使用錐狀電腦斷層影像分析阻塞型睡眠呼吸中止症患者與正常臉型族群的咽呼吸道結構

The Analysis of Pharyngeal Airway Structure among Patients with Obstructive Sleep Apnea and People with Normal Facial Pattern by the Use of Cone-beam Computed Tomography

卓桂圓(Kuei-Yuan Cho)

指導教授 ： 曾于娟

高雄醫學大學/口腔醫學院/牙醫學系碩士班/碩士(2019年)

摘要

中文摘要
研究目的：
本研究使用錐狀電腦斷層掃描分析台灣患有睡眠呼吸中止症患者其咽呼吸道結構與擁有正常臉型的族群差異性，以及咽呼吸道結構和每小時睡眠呼吸低下或中止次數間的相關性。
材料與方法:
本研究收錄對象的主訴為經醫師的初步診斷為患有阻塞型睡眠呼吸中止症（Obstructive Sleep apnea, OSA）21名年滿20歲之成年患者進行全頭顱錐狀電腦斷層掃描（Cone-beam tomography, CBCT）及睡眠多項生理檢測（Polysomnography, PSG）。對照組為擁有正常臉型的30名年滿20歲之成年患者。由這些電腦斷層影像擷取側面測顱影像做結構標定點之線段及角度的測量。並由電腦斷層影像重組計算咽呼吸道體積：包含咽呼吸道整體、鼻咽呼吸道、腭咽呼吸道、舌咽呼吸道、口咽呼吸道（合併腭咽呼吸道及舌咽呼吸道）、下咽呼吸道及咽呼吸道最小截面積。
結果:
OSA患者的平均ANB角度為4.7±3.4度，相較對照組有較大的ANB角度(p<0.001)。而下顎長度為92.1±11.5公釐；相較對照組，下顎長度較短(p=0.029<0.05)。平均舌骨位置為(9.9±11.4, -93±18.9)，相較對照組有較後縮且較低位的舌骨位置。OSA患者的平均第二頸椎位置為(11.9±15.3, -130.3±25.0) 、第四頸椎位置為(49.7±13.4, -108.7±22.0)。比較起對照組，OSA患者有較後、下置位的第二及第四頸椎位置。其中，較下置位達顯著差異(p<0.001)。
OSA患者的平均咽呼吸道總體積是35631.3±13342.0立方釐米。其中，鼻咽呼吸道體積平均為8609.5±2377.1立方釐米、腭咽呼吸道體積平均為9340.1±4830.5立方公釐、舌咽呼吸道體積平均6903.4±4476.7立方公釐、口咽呼吸道體積平均16243.5±8001.1立方公釐及下咽呼吸道平均為10778.3±5255.3立方公釐。其中，OSA患者相較對照組有較小的腭咽呼吸道及口咽呼吸道體積(p<0.001)。此外，OSA患者平均呼吸道最小截面積是157.0±99.6平方釐米。相較對照組擁有較小的咽呼吸道最小截面積(p<0.001)。
而OSA患者的睡眠多項生理檢測（Polysomnography, PSG）結果(其中包含AHI及ODI)和側面測顱分析結果(包含SNA、SNB、ANB、Mx length、 Mn length、SN-MP及PP-MP)、錐狀電腦斷層掃描結果(包含鼻咽呼吸道體積、口咽呼吸道體積、下咽呼吸道體積、咽呼吸道整體體積及咽呼吸道最小截面積)及肥胖指標(BMI及頸圍)皆為低度相關。
結論:
OSA患者有偏向第二級骨性關係的趨勢，搭配下顎骨長度較短的顱顏結構型態。同時，OSA患者舌骨位置、第二及第四頸椎位置較後縮且低位。相較於正常臉型族群，在咽呼吸道部分為腭咽呼吸道及口咽呼吸道體積較小，以及呼吸道最小截面積較小，具顯著差異性(p<0.05)。
而就目前蒐集數據及分析方法，仍無法以錐狀電腦斷層掃描做睡眠多項生理檢測的結果之良好預測，期許將來有更進一步研究，以期利用錐狀電腦斷層掃描輔助診斷阻塞型睡眠呼吸中止症。
關鍵字: 錐狀射束電腦斷層、睡眠呼吸中止症、睡眠呼吸低下及中止次數、咽呼吸道結構、睡眠多項生理檢測。

