口腔矫治器下颌定位治疗阻塞性睡眠呼吸暂停综合征

目的观察口腔矫治器下颌定位治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的疗效。方法确诊的10例轻中度OSAHS患者，用鼻咽纤维镜定位下颌位置来制作口腔矫治器治疗，治疗前后分别用呼吸暂停低通气指数（AHI）和日间嗜唾程度评分（ESS）、鼾声评分（SS）进行疗效评价。结果治疗后AHI从（23．98±7．89）到（7．83±3．00），下降幅度达67．35％（P〈0．01），嗜睡症状和鼾声明显减轻，ESS从（8．3±2．58）降到（2．5±1．65）（P〈0．01）；SS从（7．7±1．16）降到（2．3±1．06）（P〈0．01）。结论鼻咽纤维镜辅助下颌前伸定位制作口腔矫治器治疗OSAHS临床疗效显著。每个患者的最佳下颌前伸位是不同的，建议个体化制定。     

口腔矫治器治疗高原地区阻塞性睡眠呼吸暂停低通气综合征

阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apne-a-hypopnea syndrome,OSAHS)是导致心脑血管疾病的危险因素之一[1]。对于OSAHS患者而言高原地区低氧环境,是加重其睡眠障碍的又一重要原因。作者采用口腔矫治器治疗8例高原地区OSAHS患者取得满意疗效,报告如下。     

口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征疗效观察

目的:研究矫治器治疗阻塞性睡眠呼吸低通气综合征(OSAHS)的机制及适应证并做疗效分析。方法:选确诊OSAHS患者32例,其中16例为配戴口腔矫治器(SG)组,16例为采用悬壅垂腭咽成形术(UPPP)加SG组。夜间多导睡眠监测仪(PSG)监测并拟定评定标准。结果:总有效率SG组为68.8%,而UPPP SG组为81.2%。结论:SG是治疗轻中度OSAHS简便易行的好方法。     

不同下颌前伸度口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征的系统评价

目的：评价不同下颌前伸度的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 hyponea syndrome,OSAHS）的临床疗效。方法： 计算机检索PubMed、Embase、Cochrane图书馆、CNKI、维普和万方等数据库,纳入不同下颌前伸度的口腔矫治器治疗OSAHS的随机对照试验（randomized clinical trials,RCT）和前后对照试验（before-after trials,BAT）,对其进行质量评价并提取资料,用RevMan 5.3软件进行meta分析。结果： 纳入2个RCT、2个采用了随机方法的BAT和3个非随机BAT,共244例患者。根据方法学质量评价及各试验设计情况,对其中4篇高质量研究进行meta分析,结果显示,下颌前伸量达到下颌最大前伸度（maximal mandibular advancement,MMA）50%与75%两组的治疗有效率［呼吸暂停低通气指数（apnea hypopnea index,AHI）或氧减指数（oxygen desaturation index,ODI)降低>50%］比较,I2=0%,合并效应量RR值为0.93, 95%CI为0.80~1.09;两组的治愈率（AHI或ODI<10次/h）比较,I2=45%,合并效应量RR值为0.85, 95%CI为0.68~1.06,证据尚不足以证明两组的治疗有效率和治愈率有差异。亚组分析提示病情严重程度可能是影响治愈率的重要因素。结论： 对于OSAHS患者,在一定范围内下颌前伸度增加有利于提高治疗有效率和治愈率,但尚缺乏足够证据证明75%MMA优于50%MMA;轻症患者治愈率高于重症。     

口腔矫治器治疗阻塞性睡眠呼吸暂停综合征

睡眠呼吸暂停综合症(SAS)是指在7小时夜间睡眠中反复呼吸暂停在30次以上或睡眠呼吸紊乱指数(AHI)超过5次以上,每次呼吸暂停持续10秒以上状态.它是在睡眠时以上气道反复阻塞为特征,多发生在咽部的阻塞.SAS分为阻塞性、中枢性和混合性.阻塞型SAS(OSAS)以睡眠时上气道反复阻塞为特征,其阻塞部位多发生于口咽部,该类患者是正畸矫治器治疗的主要对象[1].阻塞性呼吸暂停综合征患者表现为睡眠时打鼾,鼾声与呼吸暂停交替发生,由于缺氧、反复憋醒而中断睡眠.通过口腔矫治器前移下颌,增大上气道前壁,从而改善呼吸功能,其疗效已经得到证实.     

