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。     

两种不同口腔矫治器治疗OSAHS的疗效评价

目的：评价两种不同口腔矫治器治疗阻塞型睡眠呼吸暂停低通气综合症（OSAHS）的疗效。方法：12例经过多导睡眠图（PSG）监测及临床表现确诊为OSAHS的患者随机分成两组,分别制作改良的Activator矫治器和阻鼾器。6～8周后经PSG监测,并将临床表现与治疗前进行比较。结果：戴用两种不同口腔矫治器后,呼吸紊乱指数（AHI）、平均呼吸暂停时间（MAT）、呼吸暂停指数（AI）、鼾声指数均有明显降低,而血氧饱和度（SaO：）则有明显升高。在矫治器的固位状况比较中,改良的Activator矫治器优于阻鼾器,在戴用舒适度上阻鼾器略优于改良的Acti-vator矫治器。结论：两种不同口腔矫治器在治疗OSAHS中均是比较好的方法,但在矫治器的选配上需因人而异,老年人、高角病例不宜选择阻鼾器。     

下颌前伸式阻鼾器的改良及对轻中度OSA的临床疗效评价

目的: 对临床常用的胶联一体下颌前伸式阻鼾器进行改良,评价其对轻、中度阻塞型睡眠呼吸暂停综合征(OSA)的临床疗效。方法: 40例经多导睡眠呼吸监测(PSG)确诊为轻、中度OSA(5＜AHI＜30)的患者,随机将其均分为实验组及对照组,分别佩戴改良一体式阻鼾器和软压膜一体式阻鼾器,佩戴前及3月后行个人问卷调查及PSG监测,分别记录患者主观症状及睡眠参数变化,比较两组治疗前、后情况差异。结果: 与治疗前比较, 实验组18例的AHI下降了50%以上,客观有效率为90%,高于对照组55%;实验组治疗后N1%显著减少、N2%和N3%显著增加(P<0.05),对照组治疗前、后睡眠结构没有明显改善。实验组主观症状改善率高于对照组,无睡眠中阻鼾器脱落现象发生。结论: 改良一体式阻鼾器对于轻、中度OSA有更好的治疗效果,在OSA的治疗中有广阔的临床应用价值。     

阻鼾器治疗阻塞性睡眠呼吸暂停综合征的临床研究

目的　研究XT -1B型阻鼾器治疗阻塞性睡眠呼吸暂停综合征 (OSAS)的临床效果。方法　通过夜间PSG监测 ,观察和分析戴用阻鼾器前后睡眠呼吸紊乱指标的变化及主要症状的改变情况。结果　戴用阻鼾器后呼吸暂停低通气指数 (AHI)平均降低了 3 1.2次 /h(P <0 .0 0 1) ,最低血氧饱和度平均升高了 11.9% (P <0 .0 1) ,平均呼吸暂停时间 (MAT)减少了 12 .6s(P <0 .0 1) ,所有患者呼吸暂停现象明显改善 ,其中 11例呼吸暂停已完全消失。结论　阻鼾器治疗OSAS患者 ,可明显改善患者的睡眠质量、有效消除睡眠呼吸暂停 ,且可提高血氧饱和度 ,临床症状得到明显改善     

阻塞性睡眠呼吸暂停低通气综合征患者计算机辅助下颌定位系统的研制与矫治器疗效预测

目的研制适用于阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的计算机辅助下颌前伸定位系统（CAMRS），利用该系统初步判定OSAHS患者的下颌最适前伸距离，预测其口腔矫治器的疗效。方法CAMRS通过计算机控制微型步进电机，借助螺母与螺栓问的相对移动控制下颌前伸，结合多导睡眠图（PSG）监测，对14例OSAHS患者夜间睡眠进行下颌前伸定位和口腔矫治器疗效预测。结果CAMRS运行稳定，能有效前伸下颌，对睡眠干扰小。14例患者随着下颌的逐步前伸，睡眠呼吸暂停低通气指数（AHI）逐步改善，但每例患者的下颌最适前伸距离不同，与其病情的严重程度呈正相关关系（r=0．72747）。结论新研制的CAMRS系统运行稳定有效，对睡眠干扰小。通过该系统可以预先确定OSAHS患者的下颌最适前伸距离，并预测口腔矫治器的疗效。     