關鍵字

錐狀射束電腦斷層 ； 睡眠呼吸中止症 ； 睡眠呼吸低下及中止次數 ； 咽呼吸道結構 ； 睡眠多項生理檢測

並列摘要

Abstract
Purpose:
The purpose of this study was, by the use of cone-beam computed tomography, to evaluate the differences of upper airway size or skeletal pattern between patients with obstructive sleep apnea (OSA) and patients with normal facial pattern in Taiwan, and to determine whether there is correlation between the size of upper airway and the apnea hypopnea index (AHI).
Materials and Methods:
Twenty-one adult patients who had obstructive sleep apneas were included in this study. They were arranged for taking cone-beam computerized tomography (CBCT) and polysomnography (PSG). At the same time, we also collected 30 adult patients as a control group who had normal facial pattern to take CBCT for other medical needs. With the source of CBCT data, landmarks on lateral cephalograms were located. Linear and angular measurement were then calculated. Volumetric size (including total pharyngeal airway, nasopharyngeal airway, velopharyngeal airway, glossopharyngeal airway, oropharyngeal airway, and hypopharyngeal airway) and smallest cross-sectional area of pharyngeal airway space were also measured.
Results:
The mean ANB angle among OSA patients was 4.7±3.4°; which was larger than control group(p<0.001). The mean distance of Ar-B (mandible length) of OSA patients was 92.1±11.5mm; which was shorter than control group(p=0.029<0.05). The mean position of hyoid bone among OSA patients was (9.9±11.4, -93.7±18.9). The position of hyoid bone was more inferior positioned among OSA group when comparing to control group. (p<0.001). The mean position of C2 (second vertebrae) among OSA patients was (11.9±15.3, -130.3±25.0); the mean position of C4 (fourth vertebrae) was (49.7±13.4, -108.7±22.0). OSA patients had a significantly more inferior positioned of C2 and C4 when comparing to the control group (p<0.001).
The mean volume of total pharyngeal airway space among OSA patients was 35631.3±13342.0mm3. The mean volumetric size of nasopharyngeal, velopharygeal, glossopharyngeal, oropharyngeal and hypopharyngeal portions were 8609.5±2377.1mm3, 9340.1±4830.5mm3, 6903.4±4476.7mm3, 16243.5±8001.1mm3 and 10778.3±5255.3mm3 seperately among OSA patients. The velopharyngeal and oropharyngeal airway spaces were significantly smaller among OSA group when comparing to the control group (p<0.001). The mean constriction area of pharyngeal airway space was 157.0±99.6mm2. Comparing to the control group, the OSA group had a significantly smaller constriction area of pharyngeal airway space (p<0.001).
The correlation between PSG results (AHI and ODI) and cephalometric analysis, pharyngeal airway spaces(nasopharynx, vezophaynx, glossopharynx, oropharynx, hypopharynx, total pharynx and constriction area ) and obesity indicators(BMI and neck circumference) are all low.
Conclusion:
The OSA patients have a tendency of skeletal Class II with retrusive mandible. At the same time, the hyoid bone, the second and fourth are more inferior positioned. The volumetric sizes of velopharyngeal and orophayngeal portions are relative smaller among OSA patients. And the constriction area of pharyngeal airway space among OSA patient is also siginificant smaller.
Currently, we are still unable to find a modulus that can precisely predict the PSG results by using CBCT evaluation.
Keyword:
Cone-beam computerized tomography (CBCT), obstruction sleep apnea-hypopnea (OSA), apnea-hypopnea index (AHI), upper airway structure, polysomnography (PSG)

並列關鍵字

Cone-beam computerized tomography (CBCT) ； obstruction sleep apnea-hypopnea (OSA) ； apnea-hypopnea index (AHI) ； upper airway structure ； polysomnography (PSG)

參考文獻

參考文獻

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