可调式下颌前移口腔矫治器治疗阻塞型睡眠呼吸暂停低通气综合征

目的:观察可调式下颌前移口腔矫治器(AOA)治疗阻塞型睡眠呼吸暂停低通气综合征(OSAHS)的疗效分析.方法:使用AOA 18例0SAHS患者,3个月后复查主观症状及多导睡眠图(PSG).结果:患者对AOA的耐受率为77.8%,鼾声、睡眠惊醒、白日嗜睡等症状改善或消失,PSG五项监测指标治疗前后差异有显著性,治疗后明显好转.结论:AOA是治疗OSHAS的较好方法.     

热塑成形口腔矫治器治疗阻塞性睡眠呼吸暂停综合征的疗效研究

目的评价热塑成形XT—B1型口腔矫治器治疗轻中度阻塞型睡眠呼吸暂停低通气综合征（OSAHS）的疗效．方法采用38例经多导睡眠图（PSG）检测并诊断为轻中度OSAHS的患者．用加热变型的高分子塑料注塑成形的XT—B1型口腔矫治器治疗,对比治疗前后患者的睡眠分期、呼吸事件、病情程度分级,以及患者自评主观症状（ESS评分）的变化,患者亲戚或同室居住者观察患者夜间鼾声强度的变化,患者对此项治疗方式的评价．结果XT—B1型口腔矫治器治疗后患者呼吸事件各项指标改善,病情程度分级下降,睡眠分期结构较治疗前更趋向健康年轻成人的睡眠特征．患者白天困倦缓解,患者及患者亲戚或同室居住者对此项治疗方式认可．结论XT—B1型热塑成形口腔矫治器可以作为轻中度OSAS治疗的经济方案,效果肯定,制作简便．     

口腔矫治器治疗对阻塞性睡眠呼吸暂停低通气综合征患者血压的影响

目的 研究口腔矫治器(OA)对轻中度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血压的影响.方法 46例轻中度OSAHS患者在继续使用原降压药(种类和剂量不变)的基础上分为睡眠时配戴OA治疗组(OA组,25例,合并高血压者15例)和非OA治疗组(N-OA组,21例,合并高血压者13例),OA组于OA治疗前和治疗12周末、N-OA组于入组时和12周末行多导睡眠图监测[记录呼吸暂停低通气指数(AHI)、微觉醒指数(AJ)、平均血氧饱和度(SaO2)和最低SaO2]和动态血压监测,记录OA组患者每夜使用OA的平均时间,并应用Pearson检验分析OA治疗所致夜间平均动脉压(MAP)变化与其他参数的关系.结果 OA组患者每夜使用OA时间平均(6.8±1.0)h,治疗12周末AHI(次/h)、AJ(次/h)明显降低(7.0±3.8比21.0±6.5,22.9±6.3比32.2±9.3,均P<0.01),平均SaO2和最低SaO2明显升高(95.2%±0.6%比94.1%±1.0%,86.8%±43.5%比80.O%±5.2%,均P<0.01),同时24 h收缩压、日间收缩压和夜间收缩压、舒张压、MAP(nun Hg,1mmHg=0.133 kPa)均明显降低(127.2±7.5比129.4 4±8.8,131.5±6.9比133.6±8.1,121.3±7.0比125.3±9.3,76.1±6.1比78.8±6.8,94.3±7.6比91.2±6.4,均P<0.01);夜间MAP下降与AI下降(r=0.37,P=0.005)、AHI下降(r=0.32,P=0.011)、治疗前夜间收缩压(r=0.39,P=0.015)、舒张压(r=0.30,P=0.024)相关.N-OA组12周末各项指标均无明显变化.结论 OA治疗可降低OSAHS患者血压,血压降低程度与睡眠呼吸暂停低通气纠正程度和治疗前血压水平相关.     

口腔矫治器治疗阻塞性睡眠呼吸暂停综合征38例报告

打鼾是鼾症和阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的主要症状之一，也是患者就诊的主要原因。由于睡眠期间上呼吸道塌陷，致使上呼吸道狭窄或阻塞，从而引起呼吸暂停、低氧血症和睡眠中多次憋醒。这些现象的反复发作，破坏了正常的睡眠结构，致使患者白天嗜睡，日间注意力减退，记忆力下降，发生交通意外，并易发生缺血性心脏病和脑血管意外，甚至会导致夜间猝死。由于其发病率较高，且引起一系列后果，对公众健康危害大。因此，国内外学者对其研究较多，目前的研究认为，OSAHS是一种多因素、复杂的多基因的疾患，但其发病机制目前尚不清楚，还有待进一步研究。有效地治疗方法不外乎是持续正压通气治疗（CPAP）、手术、口腔矫治器等3种手段。2003年4月～2005年10月，我们经多导睡眠图监测筛选出38例轻、中度OSAHS患者，应用口腔矫治器进行治疗，取得了良好的疗效，报告如下。     

