Miyao Etsuko, Noda Akiko, Miyao Masaru, Yasuma Fumihiko, Inafuku Shigeru
Ars Orthodontics Clinic, Nagoya University School of Health Sciences, Nagoya.
Intern Med. 2008;47(18):1573-8. doi: 10.2169/internalmedicine.47.0717. Epub 2008 Sep 16.
The maxillofacial characteristics of patients with obstructive sleep apnea syndrome (OSAS) have previously been analyzed using standard cephalometric analysis. Malocclusion influences the occurrence of sleep apnea, but the pathology of malocclusion in OSAS has not yet been fully investigated. Therefore, we investigated malocclusion in patients with OSAS using cephalometric and dental analysis.
Cephalometric and dental analyses were performed to evaluate malocclusion in 97 male patients with OSAS (49.7+/-11.7 years). The number of apnea and hypopnea episodes per hour (apnea-hypopnea index: AHI) was determined by standard polysomnography.
The overall prevalence of severe overjet (the horizontal distance between the upper and lower incisors of >or=6 mm) was 43.3%. AHI was significantly correlated with body mass index (BMI) in obese OSAS patients (r=0.385, p=0.010), whereas it was significantly correlated with overjet in non-obese OSAS patients (BMI<25 kg/m2) (r=0.313, p=0.022). Multiple regression analysis revealed that BMI was the significant factor contributing to increased AHI in all patients, and overjet was in non-obese OSAS patients. There were no significant differences between non-obese and obese OSAS patients in the angle of protrusion of the superior alveolar base (SNA) or in the angle of protrusion between the superior and inferior alveolar bases (ANB). The angle of protrusion of the inferior alveolar base (SNB) was significantly smaller in non-obese than in obese OSAS patients.
We have shown that overjet was associated with the severity of OSAS in non-obese patients. Our findings suggest that malocclusion may play an important role in the development of sleep apnea/hypopnea.
以往曾采用标准头影测量分析法对阻塞性睡眠呼吸暂停综合征（OSAS）患者的颌面特征进行分析。错牙合影响睡眠呼吸暂停的发生，但OSAS中错牙合的病理情况尚未得到充分研究。因此，我们采用头影测量和牙科分析方法对OSAS患者的错牙合情况进行了研究。
对97例男性OSAS患者（49.7±11.7岁）进行头影测量和牙科分析，以评估错牙合情况。通过标准多导睡眠图测定每小时呼吸暂停和低通气发作次数（呼吸暂停低通气指数：AHI）。
严重覆盖（上下切牙间水平距离≥6 mm）的总体患病率为43.3%。肥胖OSAS患者的AHI与体重指数（BMI）显著相关（r = 0.385，p = 0.010），而在非肥胖OSAS患者（BMI<25 kg/m2）中，AHI与覆盖显著相关（r = 0.313，p = 0.022）。多元回归分析显示，BMI是所有患者AHI升高的重要因素，而覆盖是非肥胖OSAS患者AHI升高的重要因素。非肥胖和肥胖OSAS患者在上牙槽座突角（SNA）或上下牙槽座突角（ANB）方面无显著差异。非肥胖OSAS患者的下牙槽座突角（SNB）显著小于肥胖OSAS患者。
我们已经表明，覆盖与非肥胖患者OSAS的严重程度相关。我们的研究结果表明，错牙合可能在睡眠呼吸暂停/低通气的发生发展中起重要作用。
