软或硬塑下颌前移口腔矫治器治疗阻塞型睡眠呼吸暂停综合征（附20例报告）

目的 软或硬塑下颌前移口腔矫治器（OA）治疗阻塞型睡眠呼吸暂停综合征（OSAS）的疗效分析。方法 使用软或硬塑下颌前移OA治疗OSAS患者20例,3个月后复查主观症状及多导睡眠图（PSG）。结果 软、硬塑下颌前移OA以及合并统计患者的耐受率分别为83%、75%、78%,鼾声、睡眠憋醒、白日嗜睡等症状改善或消失,PSG五项监测指标前后差异有显著性,治疗后明显好转。结论 软或硬塑下颌前移OA是治疗OSAS的较好方法。     

改良型Activator矫治器治疗OSAS疗效评价

目的 :通过戴用改良型Activator矫治器治疗OSAS ,探讨其影响患者睡眠呼吸结构 ,改善通气的作用机制。方法 :13例患者均根据多导睡眠呼吸监测结果及临床表现确诊为OSAS ,戴用改良的Activator矫治器 1-2月后再行多导睡眠呼吸监测 ,并与戴用前进行比较 ;结果 :戴用改良型Activator矫治器后 ,呼吸暂停低通气指数、呼吸紊乱指数、睡眠呼吸紊乱指数、最长呼吸暂停时间 (s)分别降低了 4.73± 3 .64、3 0 .85± 13 .3 2、3 0 .0 2± 9.48、5 5 .3 1± 2 2 .19(P <0 .0 1) ,最低血氧饱和度则升高了 13 .85± 6.2 4(P <0 .0 1) ,患者的客观症状如睡眠鼾声等得以改善。结论 :改良型Activator矫治器是下颌前移口腔矫治器治疗OSAS一种比较好的方法。     

口腔矫治器治疗阻塞性睡眠呼吸暂停综合征的临床研究

目的评价改良口腔矫治器治疗阻塞性睡眠呼吸暂停综合征(OSAS)的临床疗效。方法采用下颌前移式口腔矫治器治疗24例OSAS患者,治疗前后分别经夜间多导睡眠监测(PSG),比较睡眠呼吸暂停指数(AI)、呼吸暂停低通气指数(AHI)、最低血氧饱和度(SaO2)等呼吸紊乱指标的变化。结果治疗前、后患者呼吸暂停指数、呼吸暂停低通气指数、血氧饱和度指标变化差异有显著性(P<0.001),21例呼吸暂停低通气指数下降了50%以上,客观有效率为87.5%。结论改良口腔矫治器是治疗轻、中度阻塞性睡眠呼吸暂停综合征的有效方法。     

用下颌前移垫治疗鼾症和阻塞性睡眠呼吸暂停综合征患者2年后颅下颌功能状态的评价

鼾症和阻塞性睡眠呼吸暂停综合征(obstructivesleep apnoea syndrome,OSAS)是人群中较常见的疾病。OSAS可以引起高血压,夜间心律不齐,肺动脉高压等多种并发症,甚至猝死。使用下颌前移类(牙合)垫治疗鼾症和OSAS的同时,也可能增加口面部的负担,对TMU和口颌系统产生不良影响。本文拟对用下颌前移类(牙合)垫治疗鼾症和阻塞性睡眠呼吸暂停综合征2年后患者TMJ和咀嚼系统的功能状态进行     

下颌正中前移的方法探究

目的探讨判断下颌正中前移的方法。方法48例鼾症及阻塞性睡眠呼吸暂停综合征患者使用口腔矫治器治疗,采用双侧后牙前移相同距离及前移前后上下前牙区中线不变的方法来判断下颌正中前移后,摄双侧颞下颌关节薛氏位X线片检查髁突前移情况。结果2例双侧髁突前移距离不同,其余46例相同。结论下颌前移前后,上下前牙区中线一致及双侧后牙前移距离相同,并不表示髁突前移距离亦相同,但前者是后者的重要评判指标。     