儿童阻塞性睡眠呼吸暂停低通气综合征治疗的研究进展

儿童阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome,OSAHS）是指因部分或全部上气道阻塞引起的通气障碍,可扰乱儿童正常呼吸和睡眠,影响儿童生长发育,甚至导致错颌畸形的疾病,是当前耳鼻咽喉及正畸科研究的热点问题。目前对于儿童OSAHS的治疗方式多样,以正畸治疗和手术治疗较为常见,而正畸与手术等多学科的联合治疗当下愈发突显地位。本文将对目前儿童OSAHS的多种治疗方法及其适应证的研究进展作一综述,并重点介绍儿童OSAHS的正畸治疗方法及该领域的研究现况。     

阻塞性睡眠呼吸暂停低通气综合征的治疗进展

阻塞性睡眠呼吸暂停低通气综合征是一种严重危害人们身体健康的疾病。手术与非手术两种治疗方案越来越受到人们的关注。笔者就该病的目前治疗状况作一综述。     

Serum adiponectin level in patients with obstructive sleep apnea hypopnea syndrome

Background Adiponectin, secreted by adipocytes, has been found to be associated with diabetes, obesity and some cardiovascular diseases. Obstructive sleep apnea hypopnea syndrome (OSAHS) is also closely related to obesity and easily complicated with diabetes and some cardiovascular diseases. This study was carried out to explore the change of serum adiponectin level in patients with OSAHS.Methods Polysomnography was performed in 71 patients with OSAHS (OSAHS group) and 26 simple obese controls (control group). The two groups had no significant difference in age and body mass index (BMI). Radioimmunoassy was used to test serum adiponectin level.Results Serum adiponectin level was significantly lower in OSAHS group ［(5.03±1.01) mg/L］ than that in the control group ［(7.09±1.29) mg/L, P&lt;0.05］. The differences between two groups were independent of gender. In OSAHS groups, serum adiponectin levels were negatively correlated with apnea hypopnea index (AHI) （r=-0.78, P&lt;0.01）, BMI （r=-0.13, P&lt;0.05）, waist circumsference (r=-0.36, P&lt;0.01), and neck circumference (r=-0.42, P&lt;0.01), but positively correlated with the minimal pulse oxyhemoglobin saturation （r=0.48, P&lt;0.01）. Conclusion OSAHS may contribute to the decrease of serum adiponectin level independent of obesity.     

OSAHS患者血清瘦素水平测定及其临床意义

目的 探讨测定阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清瘦素水平的临床意义.方法 选择年龄、性别差异无统计学意义的肥胖OSAHS患者65例(肥胖OSAHS组)、非肥胖OSAHS患者39例(非肥胖OSAHS组)、单纯肥胖患者13例(肥胖对照组)和健康人22名(正常对照组)进行多导睡眠图(PSG)监测,用放射免疫法测定所有对象的血清瘦素水平.结果 肥胖OSAHS组血清瘦素水平(17.85±7.86)ng/L较非肥胖OSAHS组(13.42±6.11)ng/L增高(P＜0.01);肥胖OSAHS及非肥胖OSAHS组血清瘦素较肥胖对照组(12.25±4.72)ng/L、正常对照组(7.86±2.02)ng/L增高(P＜0.05或0.01).OSAHS患者血清瘦素水平较对照组升高(F=7.01,P＜0.01),肥胖患者血清瘦素水平较非肥胖者升高(F=17.38,P＜0.01),肥胖与OSAHS无交互作用(F=1.44,P＞0.05).血清瘦素水平与体重指数(BMI)、微觉醒指数(MAI)、呼吸暂停低通气指数(AHI)、氧减指数(ODI4)呈正相关(r=0.39、0.17、0.24、0.24,P＜0.01或0.05). 结论 OSAHS患者、肥胖患者血清瘦素水平增高,除肥胖因素外,OSAHS本身也是引起瘦素水平升高的原因.     

阻塞性睡眠呼吸暂停低通气综合征与高血压相关

目的：探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者与高血压的关系,了解OSAHS合并高血压的特点.方法：收集我院睡眠中心行多导睡眠（PSG）监测的患者177例,根据呼吸紊乱指数（AHI）分组：正常组（AHI＜5）27例,轻度组（5≤AHI≤20）40例,中度组（21≤AHI≤40）61例,重度组（AH＞40）49例,177例患者伴有高血压102例,不伴高血压75例.结果：各组间年龄差异无统计学意义（P＞0.05）;正常组与轻度组、中度组的AHI、夜间最低血氧饱和度（LSaO2）差异有统计学意义（P＜0.05）,重度组与其他3组AHI、LSaO2、BMI相比差异有统计学意义（P＜0.05）.各组高血压患病率差异有统计学意义（P＜0.05）.多因素logistic回归分析提示,AHI、LSaO2 、BMI与高血压存在相关性.结论：OSAHS与高血压密切相关.     

