国际口腔医学杂志 ›› 2020, Vol. 47 ›› Issue (3): 328-335.doi: 10.7518/gjkq.2020036

• 综述 • 上一篇    下一篇

下颌前移矫治器治疗阻塞性睡眠呼吸暂停低通气综合征的研究进展

赵圆1,杨婷1,彭文涛1,刘春艳2()   

  1. 1.河北医科大学口腔医学院 石家庄 050017;
    2.河北医科大学口腔医院正畸科,河北省口腔医学重点实验室 石家庄 050017
  • 收稿日期:2019-06-27 修回日期:2019-12-10 出版日期:2020-05-01 发布日期:2020-05-08
  • 通讯作者: 刘春艳
  • 作者简介:赵圆,学士,Email:1152896820@qq.com
  • 基金资助:
    国家自然科学基金青年科学基金(81701010)

Research progress on mandibular advancement therapy for obstructive sleep apnea hypopnea syndrome

Zhao Yuan1,Yang Ting1,Peng Wentao1,Liu Chunyan2()   

  1. 1.School of Stomatology, Hebei Medical University, Shijiazhuang 050017, China;
    2.Dept. of Orthodontics, Hospital of Stomatology, Hebei Medical University, Key Laboratory of Stomatology, Hebei Province, Shijiazhuang 050017, China
  • Received:2019-06-27 Revised:2019-12-10 Online:2020-05-01 Published:2020-05-08
  • Contact: Chunyan Liu
  • Supported by:
    Young Scientists Fund of National Natural Science Foundation of China(81701010)

摘要:

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种在临床上表现为睡眠中反复发生呼吸暂停或低通气的疾病,其发病率高且具有潜在致死危险。近年来该疾病日益受到重视,在众多治疗方法中,下颌前移矫治器作为一种非手术治疗方式,因其无创伤、便于摘戴、患者易于接受等独特的优点,是治疗轻、中度OSAHS的有效方法。本文就下颌前移矫治器分类、作用机制、与持续正压通气治疗的对比、对患者的影响等进行综述。

关键词: 下颌前移矫治器, 阻塞性睡眠呼吸暂停低通气综合征, 颏舌肌, 慢性间断性低氧

Abstract:

Obstructive sleep apnoea hypopnoea syndrome (OSAHS) is a disease characterized by recurrent apnoea or hypopnoea during sleep and has a high incidence and a potentially lethal risk. In recent years, the disease has received increasing attention. Among many treatment methods, mandibular advancement device (MAD) is a non-surgical and effective method used to treat mild and moderate OSAHS. The unique advantages of MAD include non-invasiveness, easy removal and receptiveness for patients. This article will summarise the classification, mechanism of action, difference from continuous positive airway pressure and effects of MAD on patients.

Key words: mandibular advancement device, obstructive sleep apnea hypopnea syndrome, genioglossus fatigue, chronic intermittent hypoxia

中图分类号: 