021.用下颌前移垫治疗鼾症和阻塞性睡眠呼吸暂停综合征患者2年后颅下颌功能状态的评价

[英]/Bondemark L…∥Eur J Orthod.-2000,22(1).-53～60 鼾症和阻塞性睡眠呼吸暂停综合征 (obstructive sleep apnoea syndrome, OSAS) 是人群中较常见的疾 病.OSAS可以引起高血压,夜间心律不齐,肺动脉 高压等多种并发症,甚至猝死.使用下颌前移类 垫治疗鼾症和OSAS的同时,也可能增加口面部的 负担,对TMJ和口颌系统产生不良影响.本文拟对 用下颌前移类垫治疗鼾症和阻塞性睡眠呼吸暂停 综合征2年后患者TMJ和咀嚼系统的功能状态进行 评价. 材料和方法选择鼾症和OSAS患者共32名. 制作每个患者的下颌前移类口腔矫治器,下颌前移 占下颌最大前伸量的50%～70%,垂直向打开至上 下切牙切缘间5 mm的间隙,用后牙卡环固位,矫正 器垫覆盖所有牙齿.分别在治疗前和治疗2年后 对患者进行有关TMJ和症状的问卷调查,同时进行 下颌运动和TMJ功能的临床检查,并在模型上测量 前牙覆、覆盖和磨牙关系. 结果 2年间所有患者均能接受下颌前移矫 治器的治疗,并能坚持每天戴用6～8 h,每周5～7 d.对比治疗前和治疗2年后的问卷调查,结果无显 著性差异.临床检查显示2年后下颌运动正常,无 下颌运动痛,TMJ、咀嚼肌触诊和治疗前无区别.但 是关节弹响者从治疗前的9人增加至2年后的12 人.测量模型表明前牙覆覆盖减小,磨牙关系更 偏近中.提示下颌前移及切牙唇倾度改变. 讨论使用下颌前移垫治疗鼾症和OSAS 是否会增加口面部负担是人们关心的问题.本研究 结果表明戴用此种垫2年后并未发现对颅颌系统 有副作用,治疗前TMJ和肌肉健康的患者口颌系统 能很好地耐受这种治疗.模型测量表明下颌近中移 动,切牙唇倾,但是变化量很小,临床检查和患者本 人并未发现.这些变化可能是因为TMJ改建或神 经肌肉的适应性使下颌位置产生变化.研究中发现 患者头痛减轻,原因可能是睡眠中憋气减少,睡眠质 量提高,动脉血氧饱和度提高,因此戴用垫对头痛 是有益的治疗.尽管治疗2年后关节弹响的患者有 所增加,但并无显著性,可能仅仅反映了关节弹响的 正常变化. 结论戴用下颌前移垫并未对TMJ和口 颌系统造成不良影响,说明此种治疗是可以耐受的. 但是关系的确发生了微小变化,特别是垫治疗 要持续终身,因此需要对TMJ、牙面形态、牙齿移动、 牙周组织进行更长期、进一步的评价. [张士杰摘贾培增校]     

口腔矫治器治疗阻塞性睡眠呼吸暂停综合征

目的探讨口腔矫治器对阻塞性睡眠呼吸暂停综合征(OSAS)患者的临床疗效.方法将32例OSAS患者分为轻中度组和重度组,分别制作"下颌前移型"口腔矫治器并在睡眠时配戴,用多导睡眠图监测患者治疗前后睡眠结构及呼吸功能的变化.结果使用口腔矫治器后轻中度组和重度组患者的呼吸暂停指数(AI)分别平均下降11.3次/小时(P＜0.001)和26.01次/小时(P＜0.001),最低SaO2分别平均升高3.65%(P＜0.01)和19.75秒(P＜0.05).结论口腔矫治器是治疗该病的一种有效的疗法.     

高弹性压膜式口腔矫治器治疗OSAS的临床应用研究

目的:通过应用高弹性压膜式口腔矫治器治疗阻塞性睡眠呼吸暂停综合症(OSAS),探求一种解除不能耐受手术或手术失败的,拒绝戴用CPAP的有效治疗方法,并且此方法还能解决塑料矫治器力量过于强硬而造成颞颌关节区不适等问题。方法:应用此技术临床治疗14例轻中度OSAS患者,治疗前后进行多导睡眠仪检测并拍摄头颅侧位片,观察疗效,并与塑料矫治器进行比较。结果:经临床应用及比较观察,患者乐于戴用此压膜式口腔矫治器,戴用后AI,AHI明显下降(P<0.01),SaO2明显上升(P<0.01)。头颅侧位片测量各指标显示下颌前移,软腭后、舌背后的上气道明显扩张,鼾声、日间嗜睡等症状明显改善。结论:高弹性压膜式口腔矫治器能有效治疗0SAS,消除或减少鼾声及呼吸暂停,提高血氧饱和度,比塑料矫治器力量柔和,固位好,便于摘戴和携带,有利颞颌关节的健康,而且制作过程简便,快捷,是一项值得推广应用的技术[1]。     