可调式下颌前移矫治器治疗OSAHS的临床疗效评价

目的探讨下颌前移矫治器治疗中重度OSAHS的疗效。方法选取20例中重度OSAHS患者,男19例,女1例,平均年龄54±12岁,采用下颌前移矫治器治疗,观察时间半年,分别做治疗前后上气道测量、多导睡眠监测及Epworth评估。对治疗前后结果进行统计学处理。结果戴用下颌前移矫治器后头颅侧位片显示H-MP由19.2±5.17mm降为15.25±6.20mm,P<0.05,H-C3由39.40±4.18mm增加为41.80±4.30mm,P<0.05;UPW-PNS、SPP-SPPW、Mc1-Mc2、U-MPW及PAS均增加,P<0.05;多导睡眠监测显示呼吸暂停指数(AI)、低通气、呼吸紊乱指数(AHI)、呼吸性醒觉指数(RAI)、呼吸暂停平均时间MAT及呼吸暂停最长时间LAT;都降低,P<0.05;血氧饱和度及睡眠效率显著增加,P<0.05;Epworth测量表示治疗前平均16±5分。治疗后7±4分,P<0.05。结论下颌前移矫治器能够有效治疗中重度OSAHS患者。     

口腔矫治器治疗OSAS的下颌定位

目的　口腔矫治器治疗阻塞性睡眠呼吸暂停综合征 (ObstructiveSleepApneaSyndrome,OSAS)的原理为导下颌向前 ,从而扩大上气道 ,本文即研究其下颌定位。方法　通过 41例疗效理想的OSAS病人 ,在模型、口内和头影测量片上分析颌位。结果　在模型上 ,下牙前伸 6 .2 0± 1 .45mm ,占下颌最大动度的 6 8% ;前伸至切缘相对打开 4.2 4± 0 .80mm。在头影测量片上 ,下颌相对眶耳平面前伸 3.6 8± 1 .79mm ,切缘垂直移动 8.38± 2 .5 6mm ;而相对平面 ,下颌前伸 5 .49± 1 .71mm ,切缘垂直移动 6 .94± 2 .75mm。结论　适宜的下颌定位可达到良好的治疗效果。     

改良型Twin-block阻鼾器及Silensor阻鼾器治疗OSAHS的临床比较

目的：探讨应用改良型Twin-block阻鼾器和Silensor阻鼾器治疗鼾症及阻塞性睡眠呼吸暂停低通气综合症（OSAHS）的疗效及并发症。方法：选择来我院口腔科就诊的鼾症及（OSAHS）30例患者，分别采用改良型Twin-block阻鼾器及Silensor阻鼾器进行治疗。并随访24个月，对患者戴用2种阻鼾器后的主观感觉慷者或其同住者主诵、临床检查包括下颌运动度、牙齿松动、关节区压痛、肌肉组织疼痛、咬合关系，X线头颅侧位片进行测量。结果：改良型Twin-block阻鼾器及Silensor阻鼾器对于鼾症及轻中度OSAHS均有一定的疗效。2者相比，Silensor阻鼾器所引发的并发症较少，改良型Twin-block阻鼾器会造成患者牙齿的疼痛、松动，肌肉疼痛，关节压痛及牙齿位置的改变。结论：应用改良型Twin-block阻鼾器应注意增加基牙的数量，调整咬合垫的高度，勿使相关组织承力过大。     

口腔矫治器对阻塞性睡眠呼吸暂停低通气综合征患者上气道影响的磁共振研究

目的:采用磁共振(MRI)结合三维重建技术观察口腔矫治器对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者上气道形态的影响.方法:对12例男性OSAHS患者进行静态MRI扫描,使用咬蜡块的下颌前伸定位方法,在牙尖交错位与口腔矫治器测定的下颌前伸位获得MRI图像.利用三维重建软件重现患者上气道立体形态影像,计算分析患者上...     

可调式下颌前移器治疗阻塞性睡眠呼吸暂停综合征临床研究

目的：探讨可调式下颌前移器(AMAD)治疗阻塞性睡眠呼吸暂停综合征(OSAS)的临床效果。方法：随机收集OSAS患者38例，分别制作并佩戴可调式下颌前移器(AMAD)，以多导睡眠仪(PSG)监测为主要手段，评估其治疗效果。结果：①AMAD佩戴舒适，佩戴率100％；②佩戴AMAD后，下颌前伸可以自由调节，前伸量大，最大前伸量为18mm，平均前伸量为12mm；③矫治效果受患者年龄、殆型、疾病严重程度影响。年青、轻中度的Angle Ⅱ类患者疗效比较理想。结论：AMAD是治疗OSAS的良好装置。     

Case Control Study in the Treatment of Obstructive Sleep-Disordered Breathing with a Mandibular Protrusive Appliance

