Ono T, Lowe A A, Ferguson K A, Pae E K, Fleetham J A
Department of Clinical Dental Sciences, The Faculty of Dentistry, The University of British Columbia, Vancouver, B.C., Canada.
Am J Orthod Dentofacial Orthop. 1996 Jul;110(1):28-35. doi: 10.1016/s0889-5406(96)70084-7.
Knowledge of how dental appliances alter upper airway muscle activity when they are used for the treatment of snoring and/or obstructive sleep apnea (OSA) is very limited. The purpose of this study was to define the effect of a tongue retaining device (TRD) on awake genioglossus (GG) muscle activity in 10 adult subjects with OSA and in 6 age and body mass index (BMI) matched symptom-free control subjects. The TRD is a custom-made appliance designed to allow the tongue to remain in a forward position between the anterior teeth by holding the tongue in an anterior bulb with negative pressure, during sleep. This pulls the tongue forward to enlarge the volume of the upper airway and to reduce upper airway resistance. In this study, two customized TRDs were used for each subject. The TRD-A did not have an anterior bulb but incorporated lingual surface electrodes to record the GG electromyographic (EMG) activity. The TRD-B contained an anterior bulb and two similar electrodes. The GG EMG activity was also recorded while patients used the TRD-B but were instructed to keep their tongue at rest outside the anterior bulb; this condition is hereafter referred to as TRD-X. The GG EMG activity and nasal airflow were simultaneously recorded while subjects used these customized TRDs during spontaneous awake breathing in both the upright and supine position. The following results were obtained and were consistent whether subjects were in the upright or the supine position. The GG EMG activity was greater with the TRD-B than with the TRD-A in control subjects (p < 0.05), whereas the GG EMG activity was less with the TRD-B than with the TRD-A in subjects with OSA (p < 0.01). Furthermore, there was no significant difference between the GG EMG activity of the TRD-A and the TRD-X in control subjects, whereas there was less activity with the TRD-X than with the TRD-A in subjects with OSA (p < 0.05). On the basis of these findings, it was concluded that the TRD has different effects on the awake GG muscle activity in control subjects and patients with OSA. The resultant change in the anatomic configuration of the upper airway caused by the TRD may be important in the treatment of OSA because such a change may alleviate the impaired upper airway function.
对于牙矫治器在用于治疗打鼾和/或阻塞性睡眠呼吸暂停（OSA）时如何改变上气道肌肉活动的了解非常有限。本研究的目的是确定舌保持器（TRD）对10名患有OSA的成年受试者以及6名年龄和体重指数（BMI）匹配的无症状对照受试者清醒时颏舌肌（GG）肌肉活动的影响。TRD是一种定制的矫治器，设计用于在睡眠期间通过负压将舌头保持在前部球状物中，使舌头在前牙之间保持向前的位置。这会将舌头向前拉，以扩大上气道的容积并降低上气道阻力。在本研究中，为每个受试者使用了两种定制的TRD。TRD-A没有前部球状物，但包含舌面电极以记录GG肌电图（EMG）活动。TRD-B包含一个前部球状物和两个类似的电极。当患者使用TRD-B但被指示将舌头保持在前部球状物之外休息时，也记录GG EMG活动；这种情况以下称为TRD-X。在受试者直立和仰卧位进行自主清醒呼吸期间使用这些定制的TRD时，同时记录GG EMG活动和鼻气流。得到了以下结果，无论受试者是直立还是仰卧位，结果都是一致的。在对照受试者中，TRD-B时的GG EMG活动大于TRD-A时的GG EMG活动（p<0.05），而在患有OSA的受试者中，TRD-B时的GG EMG活动小于TRD-A时的GG EMG活动（p<0.01）。此外，在对照受试者中，TRD-A和TRD-X的GG EMG活动之间没有显著差异，而在患有OSA的受试者中，TRD-X时的活动小于TRD-A时的活动（p<0.05）。基于这些发现，得出结论，TRD对对照受试者和患有OSA的患者清醒时的GG肌肉活动有不同的影响。TRD引起的上气道解剖结构的变化在OSA的治疗中可能很重要，因为这种变化可能减轻受损的上气道功能。