  • R783.5
[1] Cortés-Reyes E, Parrado-Bermúdez K, Escobar-Córdoba F . New perspectives in the treatment of obstructive sleep apnea-hypopnea syndrome[J]. Colombian J Anesthesiol, 2017,45(1):62-71.
[2] Estrella JM, Aguilar PD, Ayuso RC , et al. Obstructive sleep apnea syndrome implications on health and adherence to CPAP treatment[J]. Health, 2015,7(5):639-652.
[3] Vuorjoki-Ranta TR, Lobbezoo F, Tuomilehto H , et al. Mandibular advancement devices in the treatment of obstructive sleep apnea and snoring in community dental care: a pilot study on self-reported sleep quality[J]. Health, 2013,5(8):1-5.
[4] 王晓宇, 余哲, 赵颖 . OSAHS患者戴用下颌前移矫治器后咀嚼肌肌电活性变化的研究[J]. 口腔医学研究杂志, 2015,31(3):276-279.
Wang XY, Yu Z, Zhao Y . Follow-up study of elec-tromyography of masticatory muscles in short-term treatment of OSAHS patients with the MAD[J]. J Oral Sci Res, 2015,31(3):276-279.
[5] Basyuni S, Barabas M, Quinnell T . An update on mandibular advancement devices for the treatment of obstructive sleep apnoea hypopnoea syndrome[J]. J Thorac Dis, 2018,10(Suppl 1):S48-S56.
doi: 10.21037/jtd.2017.12.18 pmid: 29445528
[6] 黄玉辉, 王璟 . Activator矫治对颞下颌关节的影响及其与颞下颌关节紊乱病的关系[J]. 国际口腔医学杂志, 2011,38(5):563-566.
Huang YH, Wang J . Effect of activator appliance on temporomandibular joint and relationship between activator treatment and temporomandibular disorders[J]. Int J Stomatol, 2011,38(5):563-566.
[7] 赵殿才, 贺红 . 改良型Activator矫治器治疗OSAS疗效评价[J]. 临床口腔医学杂志, 2004,20(8):480-482.
Zhao DC, He H . Clinical study of patients’ sleep and respiration after the appliance of the improved Ac-tivator treats OSAS[J]. J Clin Stomatol, 2004,20(8):480-482.
[8] 黄敏方, 周嫣, 陈世稳 , 等. 软或硬塑下颌前移口腔矫治器治疗阻塞型睡眠呼吸暂停综合征(附20例报告)[J]. 临床口腔医学杂志, 2001,17(4):273-275.
Huang MF, Zhou Y, Chen SW , et al. Soft or hard plastic mandibular advancement oral appliances for the treatment of obstructive sleep apnea syndrome[J]. J Clin Stomatol, 2001,17(4):273-275.
[9] 卢钰, 邹道星, 王增全 , 等. 改良Twin-block功能矫治器治疗儿童阻塞性睡眠呼吸暂停低通气综合征临床研究[J]. 广东牙病防治, 2014,22(7):341-344.
Lu Y, Zou DX, Wang ZQ , et al. Clinical evaluation of the modified Twin-block functional appliance in the treatment of obstructive sleep apnea hypopnea syndrome in children patients[J]. J Dent Prev Treat, 2014,22(7):341-344.
[10] 张桂荣, 李济强, 刘继辉 , 等. Silensor口腔矫治器治疗阻塞性睡眠呼吸暂停综合征后患者的上呼吸道变化[J]. 国际口腔医学杂志, 2011,38(6):636-640.
Zhang GR, Li JQ, Liu JH , et al. Upper airway changes after Silensor oral appliance treatment of obstructive sleep apnea syndrome[J]. Int J Stomatol, 2011,38(6):636-640.
[11] 何玲玲, 张世炜, 王燕红 . 阻鼾器对阻塞性睡眠呼吸暂停的疗效观察[J]. 临床合理用药杂志, 2017,10(35):125-126.
He LL, Zhang SW, Wang YH . The effect of snorer on obstructive sleep apnea[J]. Chin J Clin Ration Drug Use, 2017,10(35):125-126.