A preliminary study on correlation between adiponectin genotype polymorphisms and obstructive sleep apnea hypopnea syndrome

Background  Obstructive sleep apnea hypopnea syndrome (OSAHS) is regarded as a disease with strong genetic background and associated with hypoadiponectinemia. It is worthwhile to investigate the possible correlation between the single nucleotide polymorphisms (SNPs) in the adiponectin gene and OSAHS.

Methods  With the TaqMan polymerase chain reaction (PCR) method, the SNPs at positions 45 and 276 in the adiponectin gene were determined in Chinese of Han nationality in Nanjing district consisting of 103 OSAHS patients (OSAHS group) and 67 normal controls (control group). The association of adiponectin genotype polymorphisms at positions 45 and 276 with OSAHS was analyzed.

Results  No evidence of a direct association was found between OSAHS and adiponectin genotype SNP at positions 45 and 276 (P >0.05). However, compared with those OSAHS patients having G/T+T/T genotype at position 276, the OSAHS patients with G/G genotype showed a longer neck circumference, a prolonged duration of the longest apnea event, and an elevated level of blood cholesterol and low-density lipoprotein cholesterol (P <0.05).

Conclusions  No direct association was suggested between OSAHS and adiponectin genotype distribution at positions 45 and 276 in Chinese of Han nationality in Nanjing district. However, in OSAHS patients, those with adiponectin G/G genotype at position 276, seemed to have a higher potential risk in development of OSAHS than those having adiponectin SNP276 G/T +T/T genotype.

     

阻塞性睡眠呼吸暂停低通气综合征的临床预测模型

目的根据阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的常见临床表现和脉搏血氧仪监测的数据,建立可靠性较高的临床预测、筛检模型。方法采用病例对照研究,随机抽取非OSAHS组受试者129例,OSAHS组受试者107例,用logistic回归法建立回归方程。作出ROC曲线,选择预测患病概率的诊断点。结果患病概率P=ex/(1 ex),x=-1977 127a-113b 013c,其中a代表有无夜间憋醒(有夜间憋醒=1,无夜间憋醒=0),b代表性别(男性=1,女性=2),c代表氧减饱和指数,将P>015作为OSAHS的诊断点,敏感性为963%,特异性约50%。结论疑诊为OSAHS患者的临床特点结合氧减饱和指数,可以较好的预测、筛检OSAHS患者。     

Genetics of obstructive sleep apnea/hypopnea syndrome

Objective To have a better understanding of genetic contributions to the development of obstructive sleep apnea hypopnea syndrome （OSAHS） by reviewing studies on its genetic basis.Data sources A comprehensive search of the PubMed literature without restriction on the publication date was carried out using terms ＂obstructive sleep apnea＂ and ＂candidate genes＂ or ＂genetics＂.Study selection Articles were selected if they were an original research paper or meta analysis of the genetic factors of OSAHS.Results Four intermediate phenotypes were described and several candidate genes that may determine the expression and severity of OSAHS were reviewed.Conclusion Multiple gene-gene interactions occurring in genes that affect obesity,craniofacial structure,ventilator control and asleep-awake pattern may influence the expression of OSAHS in a suitable environment.     

Pharyngeal aerodynamic characteristics of obstructive sleep apnea/hypopnea syndrome patients

Background  The role of nasal obstruction in the pathogenesis of obstructive sleep apnea/hypopnea syndrome (OSAHS) has been debated for decades. In this prospective study, we compared the pharyngeal aerodynamic characteristics of OSAHS patients and normal people, and investigated the contribution of total nasal airway resistance to the pathophysiology of OSAHS.

Methods  Computational fluid dynamics (CFD) was used to extract the average pressure and average airflow velocity in three transverse cross-sectional planes of the pharynx for statistical analysis, and the correlation between nasal resistance and the average pressure in the pharyngeal cavity was investigated.

Results  The negative pressure within the pharyngeal cavity was significantly higher in OSAHS patients than in normal subjects, and total nasal airway resistance correlated well with the average pressure in three consecutive transverse cross-sections of the pharyngeal cavity.

Conclusions  Greater negative pressure within the pharyngeal cavity contributed to the increased collapsibility of the pharynx in OSAHS patients, and the strong correlation between nasal resistance and pharyngeal pressure suggests that the nose plays a role in the pathogenesis of OSAHS.