日本人成人男性閉塞性睡眠時無呼吸症候群患者に上顎歯列弓狭窄は多いか？

Is maxillary dental arch constriction common in Japanese male adult patients with obstructive sleep apnoea?

抄録

目的 閉塞性睡眠時無呼吸症候群（OSA）の発症に対する上顎歯列弓の狭小化と上顎骨格の狭窄の寄与についてはほとんど知られていない。そこで本研究の目的は、日本人男性における上顎歯列弓幅とOSAの関係、および上顎骨格の狭窄とOSAの関係を明らかにすることである。患者の歯列弓幅を日本人男性の標準値と比較した。さらに、上顎歯列弓幅と無呼吸低呼吸指数（AHI）、肥満度、骨格パターン（SNA、SNB、ANB）、正立側面セファログラムから得られた舌の断面積、下顎歯列弓幅、オーバージェット、過蓋咬合との関連も検討した。しかし、重回帰分析の結果、上顎に対して下顎が後方に位置するほど上顎歯列弓は狭くなることが明らかになった。結論 上顎歯列弓の狭窄はOSAの発症に関連する可能性があるが、日本人OSA患者の典型的な特徴ではないと結論付けた。さらに、OSAを悪化させる要因は、上顎骨格の狭窄ではなく、むしろ前後骨格の不一致に関連した上顎歯列弓の狭窄である。

OBJECTIVES Little is known about the contributions of a narrow maxillary dental arch and maxillary skeletal constriction to the development of obstructive sleep apnoea (OSA). Therefore, the purpose of this study was to clarify the relationships between maxillary dental arch width and OSA and between maxillary skeletal constriction and OSA in Japanese male patients.METHODS Study models for 164 Japanese male OSA patients were fabricated for dental arch analyses. We compared the patients' dental arch widths with the standard value for Japanese males. Moreover, the associations between the upper dental arch width and the apnoea-hypopnoea index (AHI), body mass index, skeletal pattern (SNA, SNB, and ANB), cross-sectional area of tongue obtained from an upright lateral cephalogram, lower dental arch width, overjet, and overbite were also examined.RESULTS Although a narrower upper dental arch was associated with severer OSA, the upper dental arch in OSA patients was not significantly narrower than the Japanese standard value. However, the results of a multiple regression analysis revealed that the upper dental arch became narrower as the mandible was positioned more rearward relative to the maxilla.CONCLUSIONS We conclude that dental arch constriction in the maxilla could be associated with the development of OSA but is not a typical feature of our sample of Japanese OSA patients. Moreover, the factor that aggravates OSA is not maxillary skeletal constriction but rather maxillary dental arch constriction related to antero-posterior skeletal discrepancy.