[12] 于鑫, 刘加强, 袁玲君 , 等. 颞下颌关节盘前移位对Herbst矫治器矫治下颌后缩影响的MRI分析[J] . 中华口腔医学杂志, 2017,52(3):171-175.
Yu X, Liu JQ, Yuan LJ , et al. MRI analysis of the effect on mandibular retrusion with anterior disc displacement treated by using Herbst appliance[J]. Chin J Stomatol, 2017,52(3):171-175.
[13] 周林曦, 张桂荣, 钱玉芬 . 口腔矫治器治疗阻塞性睡眠呼吸暂停综合征研究进展[J]. 中国实用口腔科杂志, 2016,9(11):693-697.
Zhou LX, Zhang GR, Qian YF . Research progress in the oral appliances therapy for obstructive sleep apnea syndrome[J]. Chin J Pract Stomatol, 2016,9(11):693-697.
[14] 毛峻武 . Bionator矫治器矫治Ⅱ类1分类错颌的软硬组织变化[J]. 实用口腔医学杂志, 2007,23(1):28-30.
Mao JW . Hard and soft tissue changes following the treatment of Class Ⅱ division 1 malocclusion using Bionator appliance[J]. J Pract Stomatol, 2007,23(1):28-30.
[15] García NM, Blaya F, Urquijo EL , et al. Oral appliance for obstructive sleep apnea: prototyping and optimi-zation of the mandibular protrusion device[J]. J Med Syst, 2019,43(5):107.
doi: 10.1007/s10916-019-1235-3 pmid: 30887223
[16] 张颖, 王继华 . OSAHS病因的研究进展[J]. 中国现代医药杂志, 2010,12(2):120-122.
Zhang Y, Wang JH . Research progress in the etiology of OSAHS[J]. Mod Med J China, 2010,12(2):120-122.
[17] Connell T . Greater transparency needed when repor-ting orthodontic outcomes of obstructive sleep apnea treatment[J]. Am J Orthod Dentofacial Orthop, 2015,147(2):159.
doi: 10.1016/j.ajodo.2014.11.007 pmid: 25636544
[18] 李红 . 口腔矫治器治疗阻塞性睡眠呼吸暂停综合征的研究[J]. 中国城乡企业卫生, 2017,32(11):42-44.
Li H . Study on treatment of obstructive sleep apnea syndrome with oral appliance[J]. Chin J Urban Rural Enterp Hyg, 2017,32(11):42-44.
[19] Li DH, Yang XH, Zhou J , et al. Radiographic study on the efficacy of mandibular advancement in pa-tients with obstructive sleep apnea syndrome[J]. Shanghai J Stomatol, 2016,25(2):208-211.
[20] 万呼春, 周学东, 邹淑娟 , 等. 阻塞性睡眠呼吸暂停综合征的口腔治疗[J]. 华西口腔医学杂志, 2018,36(6):581-589.
Wan HC, Zhou XD, Zou SJ , et al. Oral treatment for obstructive sleep apnea syndrome[J]. West China J Stomatol, 2018,36(6):581-589.
[21] Nerfeldt P, Friberg D . Effectiveness of oral appliances in obstructive sleep apnea with respiratory arousals[J]. J Clin Sleep Med, 2016,12(8):1159-1165.
doi: 10.5664/jcsm.6058 pmid: 27397661
[22] 李栋 . CPAP与口腔矫治器治疗阻塞型睡眠呼吸暂停综合症的疗效比较[D]. 太原: 山西医科大学, 2011.
Li D . CPAP and the oral cavity appliance treatment breath obstructive sleep suspension syndrome’s cura-tive effect compares[D]. Taiyuan: Shanxi Medical University, 2011.
[23] 罗慧文 . 成人阻塞性睡眠呼吸暂停的治疗进展[J]. 江西医药, 2018,53(10):1182-1187.
Luo HW . Progress in the treatment of obstructive sleep apnea in adults[J]. Jiangxi Med J, 2018,53(10):1182-1187.
[24] 赵健, 张宗德, 赵昊 , 等. 口腔矫治器治疗OSAHS的适应证和疗效评价临床研究[J]. 医药论坛杂志, 2016,37(6):55-58.
Zhao J, Zhang ZD, Zhao H , et al. Clinical study on evaluation of indications and effecacy of oral app-liance therapy on OSAHS[J]. J Med Forum, 2016,37(6):55-58.
