中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
10期
761-765
,共5页
徐超%谢宇平%康宏%马薇%惠培林%王金凤%赵丽君%秦猛%何健民
徐超%謝宇平%康宏%馬薇%惠培林%王金鳳%趙麗君%秦猛%何健民
서초%사우평%강굉%마미%혜배림%왕금봉%조려군%진맹%하건민
睡眠呼吸暂停,阻塞性%低通气综合征%改良一体式阻鼾器%腭咽成形术
睡眠呼吸暫停,阻塞性%低通氣綜閤徵%改良一體式阻鼾器%腭嚥成形術
수면호흡잠정,조새성%저통기종합정%개량일체식조한기%악인성형술
Sleep apnea,obstructive%Hypoventilation syndrome%Modified oral appliance%Uvulopalatopharyngoplasty
目的 评价改良一体式阻鼾器对中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)行腭咽成形术(UPPP)后仍有阻塞/低通气存在的患者的治疗效果.方法 纳入2013年10月至2014年2月在甘肃省人民医院睡眠中心确诊为中重度OSAHS并行UPPP术4周后经多导睡眠图(PSG)监测仍有阻塞/低通气存在的男性患者,术后第5周开始佩戴改良一体式阻鼾器,共4周.佩戴前、后,运用问卷调查评价患者主客观睡眠状况的改善;PSG监测呼吸暂停低通气指数(AHI)和睡眠结构的变化;上气道锥形束CT扫描观察腭咽、舌咽最狭窄处矢状径和口咽容积的改变,并与AHI的变化进行相关研究.结果 共入选10例男性患者,年龄31～55岁,平均(42.4±9.2)岁;体质指数22.8～29.4 kg/m2,平均(25.0±4.8)kg/m2;AHI 15.8～35.9次/h,平均(26.0±7.5)次/h.与佩戴改良一体式阻鼾器前比较,佩戴4周后患者鼾声、日间困倦、睡眠憋醒症状得到改善,并有良好的适宜性.AHI从(26.0±7.5)降至(6.0±0.7)次/h(P ＜0.001),最低血氧饱和度(SaO2)从(79.6±3.9)％升至(87.6±1.6)％(P＜0.001),觉醒和非快眼动(NREM)1期睡眠时间占比从(11.0±2.3)％和(26.1±4.3)％分别减至(6.8±1.6)％和(11.1±1.5)％(均P＜0.001),NREM 3期睡眠和快眼动(REM)睡眠时间占比从(10.2±2.2)％和(11.6±1.4)％分别增至(17.7±3.1)％和(21.3±3.1)％(均P＜0.001);腭咽区和舌咽区最狭窄处矢状径分别增加(0.64±0.04) mm和(1.51±0.18)mm,口咽总容积增大(2 446±963) mm3(均P＜0.05);AHI与舌咽最狭窄处矢状径及口咽总容积的变化均呈负相关(均P ＜0.05).结论 UPPP后残余症状的中重度OSAHS患者佩戴改良一体式阻鼾器可显著增大舌咽水平狭窄区域的矢状径及容积,改善低通气及恢复紊乱的睡眠结构,疗效显著.
目的 評價改良一體式阻鼾器對中重度阻塞性睡眠呼吸暫停低通氣綜閤徵(OSAHS)行腭嚥成形術(UPPP)後仍有阻塞/低通氣存在的患者的治療效果.方法 納入2013年10月至2014年2月在甘肅省人民醫院睡眠中心確診為中重度OSAHS併行UPPP術4週後經多導睡眠圖(PSG)鑑測仍有阻塞/低通氣存在的男性患者,術後第5週開始珮戴改良一體式阻鼾器,共4週.珮戴前、後,運用問捲調查評價患者主客觀睡眠狀況的改善;PSG鑑測呼吸暫停低通氣指數(AHI)和睡眠結構的變化;上氣道錐形束CT掃描觀察腭嚥、舌嚥最狹窄處矢狀徑和口嚥容積的改變,併與AHI的變化進行相關研究.結果 共入選10例男性患者,年齡31～55歲,平均(42.4±9.2)歲;體質指數22.8～29.4 kg/m2,平均(25.0±4.8)kg/m2;AHI 15.8～35.9次/h,平均(26.0±7.5)次/h.與珮戴改良一體式阻鼾器前比較,珮戴4週後患者鼾聲、日間睏倦、睡眠憋醒癥狀得到改善,併有良好的適宜性.AHI從(26.0±7.5)降至(6.0±0.7)次/h(P ＜0.001),最低血氧飽和度(SaO2)從(79.6±3.9)％升至(87.6±1.6)％(P＜0.001),覺醒和非快眼動(NREM)1期睡眠時間佔比從(11.0±2.3)％和(26.1±4.3)％分彆減至(6.8±1.6)％和(11.1±1.5)％(均P＜0.001),NREM 3期睡眠和快眼動(REM)睡眠時間佔比從(10.2±2.2)％和(11.6±1.4)％分彆增至(17.7±3.1)％和(21.3±3.1)％(均P＜0.001);腭嚥區和舌嚥區最狹窄處矢狀徑分彆增加(0.64±0.04) mm和(1.51±0.18)mm,口嚥總容積增大(2 446±963) mm3(均P＜0.05);AHI與舌嚥最狹窄處矢狀徑及口嚥總容積的變化均呈負相關(均P ＜0.05).結論 UPPP後殘餘癥狀的中重度OSAHS患者珮戴改良一體式阻鼾器可顯著增大舌嚥水平狹窄區域的矢狀徑及容積,改善低通氣及恢複紊亂的睡眠結構,療效顯著.
