Department of Oral and Maxillofacial Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
Department of Clinical Laboratory, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, Japan.
Oral Maxillofac Surg. 2022 Mar;26(1):123-130. doi: 10.1007/s10006-021-00972-w. Epub 2021 May 15.
The incidence of obstructive sleep apnea (OSA) immediately after surgery in patients with dentofacial deformities without previous OSA remains unknown. We aimed to perioperatively evaluate factors associated with oxygen desaturation index (ODI) during sleep, 7 days after bilateral splitting ramus osteotomy (BSSRO) in patients without previous OSA.
Fifty-one patients (15 males, 36 females) with dentofacial deformities, scheduled to undergo BSSRO, were included. Polysomnography was performed before orthognathic surgery. Perioperative OSA was evaluated with peripheral arterial tonometry on the day of surgery and 1, 2, 3, 4, and 7 days postoperatively. Rapid eye movement (REM) sleep periods and the ODI were measured. Factors associated with perioperative ODI after surgery were statistically analyzed.
REM sleep periods were significantly decreased on the day of surgery and significantly increased at 4 and 7 days postoperatively, compared to the preoperative period. ODI increased on the day of surgery, decreased after 1 day, and increased again at 4 and 7 days postoperatively. ODI on the day of surgery was significantly increased due to increased preoperative ODI, overjet, and SN-MP angle and decreased SNA and SNB angle. ODI at 7 days postoperatively was significantly increased due to increased REM sleep periods and decreased SN-MP and gonial angle. ODI was increased in response to REM sleep periods 7 days after BSSO.
Airway management in patients with dentofacial deformity should be given more attention by preoperative assessment for OSA, even in the absence of previous OSA, until 7 days postoperatively due to REM rebound.
术前无阻塞性睡眠呼吸暂停（OSA）的牙颌面畸形患者术后即刻发生 OSA 的发生率尚不清楚。我们旨在评估术前无 OSA 的患者在双侧下颌升支矢状劈开截骨术（BSSRO）后 7 天睡眠期间与氧减指数（ODI）相关的因素。
共纳入 51 例（15 例男性，36 例女性）牙颌面畸形患者，计划行 BSSRO。在正颌手术前进行多导睡眠图检查。在手术当天及术后第 1、2、3、4 和 7 天行外周动脉张力测定术以评估围手术期 OSA。测量快速眼动（REM）睡眠期和 ODI。统计学分析与术后围手术期 ODI 相关的因素。
与术前相比，手术当天 REM 睡眠期明显减少，术后第 4 和第 7 天明显增加。手术当天 ODI 增加，术后第 1 天减少，术后第 4 和第 7 天再次增加。由于术前 ODI、覆盖量和 SN-MP 角增加以及 SNA 和 SNB 角减少，手术当天 ODI 增加。由于 REM 睡眠期增加和 SN-MP 和下颌角减少，术后第 7 天 ODI 增加。术后第 7 天 ODI 增加是对 BSSO 后 REM 睡眠期的反应。
由于 REM 反弹，即使术前无 OSA，牙颌面畸形患者的气道管理也应更加重视，直到术后 7 天。
