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。

Preliminary evaluation of treatment of obstructive sleep apnea and hypopnea syndrome using modified Herbst appliance

PURPOSES： To evaluate the effectiveness of modified Herbst oral appliance in treatment of obstructive sleep apnea and hypopnea syndrome （OSAHS） by three-dimensional CT. METHODS： Ten patients with mild or moderate OSAHS by PSG were included in the study. The upper airway was scanned at normal respiration and Muller＇s maneuver by spiral CT （GE lightspeed ultra）. Each patient was treated using Herbst oral appliance and adjusted several times until the subjective symptoms were improved. Three month later, each patient was re-evaluated by PSG and re-scanned by three-dimensional CT in two positions. The cross-section area with its corresponding sagittal and transverse diameters and the volume at retropalatal and retroglossal regions, the site and range of upper airway structure was evaluated. Paired t test was used for data analysis using SPSS 12.0 software package. RESULTS： There were significant differences between pretreatment and three months after treatment with Herbst appliance subjectively and objectively. The transverse diameter and cross-section area were increased significantly at retro palatal and retro lingual level （P〈0.05）. The volume of upper airway was augmented significantly （P〈0.05）. Muller＇s test before and after treatment indicated that obstructive sites were decreased obviously. CONCLUSIONS： Modified Herbst appliance is effective for mild or moderate OSAHS. The upper airway three-dimensional CT with Muller＇s maneuver can be used in evaluating upper airway and the efficiency of treatment with oral appliance. Supporied by Research Fund of Science and Technology Commission of Shanghai Munieipalily（l 1140902001）.