轻中度OSAHS患者戴用下颌前伸止鼾器前后上气道形态及呼吸功能变化
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摘要
目的观察轻、中度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apneahypopnea syndrome,OSAHS)患者戴用下颌前伸止鼾器(mandibular advancement snore stopping devices,MASSD)前后上气道形态及呼吸功能的变化,为明确MASSD治疗轻、中度OSAHS患者的治疗机制及临床疗效提供参考和依据。方法 60例经多导睡眠监测确诊为轻、中度OSAHS患者,晚10点至次日7点以多导睡眠监测仪监测戴用MASSD前后患者的鼾声次数、呼吸紊乱指数及最低血氧饱和度的改变。行戴用MASSD前后的上气道CBCT扫描,运用InVi-vo Dental软件重建上气道的三维形态,测量上气道各平面的矢状径、冠状径及各分区最小横截面积、容积。结果戴用MASSD前,60例患者在监测时间段9 h内的鼾声次数为[946(542,1 010)],呼吸紊乱指数为(20.61±5.19)、最低血氧饱和度为(78±8)%;戴用MASSD后,患者鼾声次数[19(11,30)]、呼吸紊乱指数(10.86±4.31)明显减小,最低血氧饱和度升高(92±3)%,差异有统计学意义(P<0.001)。较戴用MASSD前,戴用MASSD后,除硬腭平面前后的矢状径、冠状径差异无统计学意义外(P>0.05),上气道各平面的矢状径、冠状径均增大,上气道各分区及上气道最小横截面积均增大、上气道各分区容积及上气道容积均增大,差异均有统计学意义(P<0.001)。结论戴用MASSD使轻、中度OSAHS患者的气道打开,增加上气道通气量,患者呼吸功能得到改善。
Objective To investigate the changes of the upper airway shape and respiratory function in patients with mild and moderate obstructive sleep apnea-hypopnea syndrome(OSAHS) before and after wearing mandibular advancement snore stopping devices(MASSD), providing a reference and basis for the treatment mechanisms and clinical efficacy of MASSD for patients with mild and moderate OSAHS. Methods Sixty patients who were diagnosed with mild and moderate OSAHS by polysomnography were selected. Snoring frequency, the apnea hypopnea index and lowest oxygen saturation in 60 patients before and after treatment were compared. The patients' upper airways were scanned by CBCT before and after wearing MASSD. In Vivo Dental software was used to reconstruct the three-dimensional shape of upper airway. The upper airway sagittal diameter, the coronal diameter, the minimum ross-sectional area and the volume of each segment were measured. The snoring frequency, the apnea hypopnea index and the lowest oxygen saturation were compared before and after treatment. Results Before wearing MASSD, the snoring frequency, the apnea hypopnea index, and the minimum oxygen saturation of 60 patients were [946(542,1 010)],(20.61 ± 5.19),and(78 ± 8)%,respectively. After wearing MASSD,the snore frequency [19(11,30)] and the respiratory disorder index(10.86±4.31)decreased significantly and the minimum oxygen saturation increased(92 ± 3)%. Compared with before wearing MASSD,no statistically significance differences were detected(P > 0.05) except for the sagittal diameter and coronal diameter of the surface of the palatum durum. The sagittal diameter and the coronal diameter of each plane of the airway increased,and the minimum cross-sectional area of each section of the airway and the volume of each section of the airway displayed varying degrees of significant increases(P < 0.001) after wearing MASSD. Conclusion Wearing MASSD can open the airways of patients with mild and moderate OSAHS and increase the airway volume of the upper airway to improve the respiratory function.
Objective To investigate the changes of the upper airway shape and respiratory function in patients with mild and moderate obstructive sleep apnea-hypopnea syndrome(OSAHS) before and after wearing mandibular advancement snore stopping devices(MASSD), providing a reference and basis for the treatment mechanisms and clinical efficacy of MASSD for patients with mild and moderate OSAHS. Methods Sixty patients who were diagnosed with mild and moderate OSAHS by polysomnography were selected. Snoring frequency, the apnea hypopnea index and lowest oxygen saturation in 60 patients before and after treatment were compared. The patients' upper airways were scanned by CBCT before and after wearing MASSD. In Vivo Dental software was used to reconstruct the three-dimensional shape of upper airway. The upper airway sagittal diameter, the coronal diameter, the minimum ross-sectional area and the volume of each segment were measured. The snoring frequency, the apnea hypopnea index and the lowest oxygen saturation were compared before and after treatment. Results Before wearing MASSD, the snoring frequency, the apnea hypopnea index, and the minimum oxygen saturation of 60 patients were [946(542,1 010)],(20.61 ± 5.19),and(78 ± 8)%,respectively. After wearing MASSD,the snore frequency [19(11,30)] and the respiratory disorder index(10.86±4.31)decreased significantly and the minimum oxygen saturation increased(92 ± 3)%. Compared with before wearing MASSD,no statistically significance differences were detected(P > 0.05) except for the sagittal diameter and coronal diameter of the surface of the palatum durum. The sagittal diameter and the coronal diameter of each plane of the airway increased,and the minimum cross-sectional area of each section of the airway and the volume of each section of the airway displayed varying degrees of significant increases(P < 0.001) after wearing MASSD. Conclusion Wearing MASSD can open the airways of patients with mild and moderate OSAHS and increase the airway volume of the upper airway to improve the respiratory function.