BACKGROUND: Mandibular protrusive appliances have long been used to treat obstructive sleep apnea/hypopnea syndrome (OSAHS). Their efficacy regarding respiration during sleep varies greatly and remains difficult to predict. In this study the efficacy of a two-splint appliance on nocturnal breathing disorders, sleep profile, and daytime sleepiness were evaluated according to a specially-designed treatment process. PATIENTS AND METHODS: In this study 42 consecutive OSAHS patients who had been fitted with a mandibular protrusive appliance according to a preset treatment regimen were included in a follow-up analysis. The diagnosis and the degree of severity of OSHAS were determined by polysomnography in the sleep laboratory. The treatment regimen was established with the sleep laboratory physician. Treatment regimen included the diagnostic procedure in the sleep laboratory, each patient's dental requirements, the fabrication of the appliance used, and the titration of the mandibular protrusion. After having grown accustomed to the appliance for 24.5 +/- 7.8 days, 34 patients underwent overnight polysomnography. RESULTS: The mean apnea/hypopnea index decreased significantly from 19.6 +/- 12.8 to 3.3 +/- 7.8 events per hour to 83%; the apnea index also improved significantly, as did minimal oxygen saturation and the desaturation index. Changes in sleep profile did not reach statistical significance; the arousal index (p < 0.02) and the subjectively-assessed daytime sleepiness (p < 0.02) decreased significantly. A therapeutically-required AHI of below 5 events per hour was achieved in 88.2% of the patients. CONCLUSION: A significant improvement in the respiratory situation of the vast majority of OSAHS patients, particularly in their AHI, can be achieved when one applies the procedural steps and employs the mandibular protrusive appliance we describe herein.     

Oral appliances and maxillomandibular advancement surgery: an alternative treatment protocol for the obstructive sleep apnea-hypopnea syndrome.

PURPOSE: The present study comprises a retrospective evaluation of the potential application of mandibular repositioning appliance (MRA) therapy preceding maxillomandibular advancement (MMA) surgery in the treatment of the Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Our initial experiences with a new surgical protocol, in which MRA therapy serves as a predictor for success of MMA surgery, are reported. PATIENTS AND METHODS: Forty-three consecutive patients with OSAHS treated with MRA therapy were considered for inclusion (mean+/-SD; Apnea-Hypopnea Index [AHI]=27+/-20; age=53+/-9 years). All patients displaying a substantial improvement in their AHI with MRA therapy (ie,>50% reduction) who preferred surgical rather than "prosthetic" advancement of the mandible were offered MMA surgery. Accordingly, 4 out of 43 patients were treated with MMA surgery. The AHI was used as the primary outcome measure, with MMA surgery being considered successful in case of a postoperative AHI <5. RESULTS: All 4 patients included displayed substantial improvement in their AHI following MRA therapy. Moreover, in 3 patients MRA therapy resulted in a post-treatment AHI 相似文献   

Cephalometric and physiologic predictors of the efficacy of an adjustable oral appliance for treating obstructive sleep apnea

The purpose of this study was to investigate whether any physiologic or cephalometric parameters could be used to predict the efficacy of an adjustable mandibular advancement appliance for treating obstructive sleep apnea (OSA). Forty-two male and 5 female patients with OSA were recruited on the basis of baseline polysomnography with a documented Apnea and Hypopnea Index (AHI) greater than 15 per hour. Repeat polysomnography was performed with the appliance in place. Baseline cephalometry was performed for each patient, and follow-up cephalometry was completed for 19 of the subjects. The subjects were divided into 3 groups on the basis of the degree of change in the AHI with oral appliance therapy: good response (> 75% decrease in AHI), moderate response (25% to 75% decrease in AHI), and poor response (< 25% decrease in AHI). Patients with a good response were younger and had smaller upper airways. In a linear regression analysis, the change in AHI (%) was associated with physiologic (age and body mass index), cephalometric (overjet, height of the maxillary molars, vertical height of the hyoid bone), and airway variables. However, changes in either overbite or overjet were not related to changes in any of the polysomnographic variables for the 19 subjects. A stepwise regression analysis revealed a better treatment response with the adjustable mandibular advancement appliance in patients who were younger and had a lower body mass index, a longer maxilla, a smaller oropharynx, a smaller overjet, less erupted maxillary molars, and a larger ratio of vertical airway length to the cross-sectional area of the soft palate.     

