Bharadwaj Rekha, Ravikumar A, Krishnaswamy N R
Department of Orthodontics, Ragas Dental College and Hospitals, Chennai, India.
Indian J Dent Res. 2011 Nov-Dec;22(6):739-48. doi: 10.4103/0970-9290.94566.
Obstructive sleep apnea (OSA) is a potentially life-threatening disorder, characterized by repeated collapse of the upper airway during sleep with cessation of breathing. The altered mouth breathing produces morphological changes in craniofacial region.
This study was designed to compare and validate the craniofacial morphological characteristics in patients with OSA using lateral cephalometry and to investigate the dentofacial characteristics of patients with OSA with respect to the obstructive sites determined by dynamic magnetic resonance imaging (MRI) to more accurately clarify the pathophysiological features.
10 patients with OSA were divided into two groups of five each according to their obstructive site determined by dynamic MRI. (1) Obstruction at the retropalatal and retroglossal region (Rp + Rg group) and (2) obstruction at the retropalatal region (Rp group). Lateral cephalogram both in upright and supine position was taken for all the subjects. In addition, dynamic MRI was performed to identify the sites of obstruction of the upper airway.
Independent t-test was performed to evaluate the significant difference in the upright cephalometric variables between the study and control group and between the two groups. The changes in skeletal and soft tissue parameters with change in posture was assessed within the study and control group by paired t test. P value of ≤ 0.05 was considered as statistically significant.
The study indicated that the first group of patients with both retropalatal and retroglossal obstruction showed signs of skeletal discrepancy that predisposed to obstruction at the retroglossal level and the soft tissue components like the soft palate and tongue that contributed to retropalatal obstruction. However, the second group of patients with only retropalatal obstruction had primarily soft tissue components associated with increased BMI that contributed to retropalatal obstruction.
Evaluation of craniofacial morphology in OSA patients is bound to help the concerned specialist in recognizing the morphological changes induced by altered sleep pattern so as to provide the appropriate treatment.
阻塞性睡眠呼吸暂停（OSA）是一种潜在的危及生命的疾病，其特征是睡眠期间上呼吸道反复塌陷并伴有呼吸停止。口呼吸改变会导致颅面部区域出现形态变化。
本研究旨在使用头影测量法比较和验证阻塞性睡眠呼吸暂停患者的颅面部形态特征，并根据动态磁共振成像（MRI）确定的阻塞部位，研究阻塞性睡眠呼吸暂停患者的牙颌面特征，以更准确地阐明其病理生理特征。
10例阻塞性睡眠呼吸暂停患者根据动态MRI确定的阻塞部位分为两组，每组5例。（1） 腭后和舌后区域阻塞（Rp+Rg组）和（2）腭后区域阻塞（Rp组）。对所有受试者拍摄直立位和仰卧位的头颅侧位片。此外，进行动态MRI以确定上呼吸道的阻塞部位。
采用独立t检验评估研究组与对照组以及两组之间直立位头影测量变量的显著差异。通过配对t检验评估研究组和对照组内骨骼和软组织参数随姿势变化的情况。P值≤0.05被认为具有统计学意义。
研究表明，第一组腭后和舌后均阻塞的患者表现出骨骼差异的迹象，这易导致舌后水平阻塞，以及软腭和舌等软组织成分导致腭后阻塞。然而，第二组仅腭后阻塞的患者主要是与体重指数增加相关的软组织成分导致腭后阻塞。
评估阻塞性睡眠呼吸暂停患者的颅面部形态必然有助于相关专科医生识别睡眠模式改变引起的形态变化，从而提供适当的治疗。
