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。     

下颌前伸矫治器治疗睡眠呼吸暂停综合征的三维影像学评估

目的:研究下颌前伸矫治器对阻塞性睡眠呼吸暂停综合征(OSAS)患者的疗效及机制.方法:采集80例OSAS患者应用下颌前伸矫治器治疗前、后的CT数据,利用三维影像重建技术测量上气道结构及容积变化,评价口腔矫治器(0A)的疗效及机制,采用SPSS17.0软件包对数据进行方差分析.结果:下颌前伸矫治器治疗OSAS多数患者主观症状缓解或消失,客观检测指标相应改善.OSAS患者存在上呼吸道的解剖性狭窄,戴入OA后,气道各分段截面积和容积均有变化,腭咽、喉咽段增大(P＜0.01),口咽段减小(P＜0.05).结论:OSAS存在形态学病因机制,下颌前伸矫治器通过前伸下颌骨,使上气道减小,内部变化而更平滑稳定,减小涡流和狭窄,进而发挥治疗效果.     

下颌前伸式矫治器治疗阻塞性睡眠呼吸暂停低通气综合征研究现状及进展

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea and hypopnea syndrome,OSAHS）的临床表现为夜间频发的上气道阻塞和呼吸障碍,伴发日间嗜睡、疲倦等。其病因主要是上气道形态的变化和神经肌肉等因素。下颌前伸式矫治器（mandibular advacecment devices,MADs）是治疗轻、中度OSAHS的有效方法,其主要机制改变上气道形态,进而引起上气道流体力学的改变。笔者对下颌前伸式矫治器治疗阻塞性睡眠呼吸暂停低道气综合征的疗效、适应证、副作用、上气道形态变化、矫治器的下颌定位、上气道液体力学改变的研究进行综述。     

下颌前伸矫治器对阻塞性睡眠呼吸暂停低通气综合征作用的研究进展

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)临床表现为夜间频发的上气道阻塞和呼吸障碍,伴发日间嗜睡、疲倦等。病因主要包括肥胖、神经肌肉、上气道结构的变化等因素。对于患者上气道阻塞程度和位点的研究方法有多种,如X线头影测量、多层螺旋CT成像等。通过多平面重建技术建立上气道的三维结构,可以精确显示上气道的细微变化。下颌前伸矫治器是治疗轻、中度OSAHS的有效方法,通过前移下颌而使上气道特别是口咽部间隙增宽。本文对阻塞性睡眠呼吸暂停综合征(OSAHS)患者使用下颌前伸矫治器时上气道形状变化特点及其研究方法作一综述。     

OSAHS患者戴用自行调节式口腔矫治器下颌骨位置变化的研究

目的 为下颌前伸式口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea and hypopnea syndrome,OSAHS)的下颌定位提供参考.方法 采用X线头影测量分别对32例患者戴用自行调节式口腔矫治器于治疗前、医师经验位及患者调节位时下颌水平及垂直测量项目的具体数据进行统计学处理.结果 医师经验位和患者调节位与治疗前比较时测量项目均有差异,两者比较,S-Ar-Go P值为0.095,H-MP P值为0.84,均大于0.05,其他测量项目均有显著差异(P.<0.05).结论 自行调节式口腔矫治器的医师经验位和患者调节位的下颌位置存在差异,该差异可以为下颌前伸类口腔矫治器个性化治疗的下颌前伸定位研究提供参考.     

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。     

口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征及上气道形态的变化

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)临床表现为夜问频发的上气道阻塞和呼吸障碍,伴发日间嗜睡、疲倦等.病因机制主要是上气道形态的变化和神经肌因素等.口腔矫治器是治疗轻、中度OSAHS的有效方法,本文对口腔矫治器治疗OSAHS及上气道形态的变化作一综述.     

两种口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征的疗效比较

目的在下颌前伸程度相同的情况下,比较两种不同设计类（分体式与整体式）口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征（obstructivesleepapnea／hypOpneasyndrome,OSAHS）成年男性患者的主客观疗效。方法采用随机交叉实验设计,16例OSAHS患者先后戴用分体式和整体式两种口腔矫治器,每副矫治器戴用3个月,患者戴用两种矫治器之间需停戴2周。在治疗前及戴用两种矫治器3个月时分别获取患者的主观疗效、多导睡眠监测（polysomnography,PSG）及上气道大小参数。采用单因素方差分析比较两者主客观疗效及上气道形态变化。结果两种口腔矫治器治疗OSAHS的主客观疗效显著（P〈O．05）。在呼吸指标方面,戴用分体式口腔矫治器的有效率为56．3％,整体式口腔矫治器的有效率为68．9％,两者无显著性差异（P〉0．05）。分体式在改善睡眠效率和深睡眠的比例方面不及整体式（P〈O．05）。两种口腔矫治器显著增大上气道各水平的前后径（P〈O．05）,两者间无明显差别（P〉0．05）。结论两种口腔矫治器对OSAHS患者的主客观疗效大致相似,但整体式口腔矫治器在改善睡眠效率和主观依从性方面占优势。     