悬雍垂腭咽成形术与双颌前徙术联合治疗阻塞性睡眠呼吸暂停低通气综合征的初步报告

目的 在采用双颌前徙术（maxillomandibular advancement，MMA）的同时结合计算机辅助设计悬雍垂腭咽成形术（uvulopalatopharyngoplasty，UPPP），探索其治疗重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）的可行性和疗效。方法严重OSAHS肥胖患者9例，年龄（47．8±9．7）岁，体重指数（body mass index，BMI）为（35．3±2．5）kg／m^2，睡眠呼吸暂停低通气指数（apneaand hypopnea index，AHI）为（88．7±6．7）次／h。对所有患者行计算机辅助设计的UPPP和MMA联合手术治疗。患者术前、术后3、6、12个月行多道睡眠检测（polysomography，PSG）监测，同时进行上气道测量分析，以及腭咽闭合功能、语音评价。结果患者上颌骨LeFort-Ⅰ截骨前移（8．3±1．3）mm，双侧下颌矢状劈开和颏截骨前移合计（23．0±2．2）mm。随访时间7．7个月，所有患者OSAHS症状均消失，术后AHI（2．1±1．1）次／h，患者均无语音障碍和吞咽障碍，无明显颌面畸形，牙胎关系良好。结论UPPP和MMA联合手术治疗OSAHS肥胖患者的近期手术效果良好。采用MMA同期结合计算机辅助设计的UPPP不必然造成腭咽闭合功能障碍；UPPP与上颌LeFort-Ⅰ截骨联合手术不必然造成上颌骨缺血坏死或影响上颌创口愈合。     

Skeletal Effects in Class II Treatment with the Functional Mandibular Advancer (FMA)?

OBJECTIVE: The aim of this clinical study was to reveal skeletal effects during the treatment of Class II malocclusions in adolescents and young adults using a protrusive-acting fixed, rigid functional orthodontic appliance, and to quantify them in comparison with an untreated control group. We aimed to determine whether, and if so, to what extent skeletal effects diminish with increasing age, and whether inter-individual differences can be observed. METHOD: To correct their intermaxillary jaw relationship, the functional mandibular advancer (FMA) was inserted in 16 adolescents and young adults (eight males, eight females, aged from 12 years, 3 months to 18 years, 7 months) presenting with a skeletal Class II malocclusion. The course of treatment was documented cephalometrically. RESULTS: In all patients, the FMA treatment led to neutroclusion or overcorrected neutroclusion and a marked reduction in overjet. The occlusion's improvement in the sagittal dimension (overjet reduction by 4.43 +/- 2.10 mm, molar relationship improvement by 3.88 +/- 1.12 mm) was achieved by a combination of dental effects (distalization of upper teeth, mesialization of lower teeth) and skeletal effects (mandibular growth stimulation). Excepting the position and morphology of the maxillary base and the condyle's dorsal position in the fossa, all sagittal skeletal and dental changes induced by the FMA treatment were statistically significant. There was a mean increase of 1.71 +/- 1.11 mm in sagittal length of the mandible, in the sagittal-diagonal dimension of 1.42 +/- 1.51 mm and 1.53 +/- 2.15 mm, as well as a slight, significant increase in the gonial angle area. Whereas the condylar position remained stable, a forward positioning of the chin and thus significant increase in distance length was recorded from the posterior condylar margin to the anterior mandibular margin. CONCLUSIONS: Treatment with a fixed functional appliance in Class II patients effected significant changes in mandibular growth and correction of the distal intermaxillary relationship even after the pubertal growth spurt in adolescents and young adults. While the proportion of the orthopedically-induced skeletal share is subject to substantial inter-individual variability in adolescents, the overall conclusion can be drawn that skeletal effects (= stimulation of mandibular growth) in general clearly lessen with increasing patient age. In young adult patients, the correction of a distal intermaxillary jaw relationship is manifested primarily as a dento-alveolar compensation for the skeletal malocclusion.     

分体式口腔矫治器治疗OSAHS患者前后上呼吸道形态CBCT分析

目的 观察阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者戴用分体式口腔矫治器前后呼吸功能及上呼吸道形态的变化,探讨口腔矫治器治疗OSAHS的机制.方法 对15例经多导睡眠仪监测确诊为轻、中度OSAHS患者,戴用口腔矫治器前及戴用矫治器3个月后的上呼吸道行CBCT扫描,运用MIMICS 10.01和AutoCAD2010对上气道各段的矢状径、横径、截面积以及容积等指标进行测量分析,并比较治疗前后OSAHS患者呼吸暂停指数（AI）、低通气指数（HI）、呼吸紊乱指数（AHI）和最低血氧饱和度（SaO2）等指标的变化.结果 戴用口腔矫治器治疗后,OSAHS患者上呼吸道腭咽和舌咽区域的矢状径、横径、横截面积和体积均明显增大（P＜0.05）,而鼻咽区域变化不明显.戴用口腔矫治器后呼吸暂停指数（AI）、低通气指数（HI）、呼吸紊乱指数（AHI）明显降低（P＜0.05）,最低血氧饱和度（SaO2）显著提高（P＜0.05）.结论 OSAHS患者戴用口腔矫治器后,可通过扩大上气道腭咽和舌咽区域,保持上气道气流通畅,改善患者的呼吸功能而达到治疗目的.     

