气道容积增加的重要因素。

Objective:To investigate the impact of moderate mandibular advancement device(MAD)on obstructive sleep apnea syndrome(OSAS)and upper airway volume.Methods:57 OSAS patients underwent oral appliance therapy with MAD in Henan Province Hospital of TCM from June 2017 to September 2018 were enrolled.Indicators of symptoms and signs were compared between baseline and 6 months after treatment.Nasal resistance,airway volume,and in situ cross-sectional area were recorded.Based on apnea hypopnea index(AHI)reduction,the treatment response was classified as complete,partial,and non-complete.The influencing factors of treatment outcomes 6 months after MAD therapy,and upper pharyngeal airway patency and nasal resistance with and without MAD in situ were analyzed.Furthermore,multivariate analysis was carried out on the predictors.Data were processed by SPSS20.0 software.Results:The average age of male was smaller than that of female.The proportions of married and educational level above college degree were higher in male than in female(P<0.05).Age and post-treatment AHI of complete response group were lower than those of partial/non-complete response group(P<0.05).While the AHIsupine and overbite were higher than those of partial/non-complete response group(P<0.05).The AHI,AHIsupine,and oxygen saturation(SaO)were lower than 90%.Snoring,snoring symptoms,sleep quality,and total nasal inspiratory resistance of data after 6 months therapy/MAD in situ were lower than those of data without MAD in situ(P<0.05).The nasopharynx volume,oropharynx volume,hypopharynx volume,minimum cross-sectional area,and total pharyngeal airway volume were higher than those of data without MAD in situ(P<0.05).Convex profile had a positive correlation.Increased lower facial height and laryngopharyngeal reflux were negatively correlated with the increase in total upper airway volume(P<0.05),and there was no significant correlation with other indicators(P>0.05).Conclusion:Excellent MAD therapy outcomes are achieved in most patients.After treatment,the increase in airway volume is positively correlated with convex profile,and negatively associated with increased lower facial height and laryngopharyngeal reflux.