双侧拉杆式口腔矫治器治疗OSAHS前后上气道容积变化及相关因素分析

目的 通过计算机体层摄影观察轻、中度阻塞型睡眠呼吸暂停、低通气综合征患者戴用双侧拉杆式口腔矫治器前后上气道形态变化及其相关因素分析.方法 经夜间多导睡眠仪监测确诊为OSAHS的男性患者9名,年龄25～43岁,平均37岁（中位数）,戴用口腔矫治器治疗有效.3个月后分别行CT扫描,三维重建后行定量分析.结果 所有患者戴用矫治器后上气道各段容积及总容积均增大.总容积的增加百分比与患者体重指数成负相关（r=-0.70,P=0.03）,与患者下颌平面角（MP-SN）没有显著相关性（r=-0.43,P=0.25）.上气道容积的增加与患者睡眠呼吸障碍的严重程度及改善程度无明显相关关系（r=0.30,P=0.43;r=0.39,P=0.29）.结论 双侧拉杆式口腔矫治器使OSAHS患者上气道大小、形态趋于正常.体重指数影响气道大小改善的程度.同时气道大小改善的程度与患者的睡眠呼吸状况改善并不一致.     

改良Herbst矫治器治疗阻塞性睡眠呼吸暂停低通气综合征疗效的初步评价

目的:评价自行改良的Herbst可调式口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法:10例经夜间多导睡眠监测确诊为轻、中度OSAHS患者,治疗前行PSG检查、ESS嗜睡评分、上气道三维CT扫描及重建(平静呼吸位+Muller位)。经改良Herbst口腔矫治器治疗3个月后,复查PSG,戴用口腔矫治器行上气道三维CT扫描及重建(平静呼吸位+Muller位),并要求患者完成治疗后ESS嗜睡评分、舒适度调查问卷表。对治疗前、后数据采用SPSS 12.0软件包进行统计学分析。结果:OSAHS患者戴用改良Herbst口腔矫治器3个月后,主观症状明显改善,治疗后AHI、AI、MAX均低于治疗前,最低血氧饱和度(LSaO2)高于治疗前(P<0.05)。上气道CT扫描示,平静呼吸位和Muller位软腭后区和舌后区气道体积均较未戴用时增大(P<0.05),软腭后区最小截面前后径、左右径及面积的增大有显著差异(P<0.05)。OSAHS患者戴用口腔矫治器后,上气道顺应性显著降低(P<0.05)。结论:戴用改良Herbst口腔矫治器对轻、中度OSAHS患者主客观症状有明显改善,应用三维CT结合Muller试验,有助于OSAHS患者上气道评估以及治疗效果评价。     

双侧拉杆式口腔矫治器治疗阻塞型睡眠呼吸暂停综合征前后舌骨位置变化及相关因素分析

目的 观察轻、中度阻塞型睡眠呼吸暂停综合征（OSAHS）患者戴用双侧拉杆式口腔矫治器前后的舌骨位置变化,并对相关因素进行分析,探讨其治疗OSAHS的机制。方法 采用双侧拉杆式口腔矫治器对多导睡眠监测仪及白天嗜睡量表诊断为轻、中度OSAHS的9例男性患者进行治疗,于未戴口腔矫治器和戴用口腔矫治器3个月后对患者进行CT扫描和图像三维重建,分析戴用矫治器前后上气道总容积和舌骨水平位置的变化,并对与舌骨位置 变化可能的相关因素进行分析。结果 戴用双侧拉杆式口腔矫治器后,舌骨在水平方向前移（5.90±2.27）mm,在垂直 方向上移（3.31±1.82）mm,上气道总体积增大了（32.36±14.58）%。ΔH-C3hor、ΔH-C3ver均与Δvolume%正相关（r=0.77, P<0.05;r=0.79,P<0.05）,与FH-MP负相关（r=-0.83,P<0.05;r=-0.76,P<0.05）。结论 双侧拉杆式口腔矫治器使 OSAHS患者的舌骨向前上方移位。下颌平面角较小的患者舌骨向前移位较多。     