双侧拉杆式口腔矫治器治疗阻塞性睡眠呼吸暂停综合征的临床应用

目的探讨双侧拉杆式口腔矫治器在阻塞性睡眠呼吸暂停综合征（OSAS）治疗中的应用价值。方法用双侧拉杆式阻鼾器治疗OSAS患者18例，3-5个月后复查主观症状及多导睡眠图（PSG）。结果该矫治器的耐受率为89％，鼾声、白日嗜睡、夜间憋醒、口干及咽痛等症状改善或消失，PSG五项监测结果治疗前后有显著性差异，症状明显改善。结论该矫治器制作简单，戴用舒适，易于推广应用。     

Bionator矫治器治疗阻塞性睡眠呼吸暂停综合征

目的 对Bionator矫治器治疗阻塞性睡眠呼吸暂停综合征（OSAS) 疗效进行观察。方法 对8例确诊为OSAS的患者行Bionator保持咬He型矫治器治疗。作治疗前后X线头影测量分析,结合导睡眠图监测来评价疗效。结果 低通气指数（HI）、呼吸暂停指（AI）、呼吸紊乱指数（AHI）明显降低;而最低血氧饱和度(SaO2）则明显升高。头影测量表示下颌前移,上气道间隙明显扩大（P＜0．01）。结论 Bionator保持咬He矫治器可改善上气道通气状态,从而达到治疗OSAS的目的。     

两种口腔矫治器治疗老年OSAS的临床疗效评价

目的:探讨两种口腔矫治器治疗老年阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)的临床疗效。方法:选取40例老年OSAS患者,随机分为A、B两组,分别戴用silensor口腔矫治器和压膜式改良activator矫治器治疗。治疗6个月后,通过多导睡眠监测和上气道形态的CBCT测量,并结合患者主诉症状改善情况,评价两种口腔矫治器对老年OSAS患者的疗效。结果:戴用两种口腔矫治器后,老年OSAS患者的打鼾、憋醒和嗜睡症状得到改善;最低血氧饱和度升高,呼吸紊乱指数和呼吸暂停时间明显降低,差异具有统计学意义(P<0.05)。CBCT扫描显示腭咽和舌咽气道矢状径、面积和体积较治疗前明显增大,组间差异无统计学意义(P>0.05)。而silensor矫治器舒适度显著性优于改良activator式矫治器。结论:两种口腔矫治器对老年OSAS均有良好的临床疗效,silensor可调式矫治器的舒适性更好。     

分体可调式止鼾器治疗OSAS的临床研究

目的：探讨分体可调式止鼾器治疗阻塞性睡眠呼吸暂停综合征（OSAS）的效果。方法：35例OSAS患者制作分体可调式矫治器，采用多导睡眠仪监测患者戴用前后呼吸紊乱指数（AHI），呼吸暂停指数（AI），低通气指数（HI）和SaO2指标变化，进行标准化问卷调查。结果：戴用矫治器前后对比，32例呼吸暂停低通气指数下降50％以上；呼吸暂停指数和低通气指数分别降低81．17％和49．45％（P〈0．01），夜间最低血氧饱和度明显升高（P〈0．01）．患者睡眠质量均有显著改善，鼾声均消失或明显减轻．结论：分体可调式止鼾器治疗轻、中度OSAS疗效明显。     

下颌前移矫正器治疗阻塞性睡眠呼吸暂停综合征患者的疗效分析

目的　分析下颌前移矫正器治疗阻塞性睡眠呼吸暂停综合征 (OSAS)的临床疗效及与颅面结构、上气道的关系。方法　对 4 0例轻、中度OSAS患者进行治疗前X线头影测量 ,睡眠时戴用下颌前移矫正器治疗 ,用多导睡眠图监测评价疗效 ,并与颅面结构、上气道各指标进行相关分析。结果　下颌前移矫正器治疗OSAS患者的客观有效率为 88.6 %。治疗前、后睡眠呼吸暂停的通气指数 (AHI)减少百分比 (△AHI)与颅面结构中的SNB角 (r =- 0 4 97) ,ANB角 (r=0 .5 36 )及下颌平面角MP -FH(r=- 0 2 5 2 )相关 ,亦与舌骨高度H -MP(r=- 0 35 1)及软腭的长度SPL(r=- 0 36 6 )相关。结论　下颌前移矫正器通过前移下颌间接扩大上气道达到治疗效果     

