摘要目的 评价改良一体式阻鼾器对中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)行腭咽成形术(UPPP)后仍有阻塞/低通气存在的患者的治疗效果.方法 纳入2013年10月至2014年2月在甘肃省人民医院睡眠中心确诊为中重度OSAHS并行UPPP术4周后经多导睡眠图(PSG)监测仍有阻塞/低通气存在的男性患者,术后第5周开始佩戴改良一体式阻鼾器,共4周.佩戴前、后,运用问卷调查评价患者主客观睡眠状况的改善;PSG监测呼吸暂停低通气指数(AHI)和睡眠结构的变化;上气道锥形束CT扫描观察腭咽、舌咽最狭窄处矢状径和口咽容积的改变,并与AHI的变化进行相关研究.结果 共入选10例男性患者,年龄31～55岁,平均(42.4±9.2)岁;体质指数22.8～29.4 kg/m2,平均(25.0±4.8)kg/m2;AHI 15.8～35.9次/h,平均(26.0±7.5)次/h.与佩戴改良一体式阻鼾器前比较,佩戴4周后患者鼾声、日间困倦、睡眠憋醒症状得到改善,并有良好的适宜性.AHI从(26.0±7.5)降至(6.0±0.7)次/h(P ＜0.001),最低血氧饱和度(SaO2)从(79.6±3.9)％升至(87.6±1.6)％(P＜0.001),觉醒和非快眼动(NREM)1期睡眠时间占比从(11.0±2.3)％和(26.1±4.3)％分别减至(6.8±1.6)％和(11.1±1.5)％(均P＜0.001),NREM 3期睡眠和快眼动(REM)睡眠时间占比从(10.2±2.2)％和(11.6±1.4)％分别增至(17.7±3.1)％和(21.3±3.1)％(均P＜0.001);腭咽区和舌咽区最狭窄处矢状径分别增加(0.64±0.04) mm和(1.51±0.18)mm,口咽总容积增大(2 446±963) mm3(均P＜0.05);AHI与舌咽最狭窄处矢状径及口咽总容积的变化均呈负相关(均P ＜0.05).结论 UPPP后残余症状的中重度OSAHS患者佩戴改良一体式阻鼾器可显著增大舌咽水平狭窄区域的矢状径及容积,改善低通气及恢复紊乱的睡眠结构,疗效显著.

abstractsObjective To evaluate the efficacies of a modified oral appliance (MOA) for residual obstruction after uvulopalatopharyngoplasty (UPPP) in the treatment of moderate-to-severe obstructive sleep apnea hypopnea syndrome (OSAHS).Methods The patients with residual airway obstruction on polysomnography (PSG) at four weeks post-UPPP were selected from the Sleep Medicine Center,Gansu Provincial People's Hospital from October 2013 to February 2014.As of week 5 post-UPPP,all subjects wore MOA for 4 weeks.Before and 4 weeks after treatment,questionnaires were distributed to evaluated the improvement of subjective and objective sleep.The average apnea hyponea index (AHI) and sleep patterns were examined by PSG.The sagittal diameter in minimal region of retropalatal and retroglossal patency and the volume of orophary were measured by cone beam computed tomography (CBCT) scans.And the correlation between the outcomes of CBCT and AHI were analyzed.Results A total of 10 male OSAHS patients were enrolled.The average age was (42.4 ± 9.2) (31-55) years,body mass index (BMI) (25.0 ± 4.8) (22.8-29.4) kg/m2 and AHI was (26.0 ± 7.5) (15.8-35.9)/h.After wearing MOA for 4 weeks,the symptoms of snoring,daytime somnolence and suffocated waking during sleep improved as compared with that pre-treatment.All adapted to sleep with MOA.Average AHI decreased from (26.0 ± 7.5)/h to (6.0 ± 0.7)/h (P ＜ 0.001).And the lowest average oxygen saturation value (SaO2) increased from (79.6 ±3.9)％ to (87.6 ± 1.6)％ (P ＜0.001).PSG indicated that the percentage of awakening time and sleep time in nonrapid eye movement (NREM) stage 1 decreased from (11.0 ± 2.3) ％ and (26.1±4.3)％ to (6.8 ± 1.6)％ and (11.1 ±1.5)％ respectively in total sleep time (TST).The percentage of NREM stage3 sleep time and rapid eye movement (REM) sleep time in TST increased on average from (10.2±2.2)％ and (11.6±1.4)％ to (17.7±3.1)％ and (21.3±3.1)％ respectively (all P ＜ 0.001).CBCT measurements showed that the sagittal diameter in minimal region of retropalatal and retroglossal patency increased on average by (0.64 ± 0.04) and (1.51 ± 0.18) mm respectively.The average volume of orophary increased by (2 446 ± 963) mm3 (all P ＜ 0.05).Negative correlations existed between AHI and sagittal diameter of minimal region of retroglossal patency,AHI and volume of orophary (all P ＜ 0.05).Conclusion The application of MOA after UPPP can significantly increase the sagittal diameter of minimal region of retroglossal patency and the volume of orophary and improve effectively hyperpnoea and disordered sleep patterns.