Videoendoscopic diagnosis for predicting the response to oral appliance therapy in severe obstructive sleep apnea
Videoendoscopic diagnosis for predicting the response to oral appliance therapy in severe obstructive sleep apnea
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DOI：
10.1007/s11325-014-0947-3
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发表时间：
2014-12-01
影响因子：
2.5
通讯作者：
Sakai, Takayoshi
中科院分区：
文献类型：
--
作者：
Sasao, Yasuhiro;Nohara, Kanji;Sakai, Takayoshi
在治疗阻塞性睡眠呼吸暂停（OSA）时，口腔矫治器（OA）治疗适用于轻度至中度阻塞性睡眠呼吸暂停（OSA）患者。然而，由于也有重度OSA患者的OA治疗有效的报道，因此可能无法仅根据严重程度确定OA治疗的适应症。本研究的目的是确定在清醒状态下使用内窥镜治疗重度OSA患者的OA适应症。受试者包括36例（27例男性和9例女性），经整夜多导睡眠图诊断为重度OSA。在每例患者中，鼻内窥镜在鼻呼吸时以水平位置插入，并评估下颌前移时咽咽和口下咽气道的形态学变化。随着下颌前移，所有患者的口下咽均增宽，而29例患者的咽增宽，但7例未增宽。应用OA后呼吸暂停低通气指数（AHI）降低率在有咽后壁增宽组为79.8%（SD，13.0%），在无咽后壁增宽组为40.6%（SD，27.0%），两组之间差异有统计学意义。在显示咽喉增宽的组中，对增宽方向的评价显示了两种类型：“全面型”，即前后-外侧方向的周向增宽，和“外侧优势型”，即主要在外侧方向增宽。AHI下降率全能型为80.1%（SD，15.0%），侧优势型为79.3%（SD，10.6%），两者无显著差异。(1)关于骨性关节炎治疗的适应症，咽部的发现而不是下咽部的发现可能是重要的。(2)在存在咽部增宽的情况下，无论其方向如何，OA治疗的效果都是可以预期的。因此，为了确定OA治疗是否适用，内镜下评价下颌前移时咽前突的形态学变化可能是重要的。
In treatment for obstructive sleep apnea (OSA), oral appliance (OA) therapy is indicated in patients with mild-moderate OSA. However, since patients with severe OSA in whom OA therapy was effective have also been reported, it may not be possible to determine indications for OA therapy based on the severity alone. The purpose of this study was to determine indications for OA therapy using endoscopy during wakefulness in patients with severe OSA.The subjects consisted of 36 patients (27 males and 9 females) diagnosed with severe OSA using all-night polysomnography. In each patient, a nasoendoscope was inserted in a horizontal position during nasal breathing, and morphological changes in the airway of the velopharynx and oro-hypopharynx with mandibular advancement were evaluated.With mandibular advancement, the oro-hypopharynx was widened in all patients while the velopharynx was widened in 29 patients, but not in 7. The apnea hypopnea index (AHI) reduction rate after OA application was 79.8 % (SD, 13.0 %) in the group with and 40.6 % (SD, 27.0 %) in the group without velopharyngeal widening, being significantly different between the two groups. In the group showing velopharyngeal widening, evaluation of the direction of widening revealed two types: the "all-round type", which is circumferential widening in the anteroposterior-lateral directions, and the "lateral dominant type", which is widening mainly in the lateral direction. The AHI reduction rate was 80.1 % (SD, 15.0 %) for the all-round type and 79.3 % (SD, 10.6 %) for the lateral dominant type showing no significant difference.(1) Concerning indications for OA therapy, findings in the velopharynx rather than those in the hypopharynx may be important. (2) The effects of OA therapy can be expected in the presence of velopharyngeal widening irrespective of its direction. Thus, to determine whether OA therapy is indicated, endoscopic evaluation of morphological changes in the velopharynx with mandibular advancement may be important.