不同疗程戴用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对比

发布时间：2018-08-30 18:52

【摘要】：目的:观察阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者戴用不同疗程的口腔矫治器后,治疗效果的持续情况。方法:55例经多导睡眠监测诊断为OSAHS的患者,使用下颌前移型口腔矫治器治疗,下颌前伸量为患者下颌最大前伸量的60%~70%,下颌张口量为前牙切端间距4~5mm,患者每周戴用5~7 d,每天戴用6~8 h。对疗效进行回顾,根据戴用时间长短,分为4个时间组(1年以下组、1~2年组、2~6年组和6~9年组)进行比较,观察睡眠呼吸暂停及低通气指数(apnea-hypopnea index,AHI)、最长呼吸暂停时间、最低血氧饱和度(lowest oxygen saturation,LSa O_2)治疗前后的变化。结果:AHI(次/h)在1年以下组[24.50(14.65,54.05)vs.7.40(2.12,10.00),P0.001]、1~2年组[19.50(12.15,39.23)vs.1.80(0.70,6.58),P=0.001]、2~6年组[25.00(11.41,42.60)vs.4.50(1.35,7.90),P=0.001]和6~9年组[26.2(16.95,47.45)vs.4.00(1.90,26.70),P=0.043]治疗前后差异均有统计学意义;最长呼吸暂停时间在6年以下的3个组均有降低,1年以下组由57.00(37.70,61.50)s降至25.00(15.90,33.50)s(P0.001),1~2年组由41.00(25.50,62.26)s降至13.10(0.00,22.10)s(P=0.001),2~6年组由42.50(30.35,58.15)s降至15.60(0.00,28.10)s(P=0.003);最低血氧饱和度LSa O_2在1年以下组及2~6年组有所升高,1年以下组由初始的74.18%±7.96%升至84.06%±7.67%(P=0.001),2~6年组由76.71%±10.98%升至84.06%±4.64%(P=0.006),而在1~2年组及6~9年组差异无统计学意义。在组间比较中,Kruskal-Wallis检验示4组患者经矫治器治疗后,各项睡眠呼吸指数差异均无统计学意义(P0.05)。结论:口腔矫治器是一种长期治疗OSAHS的比较有效的方法,但是医生应加强对患者的疗效追踪,督促患者复诊检查,以确保疗效的持续性,并及时根据需要更换矫治器。
[Abstract]:Aim: to observe the efficacy of oral appliance in patients with obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea hypopnea syndrome,OSAHS). Methods 55 patients with OSAHS diagnosed by polysomnography were treated with mandibular anterior displacement oral appliance. The mandibular protruding volume was 60 / 70 of the maximum mandibular protruding volume, and the mandibular opening was 4 ~ 5 mm apart from the incisor end of the anterior teeth. The patients wore it for 5 ~ 7 days a week for 6 ~ 8 hours a day. The curative effect was reviewed and divided into 4 groups according to the duration of wearing. The sleep apnea and hypopnea index (apnea-hypopnea index,AHI) and the longest apnea time were observed. Minimum oxygen saturation (lowest oxygen saturation,LSa O 2) changes before and after treatment. Results [24.50 (14.65 卤54.05) vs.7.40 (2.12 ~ 10.00) vs.7.40] 1 ~ 2 years group [19.50 (12.15 ~ 39.23) vs.1.80 (0.70 ~ 6.58) P0. 001] 26 years [25.00 (11.41 42.60) vs.4.50 (1.35 卤7.90) P0. 001] and 69 ~ 9 (26. 2 (16. 955) vs.4.00 (1. 9026. 70) P0.043) were statistically significant. The longest apnea time decreased from 57.00 (37.70 卤61.50) s to 25.00 (15.90 卤33.50) s (P0.001) from 41.00 (25.50) s (62.26) s to 13.10 (0.0022.10) s (P0.001) from 42.50 (30.35) s (58.15) s to 15.60 (0.0028.10) s (P0. 3) in 1 ~ 2 years group, and the lowest oxygen saturation LSa O\ -2 increased from 1 year to 2 ~ 6 years. The following groups increased from 74.18% 卤7.96% to 84.06% 卤7.67% (P0. 001) from 76.71% 卤10.98% to 84.06% 卤4.64% (P0. 006), but there was no significant difference between the two groups. Kruskal-Wallis test showed that there was no significant difference in sleep apnea index among the 4 groups after orthodontic therapy (P0.05). Conclusion: oral appliance is an effective method to treat OSAHS for a long time, but the doctor should strengthen the follow-up of the patient's curative effect, urge the patient to return the examination, so as to ensure the continuity of the curative effect, and change the appliance according to the need in time.
【作者单位】：北京大学口腔医学院·口腔医院正畸科口腔数字化医疗技术和材料国家工程实验室口腔数字医学北京市重点实验室;首都医科大学宣武医院口腔科;
【基金】：国家自然科学基金(81400062) 中国睡眠研究会青年科研基金(2014-03)资助~~
【分类号】：R766

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