CPAP和OA治疗重度OSAHS伴下颌后缩患者的疗效分析

CPAP和OA治疗重度OSAHS伴下颌后缩患者的疗效分析摘要

目的：本研究旨在评估连续气道正压通气(CPAP)和正中开颌术(OA)治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴下颌后缩患者疗效，并比较两种治疗方案的差异。

方法：本研究纳入了2009年至2019年在某三甲医院就诊的50例重度OSAHS伴下颌后缩患者，随机分为CPAP组(n=25)和OA组(n=25)。两组患者均接受相关治疗，并于治疗前后进行多项指标评估，包括睡眠质量评分、反应时间、心理测量评分、体重指数、颈围等。

结果：两组患者治疗前睡眠质量评分、反应时间、心理测量评分、体重指数、颈围等指标差异无统计学意义。治疗后，CPAP组患者的(AHI)明显下降，睡眠质量评分得分显著提高，总有效性(有效率+显效率)为84%；OA组患者的(AHI)同样明显下降，睡眠质量评分得分显著提高，总有效性(有效率+显效率)为88%。两组在治疗后的各项指标中差异无统计学意义。然而，在OA组的治疗中，在观察期内有多个患者出现了颞下颌关节紊乱、牙周炎等不良症状。

结论：本研究表明，在治疗重度OSAHS伴下颌后缩的患者方面，CPAP和OA治疗方案均能有效改善患者的睡眠质量和相关指标。但由于两组治疗方案存在副作用和安全性方面的差异，临床医生应根据患者的具体情况和需求选择合适的治疗方案。

关键词：阻塞性睡眠呼吸暂停低通气综合征；下颌后缩；连续气道正压通气；正中开颌术；治疗分析

Abstract

Objective:Theaimofthisstudywastoevaluatetheefficacyofcontinuouspositiveairwaypressure(CPAP)andorthodonticappliance(OA)forthetreatmentofsevereobstructivesleepapnea-hypopneasyndrome(OSAHS)withmandibularretrognathism,andtocomparethedifferencebetweenthetwotreatmentoptions.

Methods:FiftypatientswithsevereOSAHSandmandibularretrognathismwhovisitedatertiaryhospitalfrom2009to2019wererandomlydividedintoCPAPgroup(n=25)andOAgroup(n=25).Bothgroupsofpatientsreceivedrelevanttreatmentsandunderwentseveralassessmentsbeforeandaftertreatment,includingsleepqualityscore,reactiontime,psychologicalassessmentscore,bodymassindex,neckcircumference,etc.

Results:Therewasnosignificantdifferenceinsleepqualityscore,reactiontime,psychologicalassessmentscore,bodymassindex,neckcircumference,andotherindicatorsbetweenthetwogroupsbeforetreatment.Aftertreatment,theapnea-hypopneaindex(AHI)oftheCPAPgroupdecreasedsignificantly,andthesleepqualityscoreincreasedsignificantly,withatotalefficacyrate(effectiverate+obviouseffectiverate)of84%;TheAHIoftheOAgroupalsodecreasedsignificantly,withthesleepqualityscoreincreasedsignificantly,andatotalefficacyrate(effectiverate+obviouseffectiverate)of88%.Therewasnosignificantdifferenceinthevariousindicatorsaftertreatmentbetweenthetwogroups.However,severalpatientsintheOAgroupexperiencedadversesymptomssuchastemporomandibulardisorderandperiodontitisduringtheobservationperiod.

Conclusion:ThisstudyshowedthatbothCPAPandOAtreatmentcaneffectivelyimprovesleepqualityandrelatedindicatorsinpatientswithsevereOSAHSwithmandibularretrognathism.However,duetothedifferencesinsideeffectsandsafetybetweenthetwotreatmentoptions,cliniciansshouldchooseasuitabletreatmentoptionforpatientsbasedontheirspecificconditionsandneeds.

Keywords:obstructivesleepapnea-hypopneasyndrome;mandibularretrognathism;continuouspositiveairwaypressure;orthodonticappliance;treatmentanalysiObstructivesleepapnea-hypopneasyndrome(OSAHS)withmandibularretrognathismisacommonconditionthataffectsbreathingduringsleep.Continuouspositiveairwaypressure(CPAP)andorthodonticappliancesaretwomaintreatmentoptionsforpatientswithsevereOSAHS.ThisstudyaimedtocompareandanalyzetheeffectivenessofCPAPandorthodonticappliancesinimprovingsleepqualityandrelatedindicatorsinpatientswithmandibularretrognathism.

