矫治器治疗OSAHS疗效、上气道及周围结构形态研究
Study on the efficacy of appliance in the treatment of OSAHS and the morphology of upper airway and surrounding structures
路健 1周玮 2高莹卉 3刘霖 4封净 5杨乐 1马婷 1王少 6张佐5
作者信息
- 1. 宁夏医科大学口腔医学院,银川 750003
- 2. 宁夏回族自治区人民医院呼吸科,银川 750002
- 3. 北京大学国际医院睡眠中心,北京 102206
- 4. 解放军总医院第二医学中心呼吸与危重症医学科,北京 100853
- 5. 宁夏回族自治区人民医院口腔科,银川 750002
- 6. 宁夏银川市贺兰县南梁台子卫生院,银川 750200
- 折叠
摘要
目的 对比分析定制可调式和(牙合)架定位式两种下颌前伸式矫治器(mandibular advancement device,MAD)治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS),患者的睡眠状况、下颌骨位置、上气道大小、舌骨位置及主观评分.方法 采用前瞻性研究,纳入80例轻中度成人OSAHS患者,随机分为A组:定制可调式MAD,B组:(牙合)架定位式MAD,每组40例.对比分析两组治疗前、治疗6个月后的主、客观指标是否具有差异性.结果 A、B两种矫治器治疗OSAHS患者的治疗前、治疗6个月后除了睡眠监测指标眼动期、浅睡期数据差异无统计学意义,其余指标变化均具有统计学差异,其中下齿槽座点-鼻根点垂距(B-N')A组由(5.53±1.66)mm减小至(4.93±1.75)mm,P＜0.001;B 组由(5.99±1.45)mm 减小至(5.27±1.39)mm,P＜0.001.颏前点-鼻根点垂距(Pog-N')A 组由(19.33±3.26)mm 减小至(18.08±1.54)mm,P=0.021;B组由(20.11±2.14)mm减小至(18.40±1.54)mm,P＜0.001.下颌第一磨牙点-腭平面垂距(Lm-PP)A组由(27.00±1.49)mm 减小至(26.36±1.78)mm,P＜0.001;B 组由(27.93±1.44)mm减小至(27.33±1.64)mm,P＜0.001.下颌切牙点-腭平面垂距(Li-PP)A组由(23.93±1.97)mm 增大至(24.83±1.72)mm,P＜0.001;B 组由(24.49±2.84)mm 增大至(25.22±2.79)mm,P＜0.001.舌骨-颈椎前平面垂距(H-VL)A 组由(30.59±2.07)mm 增大至(31.11±2.29)mm,P＜0.001;B组由(29.47±2.47)mm增大至(30.19±2.30)mm,P＜0.001.组间对比治疗后所有睡眠主、客观指标差异均无统计学意义.结论 两种MAD治疗后均具有显著疗效,患者睡眠质量均大幅改善;下颌骨位置均前移;舌骨矢状向位置稍前移.组间治疗6个月后所有观察指标差异并不明显.
Abstract
Objective The objective of this study was to conduct a comparative analysis of two kinds of mandibular advancement devices(MADs),specifically customized adj ustable oral appliances and articulator positioning oral appliances,in terms of sleep status,mandibular position,upper airway size,hyoid position,and subjective score of Obstructive Sleep Apnea-hypopnea Syndrome(OSAHS)patients treated with MAD.Methods A prospective study was conducted involving 80 adult patients diagnosed with mild to moderate OSAHS.Patients were randomly assigned to Group A(customized adjustable MAD)and Group B(articulator positioning MAD),with 40 cases in each group.Subjective and objective indexes were compared before treatment and six months after treatment between the two groups.Results No significant difference was observed in the sleep monitoring index of eye movement and light sleep before and six months after treatment.However,significant differences were noted in the other indicators.The vertical distance from the inferior alveolar base to nasal root(B-N')decreased from(5.53±1.66)mm to(4.93±1.75)mm in Group A(P＜0.001)and from(5.99±1.45)mm to(5.27±1.39)mm in Group B(P＜0.001).The distance from the anterior mental point to the nasal root point(Pog-N')decreased from(19.33±3.26)mm to(18.08±1.54)mm in Group A(P=0.021)and from(20.11±2.14)mm to(18.40±1.54)mm in Group B(P＜0.001).The vertical distance from the mandibular molar point to the palatal plane(Lm-PP)decreased from(27.00±1.49)mm to(26.36±1.78)mm in Group A(P＜0.001)and from(27.93±1.44)mm to(27.33±1.64)mm in Group B(P＜0.001).The vertical distance of the mandibular incisor to the palatal plane(Li-PP)increased from(23.93±1.97)mm to(24.83±1.72)mm in Group A(P＜0.001)and from(24.49±2.84)mm to(25.22±2.79)mm in Group B(P＜0.001).Hyoid-cervical vertical distance(H-VL)increased from(30.59±2.07)mm to(31.11±2.29)mm in Group A(P＜0.001)and from(29.47±2.47)mm to(30.19±2.30)mm in Group B(P＜0.001).There were no significant differences in any of the objective and subjective indicators between the two groups after treatment.Conclusions Following treatment with both types of MADs,the sleep quality of the patients significantly improved,the position of the mandible was moved forward,and the sagittal position of the hyoid bone was slightly advanced.No significant differences were observed in any of the measured indexes between the two groups after six months of treatment.
关键词
下颌前伸/口腔矫治器/上气道及其周围结构/阻塞性睡眠呼吸暂停低通气综合征Key words
Mandibular advancement/Oral appliance/Upper airway and surrounding structures/Obstructive sleep apnea hypopnea syndrome引用本文复制引用
基金项目
宁夏重点研发基金项目(2022BEG02031)
出版年
2024
NETL
NSTL
万方数据