CPAP和OA治療重度OSAHS伴下頜后縮患者的療效分析

CPAP和OA治療重度OSAHS伴下頜后縮患者的療效分析摘要

目的：本研究旨在評估連續(xù)氣道正壓通氣(CPAP)和正中開頜術(shù)(OA)治療重度阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)伴下頜后縮患者療效，并比較兩種治療方案的差異。

方法：本研究納入了2009年至2019年在某三甲醫(yī)院就診的50例重度OSAHS伴下頜后縮患者，隨機分為CPAP組(n=25)和OA組(n=25)。兩組患者均接受相關(guān)治療，并于治療前后進行多項指標評估，包括睡眠質(zhì)量評分、反應(yīng)時間、心理測量評分、體重指數(shù)、頸圍等。

結(jié)果：兩組患者治療前睡眠質(zhì)量評分、反應(yīng)時間、心理測量評分、體重指數(shù)、頸圍等指標差異無統(tǒng)計學(xué)意義。治療后，CPAP組患者的(AHI)明顯下降，睡眠質(zhì)量評分得分顯著提高，總有效性(有效率+顯效率)為84%；OA組患者的(AHI)同樣明顯下降，睡眠質(zhì)量評分得分顯著提高，總有效性(有效率+顯效率)為88%。兩組在治療后的各項指標中差異無統(tǒng)計學(xué)意義。然而，在OA組的治療中，在觀察期內(nèi)有多個患者出現(xiàn)了顳下頜關(guān)節(jié)紊亂、牙周炎等不良癥狀。

結(jié)論：本研究表明，在治療重度OSAHS伴下頜后縮的患者方面，CPAP和OA治療方案均能有效改善患者的睡眠質(zhì)量和相關(guān)指標。但由于兩組治療方案存在副作用和安全性方面的差異，臨床醫(yī)生應(yīng)根據(jù)患者的具體情況和需求選擇合適的治療方案。

關(guān)鍵詞：阻塞性睡眠呼吸暫停低通氣綜合征；下頜后縮；連續(xù)氣道正壓通氣；正中開頜術(shù)；治療分析

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