목적 평개개량일체식조한기대중중도조새성수면호흡잠정저통기종합정(OSAHS)행악인성형술(UPPP)후잉유조새/저통기존재적환자적치료효과.방법 납입2013년10월지2014년2월재감숙성인민의원수면중심학진위중중도OSAHS병행UPPP술4주후경다도수면도(PSG)감측잉유조새/저통기존재적남성환자,술후제5주개시패대개량일체식조한기,공4주.패대전、후,운용문권조사평개환자주객관수면상황적개선;PSG감측호흡잠정저통기지수(AHI)화수면결구적변화;상기도추형속CT소묘관찰악인、설인최협착처시상경화구인용적적개변,병여AHI적변화진행상관연구.결과 공입선10례남성환자,년령31～55세,평균(42.4±9.2)세;체질지수22.8～29.4 kg/m2,평균(25.0±4.8)kg/m2;AHI 15.8～35.9차/h,평균(26.0±7.5)차/h.여패대개량일체식조한기전비교,패대4주후환자한성、일간곤권、수면별성증상득도개선,병유량호적괄의성.AHI종(26.0±7.5)강지(6.0±0.7)차/h(P ＜0.001),최저혈양포화도(SaO2)종(79.6±3.9)％승지(87.6±1.6)％(P＜0.001),각성화비쾌안동(NREM)1기수면시간점비종(11.0±2.3)％화(26.1±4.3)％분별감지(6.8±1.6)％화(11.1±1.5)％(균P＜0.001),NREM 3기수면화쾌안동(REM)수면시간점비종(10.2±2.2)％화(11.6±1.4)％분별증지(17.7±3.1)％화(21.3±3.1)％(균P＜0.001);악인구화설인구최협착처시상경분별증가(0.64±0.04) mm화(1.51±0.18)mm,구인총용적증대(2 446±963) mm3(균P＜0.05);AHI여설인최협착처시상경급구인총용적적변화균정부상관(균P ＜0.05).결론 UPPP후잔여증상적중중도OSAHS환자패대개량일체식조한기가현저증대설인수평협착구역적시상경급용적,개선저통기급회복문란적수면결구,료효현저.
Objective To evaluate the efficacies of a modified oral appliance (MOA) for residual obstruction after uvulopalatopharyngoplasty (UPPP) in the treatment of moderate-to-severe obstructive sleep apnea hypopnea syndrome (OSAHS).Methods The patients with residual airway obstruction on polysomnography (PSG) at four weeks post-UPPP were selected from the Sleep Medicine Center,Gansu Provincial People's Hospital from October 2013 to February 2014.As of week 5 post-UPPP,all subjects wore MOA for 4 weeks.Before and 4 weeks after treatment,questionnaires were distributed to evaluated the improvement of subjective and objective sleep.The average apnea hyponea index (AHI) and sleep patterns were examined by PSG.The sagittal diameter in minimal region of retropalatal and retroglossal patency and the volume of orophary were measured by cone beam computed tomography (CBCT) scans.And the correlation between the outcomes of CBCT and AHI were analyzed.Results A total of 10 male OSAHS patients were enrolled.The average age was (42.4 ± 9.2) (31-55) years,body mass index (BMI) (25.0 ± 4.8) (22.8-29.4) kg/m2 and AHI was (26.0 ± 7.5) (15.8-35.9)/h.After wearing MOA for 4 weeks,the symptoms of snoring,daytime somnolence and suffocated waking during sleep improved as compared with that pre-treatment.All adapted to sleep with MOA.Average AHI decreased from (26.0 ± 7.5)/h to (6.0 ± 0.7)/h (P ＜ 0.001).And the lowest average oxygen saturation value (SaO2) increased from (79.6 ±3.9)％ to (87.6 ± 1.6)％ (P ＜0.001).PSG indicated that the percentage of awakening time and sleep time in nonrapid eye movement (NREM) stage 1 decreased from (11.0 ± 2.3) ％ and (26.1±4.3)％ to (6.8 ± 1.6)％ and (11.1 ±1.5)％ respectively in total sleep time (TST).The percentage of NREM stage3 sleep time and rapid eye movement (REM) sleep time in TST increased on average from (10.2±2.2)％ and (11.6±1.4)％ to (17.7±3.1)％ and (21.3±3.1)％ respectively (all P ＜ 0.001).CBCT measurements showed that the sagittal diameter in minimal region of retropalatal and retroglossal patency increased on average by (0.64 ± 0.04) and (1.51 ± 0.18) mm respectively.The average volume of orophary increased by (2 446 ± 963) mm3 (all P ＜ 0.05).Negative correlations existed between AHI and sagittal diameter of minimal region of retroglossal patency,AHI and volume of orophary (all P ＜ 0.05).Conclusion The application of MOA after UPPP can significantly increase the sagittal diameter of minimal region of retroglossal patency and the volume of orophary and improve effectively hyperpnoea and disordered sleep patterns.
