顎矯正手術が睡眠中の呼吸機能に及ぼす影響：前向き縦断研究

Effects of orthognathic surgery on respiratory function during sleep: A prospective longitudinal study.

抄録

顎矯正手術を受けた患者を治療する場合、上気道の軟部組織の変化により、閉塞性睡眠時無呼吸（OSA）のリスクがある可能性がある。本研究では、過去にOSAと診断されたことのない患者62名を対象に、在宅心肺ポリグラフィーにより睡眠中の呼吸機能を、審美的および機能的適応のための顎矯正手術前、手術後3ヶ月および1年の3回に分けて評価した。術前術後のCTによる3次元計測をもとに、外科的変位を評価した。無呼吸低呼吸指数(AHI)、仰臥位無呼吸低呼吸指数(AHI)、酸素飽和度指数(ODI)、いびき指数などの呼吸パラメータにはわずかな変化しかみられなかった。外科的変位とAHI、AHIおよびODIとの間には有意な相関はみられなかった。下顎前歯の垂直変位といびき指数との間には、弱いながらも有意な相関がみられた。本研究の限界の範囲内において、顎矯正手術を受けたOSAのない患者において、上気道の異所性閉塞のリスクは低いと思われる。

When treating patients with orthognathic surgery, there might be a risk of obstructive sleep apnoea (OSA) due to soft tissue changes in the upper airways, especially in patients treated with isolated mandibular setback or mandibular setback in combination with maxillary advancement. In the present study, we assessed respiratory function during sleep with home cardiorespiratory polygraphy in 62 patients who had not been previously been diagnosed with OSA at three times: prior to orthognathic surgery for aesthetic and functional indications, and then 3 months and 1 year after surgery. We evaluated surgical displacement based on measurements in three dimensions using pre- and post-operative computed tomography. There were only minor changes in the respiratory parameters such as the apnoea-hypopnoea index (AHI), the apnoea-hypopnoea index in the supine position (AHI), the oxygen saturation index (ODI) and the snore index. There was no significant correlation between surgical displacement and the AHI, AHI and ODI. There was a weak but significant correlation between vertical displacement of the anterior mandible and the snore index. Within the limitations of the present study, the risk for iatrogenic obstruction of the upper airways seems to be low in patients without OSA treated with orthognathic surgery.