Young J W, McDonald J P
Orthodontic Department, Victoria Hospital, Fife, UK.
Surgeon. 2004 Jun;2(3):145-51. doi: 10.1016/s1479-666x(04)80075-1.
This study aimed to identify a correlation of diagnostic clinical significance between the vertical position of the hyoid bone in relation to structures within the dentofacial skeleton and: (1) The severity of obstructive sleep apnoea hypopnoea syndrome, (OSAHS), (2) Decisions relating to the management of the condition.
Randomised retrospective survey of cephalometric records of subjects having been diagnosed as suffering with OSAHS by in patient overnight polysomnographic testing at the Edinburgh Royal Infirmary Sleep Centre, 2001-2002.
Pre-polysomnograph orthoposition lateral cephalograms of 94 subjects tested, during the period from April 1996 to September 1997, were randomly selected and traced following strict adherence to standard protocol. Edentulous arches (one or both) formed the only exclusion criterion owing to obvious effects upon vertical dimensions of the cervico-pharyngeal region. Measurement of the vertical position of the hyoid bone was made relative to a number of planes validated by numerous previous cephalometric investigations, and these were recorded along with the apnoea/hypopnoea index (AHI), and subsequent management (mandibular repositioning appliances (MRA) / continuous positive airway pressure (CPAP)). Correlations between measurements and AHI were investigated using Spearman's Correlation Coefficients, and analysis of the relationship between hyoid bone position and management groups was undertaken using Wilcoxon Ranked Sum Testing.
Statistically significant correlations were found between all linear measurements locating the hyoid bone in the vertical plane and subject AHI. The linear relationships were less reliable for subjects with AHI > 100, possibly due to a breakdown in the body's ability to respond posturally in order to maintain airway patency in more extreme cases. When the treatment groups (MRA/CPAP) were considered independently there was found to be a clear delineation between the two groups at a length of 120 mm between the sella (S- a point upon the anterior cranial base) and the hyoid (H). This, in turn, may suggest that cephalometric radiographs may be used as a reproduciable diagnostic tool.
本研究旨在确定舌骨相对于牙颌面骨骼结构的垂直位置与以下方面之间具有诊断临床意义的相关性：（1）阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的严重程度；（2）该病的治疗决策。
对2001 - 2002年在爱丁堡皇家医院睡眠中心通过住院过夜多导睡眠图测试被诊断为患有OSAHS的受试者的头影测量记录进行随机回顾性调查。
随机选取1996年4月至1997年9月期间接受测试的94名受试者的多导睡眠图检查前的正位侧位头影测量片，并严格按照标准方案进行描图。由于对颈咽区域垂直尺寸有明显影响，无牙弓（一个或两个）构成唯一的排除标准。相对于先前众多头影测量研究验证的多个平面测量舌骨的垂直位置，并记录呼吸暂停/低通气指数（AHI）以及后续治疗（下颌重新定位矫治器（MRA）/持续气道正压通气（CPAP））。使用Spearman相关系数研究测量值与AHI之间的相关性，并使用Wilcoxon秩和检验分析舌骨位置与治疗组之间的关系。
在垂直平面定位舌骨的所有线性测量值与受试者AHI之间发现了具有统计学意义的相关性。对于AHI > 100的受试者，线性关系不太可靠，这可能是由于在更极端的情况下，身体为维持气道通畅而进行姿势反应的能力出现了故障。当独立考虑治疗组（MRA/CPAP）时，发现两组之间在蝶鞍（S - 前颅底上的一个点）与舌骨（H）之间的长度为120 mm处有明显的界限。这反过来可能表明头影测量X线片可作为一种可重复的诊断工具。
