睡眠呼吸相关颅面结构的起效范围研究

By means of Acoustic pharyngometer, Rhinospirmeter,MRI,CBCT and continuous polysomnogrphy, the research would like to explore the upper airway changes with the maxillo-mandibular displacement in titrated way, especialy to find the therapeutic onset points in 3D position for obstructive sleep apnea and hypopnea syndrome(OSAHS). The target of the research is to establish a changes-reaction diagram and with acturl verification.(1)Sagittal group: 30 male adults involved, protruding mandibles by Geoge Gauge, guiding by means of acoustic pharyngometer curve, Rhinospirmeter and continuous polysomnogrphy, recorded and captured their therapeutic points. MRI scans were taken at the therapeutic points. (2)Transverse group: 15 OSAHS children were involved. Therapeutic points were captured by rapid maxillary expansion along with continuous polysomnogrphy monitoring. CBCT were taken at the end of the experiment. (3) Vertical group: 30 adult OSAHS patients, containing high, average and low mandibular angle 10 persons each, kept mandibles opening in titrated vertically at sagittal therapeutic points. The regular pattern in vertical direction was described following polysomnography monitoring. MRI scans were obtained at some turning points. (4) The research was approached to summarize a changes-reaction diagram which reflected the relationship with oralfacial bone and upper airway. 30 adult OSAHS patients in sequence were selected to verify the changes-reaction diagram in blind way. All the orthodontic, orthognathic and otolaryngology therapy were based on the morphology changes. The research was attended to provide base data for the therapies.

本研究以咽声反射仪、呼吸流量仪、MRI、CBCT和多导睡眠监测为研究手段，采用滴定法探讨颌骨位置三维方位改变与气道变化之间的关系，重点确定睡眠呼吸暂停及低通气综合征（obstructive sleep apnea and hypopnea syndrome, OSAHS）的起效点位置及界限，建立"颌骨变化-气道反应体系图"并加以验证。（1）矢向组30例男性滴定式前移下颌，在咽声反射、呼吸流量和连续夜间多导睡眠监测指引下，于滴定终点取上气道MRI资料；（2）横向组15例儿童OSAHS通过快速腭开展，连续夜间多导睡眠监测，实验终点取CBCT资料；（3）成年男性高角、均角、低角各10例，在矢向起效点上做垂直向滴定，取多导睡眠监测转折点MRI资料；（4）以30例成人OSAHS患者双盲验证"变化-反应体系图"。拟为基于形态机制的OSAHS矫治、正颌外科和耳鼻喉手术提供基础数据。

解剖因素是睡眠呼吸暂停及低通气综合征（obstructive sleep apnea and hypopnea syndrome, OSAHS）的重要病因机制及唯一能为治疗所改变的疗效机制。本课题（1）矢向方向研究了OSAHS的起效点的位置与下颌矢向前伸之间存在的滴定规律。研究通过对44例成年男性OSAHS患者采用可调式装置，在整夜便携式睡眠监测下，每夜下颌前移增加0.5mm，建立了下颌矢向前伸与多导睡眠监测客观疗效之间的曲线图，探讨了起效点和治愈点的存在规律以及上气道MRI影像变化。（2）宽度方向上对儿童进行了腭开展过程的上气道形态及功能的观察，得到CBCT、鼻阻力及PSG之间的关联数据。（3）垂直方向上对高角、均角、低角垂直骨型的作用变化，进行了CBCT/MRI和头影测量研究。（4）骨型的影响分析从矢状向、宽度和垂直向三维方向展开，分别通过CBCT/MRI了解其相互影响。系列研究结果表明，下颌移位对睡眠呼吸功能的影响变化规律呈函数曲线关系，并且存在亚型表现。特别重要的是，初始睡眠呼吸暂停低通气指数（AHI轻中重程度）与初始颅面类型（高、中、低角）对起效点和治愈点形成重要影响。骨骼类型对于上气道形态及变化有先天因素的影响。既往研究多以上气道间接指标，而本课题直接研究了夜间睡眠呼吸功能受到颌骨形态与位置改变的影响，从指标的丰度和细化程度，未见于国内外文献报道。观察结论对基于形态变化的OSAHS矫治、正颌和耳鼻喉手术等多学科实施精准医疗提供数据支持。