引文
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[4] Thapa A, Jayan B, Nehra K. Pharyngeal airway analysis in obese and non-obese patients with obstructive sleep apnea syndrome[J].Med J Armed ForcesIndia, 2015, 71(2):369-375.
[5] Abramson Z, Susarla S, August MA, et al. Three-Dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea[J]. J Oral Maxillofac Surg, 2010, 68(2):354-362.
[6] Hatcher DC. Cone beam computed tomography:craniofacial and airway analysis[J]. Dent Clin North Am, 2012, 56:343-357.
[7] Gagnadoux F, Priou P, Urban T. Sleep apneas, metabolic syndrome and cardiovascular risk:data from the Pays de la Loire sleep cohort[J]. Revue de Pneumologie Clin, 2017, 73(6):299-305.
[8] Roberts JA, Drage NA, Davies J, et al. Effective dose from cone beam CT examinations in dentistry[J]. Br J Radiol, 2009, 82(973):35-40.
[9] Ye JY. Hot point of OSAHS in clinic:a brief discussion[J]. J Clin Otorhinolaryngol Head Neck Surg, 2016, 30(6):427-428.
[10] Wu JL, Gu M, Chen SM. Factors related to pediatric obstructive sleep apnea-hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups[J]. Medicine, 2017,96(42):8281.
[11] Hill E. Obstructive sleep apnoea/hypopnoea syndrome in adults with Down syndrome[J]. Breath(Sheffield, England), 2016, 12(4):91-96.
[12] CY Liu, Lu HY, Dong FS. Effects of a mandibular advancement device on genioglossus in obstructive sleep apnoea hypopnea syndrome[J]. Eur J Orthod, 2015, 37(3):290-296.
[13] Friedman M, Wilson MN, Pulver T. Screening for obstructive sleep apnea/hypopnea syndrome:subjective and objective factors[J]. Otolaryngol Head Neck Surg, 2010, 142(4):531-535.
[2] Urtnasan E, Park JU, Lee KJ. Multiclass classification of obstructive sleep apnea/hypopnea based on a convolutional neural network from a single-lead electrocardiogram[J]. Physiol Measurement, 2018, 39(6):65003.
[3] Zhang H, Yang F, Guo YC. The contribution of chronic intermittent hypoxia to OSAHS:from the perspective of serum extracellular microvesicle proteins[J]. Metabolism, 2018, 85:97-108.
[4] Thapa A, Jayan B, Nehra K. Pharyngeal airway analysis in obese and non-obese patients with obstructive sleep apnea syndrome[J].Med J Armed ForcesIndia, 2015, 71(2):369-375.
[5] Abramson Z, Susarla S, August MA, et al. Three-Dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea[J]. J Oral Maxillofac Surg, 2010, 68(2):354-362.
[6] Hatcher DC. Cone beam computed tomography:craniofacial and airway analysis[J]. Dent Clin North Am, 2012, 56:343-357.
[7] Gagnadoux F, Priou P, Urban T. Sleep apneas, metabolic syndrome and cardiovascular risk:data from the Pays de la Loire sleep cohort[J]. Revue de Pneumologie Clin, 2017, 73(6):299-305.
[8] Roberts JA, Drage NA, Davies J, et al. Effective dose from cone beam CT examinations in dentistry[J]. Br J Radiol, 2009, 82(973):35-40.
[9] Ye JY. Hot point of OSAHS in clinic:a brief discussion[J]. J Clin Otorhinolaryngol Head Neck Surg, 2016, 30(6):427-428.
[10] Wu JL, Gu M, Chen SM. Factors related to pediatric obstructive sleep apnea-hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups[J]. Medicine, 2017,96(42):8281.
[11] Hill E. Obstructive sleep apnoea/hypopnoea syndrome in adults with Down syndrome[J]. Breath(Sheffield, England), 2016, 12(4):91-96.
[12] CY Liu, Lu HY, Dong FS. Effects of a mandibular advancement device on genioglossus in obstructive sleep apnoea hypopnea syndrome[J]. Eur J Orthod, 2015, 37(3):290-296.
[13] Friedman M, Wilson MN, Pulver T. Screening for obstructive sleep apnea/hypopnea syndrome:subjective and objective factors[J]. Otolaryngol Head Neck Surg, 2010, 142(4):531-535.