Prospective clinical trial comparing the effects of conventional Twin-block and mini-block appliances: Part 1. Hard tissue changes.

PURPOSE: The aim of this prospective clinical trial was to compare the dentoskeletal effects of a conventional and a modified Twin-block (TB) appliance. The conventional TB appliance was constructed with a large, single-step advancement. The modified appliance, termed the mini-block (MB), was incrementally advanced, incorporated a maxillary incisor torquing spring, and had a reduced bite-block height. MATERIAL: Seventy patients were placed into age- and sex-matched pairs. Patients in each pair were allocated to opposing appliance groups. Active treatment lasted 9 months, irrespective of the final overjet attained, and final cephalometric records were taken at 12 months (+/-1 month). Both groups showed pretreatment equivalence for age, sex, overjet, and cephalometric variables. RESULTS: The TB group experienced a significantly greater reduction in overjet (median, -8 mm; P = .02) compared with the MB group (median, -4 mm). This improved overjet reduction was associated with significantly greater forward movement of pogonion (median change, TB: 3.3 mm; MB: 2.1 mm; P = .02) and greater retroclination of the maxillary incisors (median change, TB: -5 degrees ; MB: -1.9 degrees ; P = .04). No significant intergroup difference was found for changes in total anterior facial height (median change, TB: 4.4 mm; MB: 4.3 mm) and mandibular incisor proclination (median change, TB: 1.3 degrees ; MB, 2.4 degrees ). CONCLUSIONS: Progressive mandibular advancement was not associated with greater mandibular growth compared with single-step advancement. The maxillary incisor torquing spring seems to be effective at reducing maxillary incisor retroclination. Reduced bite activation in the MB group did not result in less mandibular incisor proclination. There was considerable individual variation in appliance effects within both groups.     

口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征——计算机辅助下颌前伸定位

目的:评价计算机辅助下颌前伸定位系统(CAMRS)用于提高口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)疗效的临床实效性。方法:采用交叉试验设计对11例男性OSAHS患者先后夜间戴用"经验式"口腔矫治器(凭经验确定下颌前伸量)和"测定式"口腔矫治器(由CAMRS确定下颌前伸量)治疗各1个月,分析比较2种口腔矫治器的主、客观疗效及下颌前伸量,以检验CAMRS的有效性和临床实用性。结果:2种方法确定的平均下颌前伸量无显著性差异(P>0.05),但是CAMRS测定的最适下颌前伸量个体间变异大,变异范围为最大前伸量的33%~100%。"测定式"口腔矫治器治疗OSAHS的疗效优于"经验式"口腔矫治器(P<0.01)。结论:计算机辅助下颌前伸定位系统的临床应用,能够为OSAHS患者接受口腔矫治器治疗时提供个体化的最适下颌前伸位,提高了疗效。     

Effects of an anteriorly titrated mandibular position on awake airway and obstructive sleep apnea severity.

The objective of this study was to investigate whether a reduction of obstructive sleep apnea (OSA) severity was associated with significant upper airway (UA) changes after an anterior titration of the mandibular position. Eighteen OSA patients with a mean (SD) apnea hypopnea index (AHI) of 32.5 (12.3) were recruited. Baseline supine cephalometry was obtained before the initial insertion, and follow-up supine cephalometry was undertaken after titration with a titratable oral appliance in place. The mean AHI before treatment was significantly reduced to 9.7 (7.4) (P <.001) after titration. In 13 responders with AHI reduced to < or =15/h, a significant forward displacement of the anterior wall of the velopharynx (P <.05) was observed. In addition, there was a significant forward displacement of the posterior wall of the oropharynx and the hypopharynx (P <.05). In the 5 nonresponders, no significant changes in the position of the anterior and posterior wall were observed. There was no significant difference in the total amount of mandibular advancement between responders and nonresponders. We conclude that treatment success with oral appliance therapy appears to depend not only on anterior titration of the mandibular position to enlarge the UA, but also on the amount of change in the size of the UA in response to mandibular advancement.