Microimplant-based mandibular advancement therapy for the treatment of snoring and obstructive sleep apnea: a prospective study

Objective:To investigate the efficacy of orthodontic microimplant–based mandibular advancement therapies for the treatment of snoring and obstructive sleep apnea (OSA) in adult patients.Materials and Methods:Ten adult OSA patients (seven men, three women; mean age 60.00 ± 9.25 years) were each treated with two mandibular orthodontic microimplants attached to a customized reverse face mask for mandibular advancement. Pretreatment and posttreatment outcome measures of microimplant mobility, apnea-hypopnea index, snoring, respiratory movement, and Epworth sleepiness scores were evaluated after 6 months.Results:Highly significant reductions in the apnea-hypopnea index, snoring, and sleep variables were observed. Sixteen of the 20 (80%) microimplants were stable and showed no mobility, and four (20%) demonstrated grade 1 or 2 mobility and required removal and reinsertion of a new microimplant.Conclusions:Favorable reductions in sleep variables highlight the potential of microimplant-based mandibular advancement therapy as an alternative treatment modality for OSA patients who cannot tolerate continuous positive airway pressure and oral appliance therapy.     

可调式口腔矫治器治疗睡眠呼吸暂停综合征后患者的上气道形态变化

目的比较可调式口腔矫治器治疗不同程度阻塞性睡眠呼吸暂停综合征(OSAS)患者前后上气道三维形态的变化。方法采用可调式口腔矫治器对多导睡眠监测仪及白天嗜睡量表诊断为OSAS的36例患者进行治疗,戴用4个月时,比较不同程度OSAS患者治疗前后舌咽、腭咽等不同部位上气道形态在CBCT下的变化。结果相比治疗前,在戴用可调式矫治器4个月时,轻度OSAS患者腭咽和舌咽各部位的变化值均有统计学意义;对于中度OSAS患者,除腭咽段最小横径变化,及舌咽段最小横径和最小截面积变化外,其余变化均有统计意义;重度OSAS患者腭咽和舌咽各部位的变化值均无统计学意义。结论可调式矫治器治疗轻中度OSAS患者,气道变化明显;对于重度OSAS患者来说,气道改善不明显。     

Non-apneic snoring and the orthodontist: the effectiveness of mandibular advancement splints

OBJECTIVE: Non-apneic snoring is a very common problem, which impacts on all family members. Oral appliances have been used in the management of snoring. These posture the mandible forward during sleep, opening the airway and so reducing the potential for noise generation. This articles aims to objectively evaluate the effectiveness of mandibular advancement splints (MAS) in non-apneic snorers. DESIGN: Prospective clinical trial. SETTING: University Dental Hospital and School. SUBJECTS AND METHODS: 35 consecutively referred adults with proven non-apneic snoring. INTERVENTIONS: Subjects were fitted with a removable, adjustable Herbst MAS. MAIN OUTCOME MEASURES: Questionnaires determined changes in snoring incidence, daytime tiredness, any side effects and their duration. Eleven subjects completed overnight domiciliary sleep recordings of oxygen saturations, pulse rates and sound profile, before and 1 month after fitting the MAS. RESULTS: The questionnaires and sleep recordings suggested that the MAS significantly reduced snoring incidence (p<0.05) and improved sleep quality. Daytime tiredness, as assessed by the Epworth Sleepiness Scale, was significantly reduced (p<0.001). Initial side effects of muscular and TMJ discomforts were mostly resolved after 1 month of appliance wear. CONCLUSIONS: Use of a MAS improves snoring incidence and sleep quality in most patients with non-apneic snoring.     

