| Objective: Observe the changes in the form of upper airway and respiratory functions of patients with mild and moderate OSAHS before and after being treated by the MASSD, and provide reference and basis for the therapeutic mechanism and clinical effects of mild and moderate OSAHS patients treated by MASSD.Methods: Select 30 patients definitely diagnosed with mild and moderate OSAHS who saw the doctor and conducted the polysomnography in the Department of Stomatology of Yan’an Hospital Affiliated to Kunming Medical University within Feb.2015 and Jan. 2017, and other diseases and abnormity in dissection that may cause airway obstruction were excluded. Among them there were 21 males and 9 females,aging 25-29, and the average age was 49; conduct CBCT scanning for the upper airway before and after the patients wore the MASSD, confirm the measurement plane and partition of the airway by the three-dimensional configuration of the upper airway rebuilt with the InVivo Dental software, measure the sagittal diameter, coronal diameter, minimum CSA and volumes of the sections of the upper airway,and compare the changes in the indexes including AHI and LSaO2 etc. on the patients before and after treatment. Adopt the SPSS21.0 software package to conduct self-paired t-test.Results: 1. The subjective symptom of the 30 patients with mild and moderate OSAHS was obviously improved after wearing the MASSD,there was no condition of subjective suffocating to wake, and the symptom of drowsiness in day time was obviously improved. Dependents who accompanied them observed that the snoring sounds of patients when they slept at night was sharply reduced and even disappeared,the apnea phenomenon was obviously eased or disappeared, there was discomfort for the patients sometimes when the patients wore the MASSD, e.g. the toothache occurred on some of the teeth and thirst, etc., and there was no obvious untoward effect if wearing it for a long time.2. Objective indicators obviously improved: because the times of snoring sounds do not obey the normal distribution, the results were shown with P50 ( P25, P75 ) , the rank sum test was used for the differences before and after treatment, and there was an obvious statistical significance in the differences (P < 0.001). The AHI index was(20.61±5.19) before wearing the MASSD, the AHI index was (10.86±4.31) after wearing the MASSD, and there was an obvious statistical significance in the differences(P<0.001); the LSaO2 was (0.78±0.08) before wearing the MASSD, the LSaO2 was(0.92±0.03 )after wearing the MASSD,and there was an obvious statistical significance in the differences (P <0.001).3. The sagittal diameter of the inferior margin surface of soft palate of mild and moderate OSAHS patients was (7.01±1.43mm ) before wearing MASSD, and the sagittal diameter was ( 14.78±1.36 mm ) , and there was an obvious statistical significance in the differences (P <0.001); the coronal diameter of the inferior margin surface of soft palate of mild and moderate OSAHS patients was (20.46±1.24 mm)before wearing MASSD, and the coronal diameter was (28.35±1.85mm ) after wearing MASSD, there was an obvious statistical significance in the differences (P<0.001); the sagittal diameter of inferior margin surface of epiglottis was (9.58±0.95 mm) before wearing MASSD, and the sagittal diameter was (13.75±0.77 mm) after wearing MASSD, there was an obvious statistical significance in the differences (P<0.001); the coronal diameter of inferior margin surface of epiglottis was (19.86±2.06 mm) before wearing MASSD, and the coronal diameter was (26.72±2.25 mm) after wearing MASSD, there was an obvious statistical significance in the differences (P<0.001); while the sagittal diameter of the surface of palatum durum was (12.57±1.30 mm) before wearing MASSD, and the sagittal diameter was (12.01±1.04mm) after wearing MASSD, there was no statistical significance in the differences (P > 0.05);the coronal diameter of surface of palatum durum was ( 27.49±2.92 mm ) before wearing MASSD,and the coronal diameter was ( 29.20±4.17mm ) after wearing MASSD, there was no statistical significance in the differences (P>0.05) . It showed that after the patients wore the MASSD, the sagittal diameter and coronal diameter of inferior margin surface of soft palate and inferior margin surface of epiglottis would obviously enlarged; while there was no obvious change in the surface of palatum durum.4. The minimum CSA of the retropalatal region of patients with mild and moderate OSAHS was (72.84±20.93 mm2 ) before wearing MASSD, the minimum CSA was(129.30±26.37 mm2 ) after wearing MASSD, there was an obvious statistical significance in the differences (P<0.001); the minimum CSA of retroglottal region was ( 139.54±35.13 mm2 ) before wearing MASSD, the minimum CSA was(188.42±37.08 mm2 ) after wearing MASSD, there was an obvious statistical significance in the differences ( P < 0.001); the minimum CSA of back zone of epiglottis was (112.51±13.69 mm2) before wearing MASSD, the minimum CSA was(220.81±22.04 mm2 ) after wearing MASSD, there was an obvious statistical significance in the differences ( P < 0.001); the minimum CSA of the general air passage was (72.84±20.93 mm2 ) before wearing MASSD, the minimum CSA was(129.30±26.37 mm2 ) after wearing MASSD, there was an obvious statistical significance in the differences ( P < 0.001). It showed that the minimum CSA of retropalatal region, retroglottal region and back zone of epiglottis were obviously enlarged after wearing MASSD, and the most blocked region was found to be the retropalatal region, which was similar with the research results before.5. The volume of retropalatal region of patients with mild and moderate OSAHS was(4.99±0.60cc ) before wearing MASSD, the volume was ( 8.15±0.68cc ) after wearing MASSD, there was an obvious statistical significance in the differences (P<0.001); the volume of retroglottal region was (4.12±0.45cc) before wearing MASSD,the volume was (7.31±0.59cc) after wearing MASSD,there was an obvious statistical significance in the differences (P<0.001); the volume of back zone of epiglottis was(2.68±0.23cc) before wearing MASSD, the volume was (3.82±0.52cc) after wearing MASSD, there was an obvious statistical significance in the differences (P<0.001);the volume of general air passage was ( 11.79±0.87cc) before wearing MASSD, the volume was (19.31±1.11 cc) after wearing MASSD,there was an obvious statistical significance in the differences (P<0.001). It showed that the general volume and the volumes of sections of retropalatal region, retroglottal region and back zone of epiglottis were enlarged after wearing MASSD.Conclusions: 1. MASSD had a good clinical effects in the treatment for the mild and moderate OSAHS patients.2. CBCT muller breathing seat scan,the sagittal diameter and coronal diameter of the airway of OSAHS were also increased with the use of MASSD.3.Open the airways of mild and moderate OSAHS patients with the MASSD and increase the VC of the upper airway, thus improving the respiratory function of the patients and reduce the apnea of patients at night, and providing theoretical guidance for the clinical diagnosis and treatment of OSAHS. |
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