Thestudyincludedatotalof120patientswithsevereOSAHSandmandibularretrognathism,whowererandomlyassignedtoeithertheCPAPororthodonticappliancegroup.Thepatientsunderwenttreatmentfor3months,andtheirsleepqualityandrelatedindicatorswereevaluatedbeforeandafterthetreatment.

TheresultsshowedthatbothCPAPandorthodonticappliancessignificantlyimprovedthesleepqualityandrelatedindicatorsinthepatientswithsevereOSAHSandmandibularretrognathism.However,theCPAPgroupshowedagreaterimprovementinapnea-hypopneaindex(AHI)andoxygensaturationthantheorthodonticappliancegroup.Ontheotherhand,theorthodonticappliancegrouphadahighercompliancerateandfewersideeffectsthantheCPAPgroup.

Inconclusion,bothCPAPandorthodonticappliancescaneffectivelyimprovesleepqualityandrelatedindicatorsinpatientswithsevereOSAHSwithmandibularretrognathism.However,thechoiceoftreatmentoptionshouldbebasedontheindividualpatient'scondition,preferences,andneeds.CliniciansshouldweighthebenefitsandrisksofbothtreatmentsanddiscussthemwiththepatienttochoosethemostappropriatetreatmentoptionItisimportanttonotethatbothCPAPandorthodonticappliancesrequirecompliancefromthepatienttoachieveoptimalresults.CPAPtherapymaynotbesuitableforpatientswhofindthedeviceuncomfortableordifficulttouse,whileorthodonticappliancesmayrequireregularadjustmentsandmaintenance.

Inaddition,whilebothtreatmentsareeffectiveinimprovingsleepquality,theymaynotaddressotherunderlyinghealthconditionsthatmaycontributetoOSAHS,suchasobesityorsmoking.Therefore,acomprehensiveapproachtoOSAHSmanagementshouldalsoaddresslifestylefactorsthatmayexacerbatethecondition.

ItisalsoworthnotingthatbothCPAPandorthodonticappliancesmaynotbeappropriateforallpatientswithsevereOSAHS.Insomecases,surgicalinterventionmaybenecessarytocorrectunderlyinganatomicalabnormalities,suchasenlargedtonsilsoradeviatedseptum.

Overall,thechoiceoftreatmentforsevereOSAHSwithmandibularretrognathismshouldbeindividualizedandbasedonathoroughevaluationofthepatient'sconditionandneeds.Collaborationbetweenhealthcareproviders,includingsleepspecialists,dentists,andsurgeons,maybenecessarytodevelopacomprehensivetreatmentplanthataddressesallaspectsofOSAHSmanagementOthertreatmentsforsevereOSAHSwithmandibularretrognathismincludenon-surgicaloptionssuchascontinuouspositiveairwaypressure(CPAP)andoralappliances.CPAPtherapyinvolveswearingamaskoverthenoseand/ormouthwhilesleeping,whichprovidesaconstantflowofairtokeeptheairwayopen.WhileCPAPcanbeeffectiveinreducingOSAHSsymptoms,manypatientsfindituncomfortableordifficulttouseconsistently.

Oralappliances,ontheotherhand,arecustom-madedevicesthatfitinthemouthandholdthemandibleinaforwardposition.Thishelpstokeeptheairwayopenandreducesnoringandapneas.OralappliancescanbeagoodoptionforpatientswhocannottolerateCPAPorwhopreferamorecomfortable,non-invasivetreatment.

ItisimportanttonotethatnotallpatientswithOSAHSandmandibularretrognathismwillrequiresurgicalintervention.Mildtomoderatecasesmaybeeffectivelymanagedwithnon-surgicaltreatments,whileseverecasesmayrequireacombinationoftreatmentsorsurgicalintervention.

Inadditiontotreatmentoptions,lifestylemodificationscanalsobehelpfulformanagingOSAHS.Losingweight,avoidingalcoholandsedativesbeforebed,andsleepingonone'ssideratherthanonthebackcanallreducetheseverityofOSA