Sakat Muhammed Sedat, Sütbeyaz Yavuz, Yüceler Zeynep, Kantarci Mecit, Kilic Korhan, Kurt Sezgin
*Palandoken Government Hospital, Erzurum †Kolan International Hospital, Department of Ear Nose and Throat, Istanbul ‡Bozok University, Yozgat §Ataturk University, Department of Radiology, Erzurum ||Kafkas University, School of Medicine, Department of Ear Nose and Throat, Kars, Turkey.
J Craniofac Surg. 2016 Jan;27(1):82-6. doi: 10.1097/SCS.0000000000002267.
Obstructive sleep apnea syndrome (OSAS) is characterized by episodes of upper respiratory tract obstruction, decreased oxygen saturation, and sleep fragmentation during sleep, as well as excessive daytime somnolence. Cephalometric analysis offers distance, angle, area, and volume measurements between separate reference points belonging to bony and soft tissues on a film. Cephalometric measurements made with multislice computed tomography (CT) are quite helpful for standardization of measurements and obtaining highly reliable results. The aim of the current study was to make cephalometric measurements with multislice CT in OSAS patients and compare their results with those of a healthy control population. The authors also aimed to determine, which cephalometric parameters might be more valuable for diagnosis of OSAS.
This study included 30 patients who were diagnosed with severe OSAS (apnea-hypopnea index >30) by an overnight polysomnography study, performed for suspected OSAS and 10 healthy controls without snoring or apnea who underwent three-dimensional head & neck multislice CT for any indication. All patients underwent a three-dimensional head & neck multislice CT to make cephalometric measurements and compare them across the groups.
ANS-PNS (anterior and posterior nasal spine), Go-Gn, and UP-PhW distances, as well as sella-nasion-A and sella-nasion-B angles, were significantly lower in the OSAS group compared with the controls (P < 0.05). Mandibulas plane -H, UD, TT-EA, ANS-B, PNS-TB, TT-TB, B-N, and PNS-PhW distances were significantly higher in the patient group compared with the controls (P < 0.05).
Our study reached the conclusion that some cephalometric measurements showed significant differences in patients with obstructive sleep apnea compared with the control group, and hence may lead to a susceptibility to having OSAS. Cephalometric measurements performed with multislice CT have come to the forefront as one of the most important tools for diagnosis of OSAS. An inferiorly located hyoid bone may be most commonly responsible for apnea episodes. It was also concluded that an inferiorly located hyoid bone might have been the result of maxillomandibular underdevelopment.
阻塞性睡眠呼吸暂停综合征（OSAS）的特征是睡眠期间上呼吸道阻塞发作、氧饱和度降低、睡眠片段化以及白天过度嗜睡。头影测量分析可提供X线片上属于骨组织和软组织的不同参考点之间的距离、角度、面积和体积测量值。使用多层计算机断层扫描（CT）进行的头影测量对于测量标准化和获得高度可靠的结果非常有帮助。本研究的目的是对OSAS患者进行多层CT头影测量，并将其结果与健康对照人群的结果进行比较。作者还旨在确定哪些头影测量参数可能对OSAS的诊断更有价值。
本研究纳入了30例经夜间多导睡眠图检查诊断为重度OSAS（呼吸暂停低通气指数>30）的患者，这些患者因疑似OSAS而接受检查，以及10例无打鼾或呼吸暂停的健康对照者，他们因任何指征接受了三维头颈部多层CT检查。所有患者均接受三维头颈部多层CT检查以进行头影测量并在各组间进行比较。
与对照组相比，OSAS组的ANS-PNS（前鼻棘和后鼻棘）、Go-Gn以及UP-PhW距离，以及蝶鞍-鼻根-A和蝶鞍-鼻根-B角度均显著降低（P<0.05）。与对照组相比，患者组的下颌平面-H、UD、TT-EA、ANS-B、PNS-TB、TT-TB、B-N和PNS-PhW距离显著更高（P<0.05）。
我们的研究得出结论，一些头影测量在阻塞性睡眠呼吸暂停患者中与对照组相比显示出显著差异，因此可能导致患OSAS的易感性。使用多层CT进行的头影测量已成为诊断OSAS最重要的工具之一。舌骨位置较低可能是呼吸暂停发作最常见的原因。研究还得出结论，舌骨位置较低可能是上颌下颌发育不足的结果。