[25] Glos M, Penzel T, Schoebel C , et al. Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime[J]. Schlaf Atmung, 2016,20(2):635-646.
doi: 10.1007/s11325-015-1265-0 pmid: 26463420
[26] Zhu YF, Long H, Jian F , et al. The effectiveness of oral appliances for obstructive sleep apnea syndrome: a meta-analysis[J]. J Dent, 2015,43(12):1394-1402.
doi: 10.1016/j.jdent.2015.10.008 pmid: 26485532
[27] Aarab G, Lobbezoo F, Hamburger HL , et al. Effects of an oral appliance with different mandibular protrusion positions at a constant vertical dimension on obstructive sleep apnea[J]. Clin Oral Investig, 2010,14(3):339-345.
doi: 10.1007/s00784-009-0298-9 pmid: 19536571
[28] 刘佳 . 持续气道正压通气治疗OSAHS临床疗效[J]. 世界最新医学信息文摘, 2018,18(35):136,138.
Liu J . Clinical effect of continuous positive airway pressure on OSAHS[J]. World Latest Med Inf, 2018,18(35):136,138.
[29] 岳英明, 孟琨, 邱小建 . CPAP和Auto-CPAP治疗重度OSAHS患者的临床疗效比较[J]. 首都医科大学学报, 2018,39(1):120-127.
Yue YM, Meng K, Qiu XJ . Comparison on clinical efficacy of CPAP and Auto-CPAP in patients with severe OSAHS[J]. J Cap Med Univ, 2018,39(1):120-127.
[30] Schwartz M, Acosta L, Hung YL , et al. Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis[J]. Schlaf Atmung, 2018,22(3):555-568.
doi: 10.1007/s11325-017-1590-6 pmid: 29129030
[31] 郭丽, 韩云飞 . 中重度OSAHS患者术后CPAP治疗的随访护理[J]. 全科医学临床与教育, 2018,16(5):596-598.
Guo L, Han YF . Follow up nursing of postoperative CPAP in patients with moderate and severe OSAHS[J]. Clin Educ Gen Pract, 2018,16(5):596-598.
[32] Kant S, Dubey A, Bajaj D , et al. Prospects of mandi-bular advancement device (MAD) as a preferred treatment of obstructive sleep apnea in India: a syste-matic review[J]. Ann Trop Med Public Health, 2017,10(1):1.
[33] 曾莉, 韦一 . 持续气道正压通气联合口腔阻鼾器治疗重症阻塞性睡眠呼吸暂停低通气综合征疗效分析[J]. 中国现代药物应用, 2018,12(14):16-18.
Zeng L, Wei Y . Curative effect analysis of continuous positive airway pressure ventilation combined with oral snoring apparatus in the treatment of severe obstructive sleep apnea hypopnea syndrom[J]. Chin J Mod Drug Appl, 2018,12(14):16-18.
[34] 刘春艳 . 下颌前移矫治器治疗OSAHS前后颏舌肌功能结构改变及机制探讨[D]. 石家庄: 河北医科大学, 2015.
Liu CY . The mechanisms of OSAHS-induced func-tional and structural changes in genioglossus and effects of a mandibular advancement device therapy[D]. Shijiazhuang: Hebei Medical University, 2015.
[35] 李懿波, 李永明, 陈金武 , 等. OSAHS患者经口腔矫治器治疗前后上呼吸道形态及气流动力学变化[J]. 实用口腔医学杂志, 2014,30(2):183-187.
Li YB, Li YM, Chen JW , et al. The change of mor-phology and airflow dynamics in upper airway by the use of oral appliance in OSAHS patients[J]. J Pract Stomatol, 2014,30(2):183-187.
[36] 常琳, 李德宏, 朱鹏飞 , 等. 轻中度OSAHS患者戴用下颌前伸止鼾器前后上气道形态及呼吸功能变化[J]. 口腔疾病防治, 2019,27(1):35-40.
