Study for the etiological diagnosis of obstructive sleep apnea and survey in oral and maxillofacial diseases.

尽管各种解剖畸形被认为是阻塞性睡眠呼吸暂停综合征的病因，但对这种疾病的形态学分析还没有很好的建立。本研究探讨了一种新的诊断OSA病因和严重程度的方法，即用睡眠血氧测定法代替多导睡眠图来诊断OSA，该方法适用于不合作的儿童。结果表明，TSpO_2 <90%与呼吸暂停低通气指数（AHI）密切相关，提示TSpO_2 <90是诊断OSA的生理学指标。本研究的对象包括13例手术治疗的阻塞性睡眠呼吸暂停（OSA）患者，共26对手术前后的头颅X线片和多导睡眠图进行分析。结果，通过多变量分析得到两个气道分析图（AAC）。一个回归方程为（AHI）=1.48（EX）-2.63（mPAS）+32.6，R^2 = 0.70，其中mPAS为后气道间隙的平均宽度，单位为mm，EX为软腭超过咽部深度的长度，单位为mm;另一个回归方程为（AHI）=1.62（EX）+0.98（PPH）-74.9，R^2 = 0.71，其中PPH是从腭平面到舌骨的距离，单位为mm。OSA在口腔颌面部疾病中的发生率通过睡眠血氧饱和度和AAC进行了调查，然后在各种情况下发现了许多OSA，如下颌后（小颏，无颌，RA），Pierre-Robin综合征，Crouzon综合征，腭裂术后和上下颌固定。总之，似乎许多口腔颌面外科医生只是没有意识到，即使在口腔颌面部的常见疾病中也会发生OSA。

In spite of variant anatomic deformities claimed as etiologic factors for OSA,the morphologic analysis of this condition has not been well established. In this study, a new method of diagnosing the etiology and the severity of OSA was studied.To diagnose any patients as OSA,the Sleep Oximetry which was a method applicable even to uncooperative child for diagnosis of OSA instead of polysomnography was developed. A parameter, %TSpO_2<90 which was the percentage of the time spent below 90% of SpO2 was related to the apnea/hypopnea index (AHI) closely and seemed to be useful for physiological diagnosis of OSA.On the other hand, a study was designed to establish a new method of diagnosing the etiology of OSA using contrasted lateral cephalograms. The subjects of the study consisted of 13 patients who had undergone surgical treatment of OSA.Twenty six pairs of cephalograms and polysomnograms taken pre/postoperatively were used for the analysis. As result, two Airway Analyzing Charts (AAC) were obtained from the multivariate analysis. One regression equation was (AHI)=1.48(EX)-2.63(mPAS)+32.6 with an R^2 value of 0.70, where mPAS is the average width of the posterior airway space in mm and EX is the length of the soft palate in excess of the pharyngeal depth in mm. The other was (AHI)=1.62(EX)+0.98(PPH)-74.9 with an R^2 value of 0.71, where PPH is the distance from the palatal plane to the hyoid bone in mm.The incidence of OSA in the oral and maxillofacial diseases was investigated with Sleep Oximetry and AACs and then many OSAs were found in the various conditions such as retromandible (microgenia, agnathia, RA), Pierre-Robin syndrome, Crouzon syndrome, postpalatoplasty and maxillomandibular fixation. In conclusion, it seems that many oral and maxillofacial surgeons merely have not become aware of OSAs which have been occurring even in the common diseases of oral and maxillofacial region.