Orthodontic appliances in the treatment of sleep apnea: a cephalometric and polysomnographic study]

AIM: Effects of oral appliances on snoring in patients with obstructive sleep apnoea syndrome: correlation between cephalometry with and without oral appliance (OA) in place. SUBJECTS: 15 patients were treated with 3 types of OA: Herbst, tooth positioner and QuietKnight. METHODS: All patients underwent a full-night diagnostic polysomnography. They were asked to use their OA each night during one month. All the subjects then underwent a second polysomnography with the OA in place. Standard cephalometric analysis was done in each patient with and without the OA in place. RESULTS: Although average apnea-hypopnea index decreased significantly, snoring was not affected by the OA. Only in 7 patients a reduction was observed. There was a strong correlation between the change in snoring index during sleep and 2 cephalometric variables: ANB angle without, and overjet with the OA in place. No change in quality of sleep was observed. CONCLUSION: OA are indeed effective in decreasing the number of obstructive apneas and hypopneas, without affecting the quality of sleep. Snoring reduction with OA may be predicted by cephalometry.     

Effects of a mandibular advancement device for the treatment of sleep apnea syndrome and snoring on respiratory function and sleep quality

In this study the fabrication of a simplified mandibular advancement device for sleep apnea syndrome was described. Its effect on respiratory function and sleep quality variables was evaluated polysomnographically in 256 patients with sleep apnea syndrome and snoring. Polysomnographic recordings were performed twice, before and after insertion of the oral appliance. The mean apneahypopnea index (AHI) decreased significantly (p < 0.0001) with the appliance to 18.2 from 43.2 without it. Responders defined by AHI < 10 were 54% and those defined as a 50% decrease of AHI were 66%. Oxygen saturation, duration of apnea, sleep efficiency, and total arousal were improved significantly after treatment without major side effects. The device improved significantly the respiratory function and sleep quality in patients with sleep apnea syndrome. Compliance was about 90% followed for 2.5 years. This appliance offers some advantages over other therapies because it is noninvasive, easy to fabricate, and well accepted by patients.     

双(牙合)板矫治器治疗阻塞性睡眠呼吸暂停综合征的研究

目的介绍一种上下颌分体式的双(牙合)板矫治器,探讨应用该矫治器治疗阻塞性睡眠呼吸暂停综合征(OSAS)的效果.方法为 29 例 OSAS 患者制作双(牙合)板矫治器,戴用矫治器前后进行多导睡眠监测对比疗效;治疗前后进行标准化的问卷调查,记录患者症状的变化及口颌系统的不适感和副作用.结果与戴用矫治器前比较,26 例的呼吸暂停低通气指数下降了 50 % 以上,客观有效率为 89.7 %;呼吸暂停指数和低通气指数分别降低 74.39 % 和 47.94 %(P<0.01),夜间最低血氧饱和度明显升高(P<0.01).戴用矫治器初期不适症状主要为唾液增多及晨起后短暂的颞下颌关节和牙齿的酸胀感,一周内不适感基本消失.结论双(牙合)板矫治器是治疗轻、中度OSAS 的有效方法,其长期疗效和副作用尚待进一步观察.     

三种阻鼾器对男性OSAHS患者颞下颌关节的影响初探

目的对比热塑成形型阻鼾器,改良型Twin Block型阻鼾器以及Silensor型阻鼾器对阻塞性睡眠呼吸暂停低通气综合征患者颞下颌关节的影响。方法临床收集颞下颌关节正常且患阻塞型睡眠呼吸暂停低通气综合征男性患者30名(60侧),随机平均分为三组,分别予以热塑成形型阻鼾器,改良型Twin Block型阻鼾器以及Silensor型阻鼾器治疗OSAHS,在治疗前、治疗一个月及治疗三月时对患者行颞下颌关节CT扫描、颞下颌关节检查。测量颞下颌关节前(A)、后间隙(P)大小,记录颞下颌关节新增症状侧数,对数据进行统计分析。结果三组患者在治疗前、治疗一个月、治疗三个月时的关节前、后间隙方差分析表明各组在治疗过程中关节间隙均无明显变化(P>0.1)。三组患者组间的log(eP/A)值方差分析显示三种阻鼾器在治疗患者时,关节前、后间隙的log(eP/A)值总体均值无差异(P>0.1)。治疗一个月和三个月时,三组患者新增颞下颌关节症状侧数χ2检验均大于0.1,在新增关节症状上无差异。结论三种阻鼾器在三个月治疗中均末对颞下颌关节产生影响,临床治疗OSAHS患者时应密切关注患者颞下颌关节情况。