阻塞性睡眠呼吸暂停低通气综合征患者的牙弓与上气道形态变化及相关性分析

目的：：比较阻塞性睡眠呼吸暂停低通气综合征( OSAHS)患者与正常人牙弓及上气道形态差异,揭示OSAHS牙弓形态改变与上气道容积对应变化的关系。方法：利用上气道CBCT扫描及口腔模型测量经PSG诊断为OSAHS的男性患者( n=22)与正常男性对照(n=19)的牙弓形态与上气道容积变化,并行相关性分析。结果：OSAHS组上颌牙弓长度与腭弓高度分别大于对照组(均P<0.05);OSAHS组鼻咽段、腭咽段截面积及上气道总容积与腭弓高度、上颌牙弓长度呈负相关(均P<0.05),与上颌后段牙弓宽度呈正相关关系(P<0.05)。结论：OSAHS患者上颌牙弓形态的异常与鼻咽段和腭咽段容积的变化有关联。     

三维CT重建在肥胖OSAHS患者与正常人群上气道比较中的应用

目的 通过三维CT(3D-CT) 重建技术,分析肥胖阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者与正常成人上气道的差异,并用于困难气道的预测。方法 选择肥胖OSAHS患者及正常成人对照各31例,肥胖OSAHS患者美国麻醉师协会（ASA）分级Ⅱ级,年龄（34.33±10.07）岁（17~55岁）,BMI为（39.05±5.17）kg/m²。对照组ASA分级Ⅰ~Ⅱ级,年龄（28.34±6.41）岁（18~35岁）,BMI为（23.23±4.51）kg/m²。采用Mimics 11.04软件,分别对2组对象的上气道三维CT重建数据进行测量分析,得到包括气道最小横截面、气道体积等数据,比较困难气道患者与正常人咽气道三维形态的差异,采用SPSS 21.0软件包对数据进行统计学分析,评价困难气道患者上气道三维CT形态特征。结果 困难气道患者上气道总体积、软腭后区体积及会厌后区体积与正常对照组相比均显著减小（P<0.05）,舌后区体积与正常对照组无显著差异（P>0.05）。结论 3D-CT重建测量可以明确上气道狭窄部位、严重程度,可作为较好的困难气道术前评估量化手段。     

Effective three‐dimensional evaluation analysis of upper airway form during oral appliance therapy in patients with obstructive sleep apnoea

The oral appliance (OA) is considered to be an effective treatment modality for obstructive sleep apnoea (OSA). Upper airway enlargement during OA therapy is critical, and lateral cephalometry has been used for the two‐dimensional evaluation of upper airway form during this therapy. However, this method cannot provide an accurate three‐dimensional (3D) view of upper airway form. To confirm the effects of OA on the upper airway in patients with OSAS, we performed CT in the presence and absence of OA in 15 Japanese patients (12 males, 3 females) who responded to OA therapy. CT in the presence and absence of OA was consecutively performed for each patient, and upper airway cross‐sectional area in six arbitrary planes parallel to the palatal plane was measured. Next, 3D image reconstruction was performed; morphological changes in upper airway form were evaluated, and upper airway volume at three levels from the palatal plane to the deepest point of the epiglottis was measured. The cross‐sectional area of two planes in the posterior soft palate region significantly increased in the presence of OA compared with that in the absence of OA. In the presence of OA, upper airway cross‐sectional area and volume significantly increased in the posterior soft palate region compared with those in the posterior tongue region. 3D CT image reconstruction accurately confirmed morphological changes in the upper airway during OA therapy. Continued use of this 3D evaluation is expected to improve the results of OA therapy in the future.     

OSAHS患者上气道磁共振影像研究

目的：研究清醒状态下阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者与正常健康人在磁共振（MRI）上的上气道参数差异和阻塞平面情况。方法：OSAHS患者和正常健康人各20例，进行MRI检查和测量。结果：①．OSAHS组RP区，RG区气道截面积明显小于对照组（p〈0．01）；②．OSAHS组RP区、RG区、EPG区气道前后径／左右径（AP／LR）比值均明显大于对照组（p〈0．05）；③．OSAHS组RP区、RG区、EPG区咽侧壁厚度均明显大于对照组（p〈0．05）；RG区，EPG区咽后壁厚度明显大于对照组（p〈0．01）；④．OSAHS组软腭长度、厚度和截面积均明显大于对照组（P〈0．05）：⑤．95％的OSAHS患者在清醒状态下即可见上气道阻塞平面。70％的OSAHS患者为多平面阻塞，阻塞多发生于软腭后区。结论：OSAHS患者上气道参数与正常健康人有显著性差异。软腭后区是OSAHS患者上气道最狭窄的部位。     

可调式阻鼾器治疗阻塞性睡眠呼吸暂停低通气综合征

目的　探讨可调式阻鼾器在阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)治疗中的应用。方法　可调式阻鼾器组 30例OSAHS患者(男 24例,女 6例),平均年龄(49 9±9 9)岁,呼吸暂停及低通气指数 (AHI) ( 33 1±22 7 )次 /h。对照组为同期治疗的 30例年龄、体重、病情相当的OSAHS患者(男 23例,女 7例),戴用普通下颌前移类矫治器。单盲法取证并比较两组疗效的差异;分析可调式阻鼾器组患者于治疗前、医师经验位和最终调整位的上气道、舌骨位置和下颌定位的差异。结果　可调式阻鼾器组的AHI值相对降低 85 8 %,高于对照组 (P<0 05);其最终调整位为下颌前伸(5 8±1 4)mm,上下切缘距(4 6±1 1)mm,占最大前伸量的(71±26)%。结论　可调式阻鼾器的疗效改善明显,其最终调整位可为下颌定位的研究提供参考。     