Chang L, Li DH, Zhu PF , et al. Research on the changes in upper airway shape and respiratory func-tion before and after upper airway treatment of pa-tients with mild and moderate OSAHS by wearing mandibular advancement snore stopping devices[J]. J Prev Treat Stomatol Dis, 2019,27(1):35-40.
[37] Hill EA . Obstructive sleep apnoea/hypopnoea syn-drome in adults with Down syndrome[J]. Breathe, 2016,12(4):e91-e96.
doi: 10.1183/20734735.012116 pmid: 28270865
[38] Liu CY, Lu HY, Dong FS , et al. Effects of a mandi-bular advancement device on genioglossus in obstruc-tive sleep apnoea hypopnea syndrome[J]. Eur J Orthod, 2015,37(3):290-296.
doi: 10.1093/ejo/cju042 pmid: 25246607
[39] 曾韶华, 刘月华 . 口腔矫治器对阻塞性睡眠呼吸暂停低通气综合征患者上气道影响的磁共振研究[J]. 实用口腔医学杂志, 2011,27(6):777-781.
Zeng SH, Liu YH . A MRI study on upper airway morphology in oral appliance treatment in patients with obstructive sleep apnea/hypopnea syndrome[J]. J Pract Stomatol, 2011,27(6):777-781.
[40] Haskell JA, McCrillis J, Haskell BS , et al. Effects of mandibular advancement device (MAD) on airway dimensions assessed with cone-beam computed to-mography[J]. Semin Orthod, 2009,15(2):132-158.
[41] 余舒星, 刘珍琪, 程雨平 , 等. 矫治器治疗OSAHS对腭咽软组织结构的影响[J]. 现代口腔医学杂志, 2018,32(5):274-278.
Yu SX, Liu ZQ, Cheng YP , et al. Effect of appliance treatment on the structure of pharynx tissue in OSAHS[J]. J Mod Stomatol, 2018,32(5):274-278.
[42] Ng JH, Yow M . Oral appliances in the management of obstructive sleep apnea[J]. Sleep Med Clin, 2019,14(1):109-118.
doi: 10.1016/j.jsmc.2018.10.012 pmid: 30709525
[43] Sanders AE, Essick GK, Fillingim R , et al. Sleep apnea symptoms and risk of temporomandibular disorder[J]. J Dent Res, 2013,92(7 Suppl):S70-S77.
[1] 赵彦惠 聂萍 陶丽 盛潇 陈金东 朱敏. 应用头影测量结合Müller试验评价肥胖对阻塞性睡眠呼吸暂停低通气综合征患者上气道可塌陷性的影响[J]. 国际口腔医学杂志, 2014, 41(4): 390-395.
[2] 刘春艳 卢海燕. 阻塞性睡眠呼吸暂停低通气综合征与颏舌肌[J]. 国际口腔医学杂志, 2013, 40(6): 829-831.
[3] 杨随兴1 封净2 张佐2. 三维有限元分析法在阻塞性睡眠呼吸暂停低通气综合征中的研究进展[J]. 国际口腔医学杂志, 2013, 40(3): 389-390.
[4] 王茜综述 王涛审校. X 线头影测量对阻塞性睡眠呼吸暂停低通气综合征患者的解剖缺陷评价[J]. 国际口腔医学杂志, 2007, 34(01): 50-50~52.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 张新春. 桩冠修复与无髓牙的保护[J]. 国际口腔医学杂志, 1999, 26(06): .
[2] 王昆润. 长期单侧鼻呼吸对头颅发育有不利影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[3] 彭国光. 颈淋巴清扫术中颈交感神经干的解剖变异[J]. 国际口腔医学杂志, 1999, 26(05): .
[4] 杨凯. 淋巴化疗的药物运载系统及其应用现状[J]. 国际口腔医学杂志, 1999, 26(05): .
[5] 康非吾. 种植义齿下部结构生物力学研究进展[J]. 国际口腔医学杂志, 1999, 26(05): .
[6] 柴枫. 可摘局部义齿用Co-Cr合金的激光焊接[J]. 国际口腔医学杂志, 1999, 26(04): .
[7] 孟姝,吴亚菲,杨禾. 伴放线放线杆菌产生的细胞致死膨胀毒素及其与牙周病的关系[J]. 国际口腔医学杂志, 2005, 32(06): 458 -460 .
[8] 费晓露,丁一,徐屹. 牙周可疑致病菌对口腔黏膜上皮的粘附和侵入[J]. 国际口腔医学杂志, 2005, 32(06): 452 -454 .
[9] 赵兴福,黄晓晶. 变形链球菌蛋白组学研究进展[J]. 国际口腔医学杂志, 2008, 35(S1): .
[10] 庞莉苹,姚江武. 抛光和上釉对陶瓷表面粗糙度、挠曲强度及磨损性能的影响[J]. 国际口腔医学杂志, 2008, 35(S1): .