320-detector CT imaging of the upper airway structure of patients with obstructive sleep apnea-hypopnea syndrome

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is one of the most common sleep disorders that have significant associated health costs. It is caused by recurrent occlusion of the upper airway during sleep. Recently, many researchers have provided evidence that patients with OSAHS tend to have a large tongue, a comparatively prolonged soft palate, and a narrow upper airway.There are many therapeutic methods for OSAHS, although determining the obstructive points is very important. Several methods to study the morphology of the upper airway in patients with OSAHS are available: acoustic reflection, fluoroscopy, endoscopic observation, and computed tomography (CT). After our hospital took the lead in the introduction the first 320-detector CT in East China, our team studied the morphology of the upper airway in patients with OSAHS using this 320-detector CT.From July 2010 to July 2011, the upper airway of 66 patients with OSAHS and 22 control subjects were scanned using a 320-detector CT scanner at the time of deep inspiration, deep expiration, normal respiration, and Müller maneuver. Cross-sectional areas of the upper airway at the nasopharyngeal, velopharyngeal, and tongue-pharyngeal levels were measured and compared. Mean velopharyngeal cross-sectional areas in OSAHS were less than those in the control group at the time of deep inspiration, deep expiration, normal respiration, and Müller maneuver (P < 0.05). Mean tongue-pharyngeal cross-sectional areas in OSAHS were less than those in the control group at the time of deep inspiration and Müller maneuver (P < 0.05).The results showed that velopharyngeal and tongue-pharyngeal areas could be the main obstructive regions for OSAHS and that the 320-detector CT scanner would be of great utility in identifying the location of the upper airway obstruction in patients with OSAHS, in exploring the pathogenesis of OSAHS, and in designing the appropriate treatment plan and surgical positioning.     

Influence of oral appliances on craniocervical posture in obstructive sleep apnea–hypopnea syndrome patients

PurposeThe existence of a relationship between head posture and mandibular function has been discussed by several authors. However, the relationship between head posture and the cervical spine in patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) who are using oral appliances (OAs) remains unknown. The aim of this study was to evaluate the changes in the cervical spine associated with the use of OAs in patients with OSAHS.MethodsFifteen patients (4 females and 11 males; mean age, 48 years) diagnosed with OSAHS were randomly selected. An OA was fabricated individually for each patient. Two lateral cephalometric radiographs were taken while the patient was sitting awake in an upright position. The first radiograph was taken in the intercuspal position and the second was taken while the subject was wearing the OA. Analyses based on the sella–nasion (SN) line were performed in the lateral cephalogram. Comparison of craniocervical angles in patients with and without the OA was performed using Wilcoxon's signed-rank test.ResultsCephalometric analysis showed that the craniocervical angles (CVT-C2V and SN-C4) with OA were higher than those without OA (P < 0.05). It seems that the OA caused a significant flexion of the cranium on the upper cervical spine. A significant increase in the craniocervical angle occurred in the fourth cervical segment.ConclusionThe changes in forward flexion of the upper cervical spine found in this study imply that changes in the craniocervical relationship should be evaluated periodically after an OA has been inserted.     

肥胖伴OSAHS患者X线头影测量研究

目的 分析肥胖伴OSAHS患者头影软硬组织的测量特征。方法 采用本科开发的OSAHS患者计算机头影测量分析系统，对67例年龄在40～60岁、BMI≥30以上的OSAHS患者(诊断经nPSG监测确立，患者AHI≥51和12例同年龄组的正常人头影软硬组织进行测量对照分析。结果 本组肥胖伴OSAHS患者头影硬组织测量特征表现为下颌骨后缩，舌骨向后下移位；软组织测量特征上表现为舌、软腭矢状面积显著增加，舌、软腭占口咽腔比明显增加，软腭后和舌后咽径明显减小。口咽部狭窄(软腭和舌后区)最多见(54．02％)，软腭水平咽腔阻塞占29．89％，上、中、下咽腔同时阻塞为1．15％，87．35％肥胖伴OSAHS患者存在上气道狭窄，72．41％患者为多部位阻塞。结论 大部分肥胖伴OSAHS患者头影硬组织测量存在异常，此类患者睡眠时上气道通气不畅多发生于口咽区，大部分患者为多部位狭窄或阻塞。