口腔诊疗与阻塞性睡眠呼吸暂停筛查

doi:10.13591/j.cnki.kqyx.2025.02.012

摘要/Abstract

摘要：

越来越多伴有阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的患者因口腔疾患于口腔医疗机构首诊。本文着眼于口腔临床实践,从口腔解剖特点、颅颌面特征、影像学检查、全身病史、临床症状及表现、风险人群、问卷量表等方面,梳理并总结了有望用于口腔诊疗中的成年OSA患者筛查方法。口腔医护人员通过筛查甄别潜在的OSA患者,可更好地发挥口腔医护团队在OSA多学科联合诊疗中的功能角色,有助于OSA防治关口的前移。

关键词: 阻塞性睡眠呼吸暂停, 筛查, 口腔医学

Abstract:

Lots of patients with obstructive sleep apnea(OSA)are first recognized in dental institutions. In consideration of dental characteristics, we summarize advances in the application of screening methods for adult OSA patients based on oral examination, craniofacial structure, imaging examination, medical history, clinical symptoms, manifestation, populations at risk and questionnaires. Dental practitioners can screen and identify potential OSA patients, play a better role in the multidisciplinary of OSA, and help the prevention of OSA.

Key words: obstructive sleep apnea, screening, stomatology

中图分类号:

R780.1

罗玉琴, 谭理军, 杜书芳, 白丁, 冯捷. 口腔诊疗与阻塞性睡眠呼吸暂停筛查[J]. 口腔医学, 2025, 45(2): 146-150.

LUO Yuqin, TAN Lijun, DU Shufang, BAI Ding, FENG Jie. Dental diagnosis and treatment and obstructive sleep apnea screening[J]. Stomatology, 2025, 45(2): 146-150.

参考文献 50

[1]	吴新民, 王月兰, 孙永涛. 阻塞性睡眠呼吸暂停患者围术期麻醉管理专家共识(2020修订版)快捷版[J]. 临床麻醉学杂志, 2021, 37(2): 196-199.
[2]	Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis[J]. Lancet Respir Med, 2019, 7(8): 687-698. doi: 10.1016/S2213-2600(19)30198-5 pmid: 31300334
[3]	Pivetta B, Chen LN, Nagappa M, et al. Use and performance of the STOP-Bang questionnaire for obstructive sleep apnea screening across geographic regions: A systematic review and meta-analysis[J]. JAMA Netw Open, 2021, 4(3): e211009.
[4]	中华医学会呼吸分会睡眠呼吸障碍学组, 中国医学装备协会呼吸病学装备技术专业委员会睡眠呼吸设备学组. 成人阻塞性睡眠呼吸暂停高危人群筛查与管理专家共识[J]. 中华健康管理学杂志, 2022, 16(8): 520-528.
[5]	Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American academy of sleep medicine clinical practice guideline[J]. J Clin Sleep Med, 2017, 13(3): 479-504. doi: 10.5664/jcsm.6506 pmid: 28162150
[6]	Chang JL, Goldberg AN, Alt JA, et al. International consensus statement on obstructive sleep apnea[J]. Int Forum Allergy Rhinol, 2023, 13(7): 1061-1482.
[7]	Miller JN, Berger AM. Screening and assessment for obstructive sleep apnea in primary care[J]. Sleep Med Rev, 2016, 29: 41-51. doi: 10.1016/j.smrv.2015.09.005 pmid: 26606318
[8]	Reibel YG, Pusalavidyasagar S, Flynn PM. Obstructive Sleep Apnea Knowledge: Attitudes and screening practices of Minnesota dental hygienists[J]. J Dent Hyg, 2019, 93(3): 29-36. pmid: 31182566
[9]	中国医师协会睡眠医学专业委员会. 成人阻塞性睡眠呼吸暂停多学科诊疗指南[J]. 中华医学杂志, 2018, 98(24): 1902-1914.
[10]	中国医师协会呼吸医师分会睡眠呼吸障碍工作委员会, “华佗工程”睡眠健康项目专家委员会. 成人阻塞性睡眠呼吸暂停低通气综合征远程医疗临床实践专家共识[J]. 中华医学杂志, 2021, 101(22): 1657-1664.
[11]	Berggren K, Broström A, Firestone A, et al. Oral health problems linked to obstructive sleep apnea are not always recognized within dental care-As described by dental professionals[J]. Clin Exp Dent Res, 2022, 8(1): 84-95.
[12]	Jokubauskas L, Pileičikienè G, Žekonis G, et al. Lithuanian dentists’ knowledge, attitudes, and clinical practices regarding obstructive sleep apnea: A nationwide cross-sectional study[J]. Cranio, 2019, 37(4): 238-245. doi: 10.1080/08869634.2018.1437006 pmid: 29431599
[13]	Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults[J]. J Clin Sleep Med, 2009, 5(3): 263-276. pmid: 19960649
[14]	Ivanoff CS, Pancratz F. Incidence of sleep disorders reported by patients at UTHSC college of dentistry: A two-year follow-up and proposed educational program[J]. J Dent Educ, 2015, 79(5): 548-556. pmid: 25941148
[15]	贺红. 《阻塞性睡眠呼吸暂停低通气综合征与口腔正畸:美国口腔正畸医师协会白皮书》解读[J]. 中华口腔医学杂志, 2020, 55(9): 667-672.
[16]	Ravesloot MJL, van Maanen JP, Hilgevoord AAJ, et al. Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery[J]. Eur Arch Otorhinolaryngol, 2012, 269(7): 1865-1871. doi: 10.1007/s00405-012-1948-0 pmid: 22310840
[17]	粟义佳, 杨佳鑫, 胡玉丽, 等. 妊娠期阻塞性睡眠呼吸暂停筛查方法的研究进展[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(12): 1361-1365.
[18]	Arora T, Al-Houqani M. Comparison of commonly used screening tools for determining obstructive sleep apnea amongst aviation employees[J]. Sleep Med, 2021, 77: 332-336. doi: 10.1016/j.sleep.2020.07.008 pmid: 32839087
[19]	Pocobelli G, Akosile MA, Hansen RN, et al. Obstructive sleep apnea and risk of motor vehicle accident[J]. Sleep Med, 2021, 85: 196-203. doi: 10.1016/j.sleep.2021.07.019 pmid: 34348205
[20]	Celikhisar H, DasdemirIlkhan G. The association of obstructive sleep apnea syndrome and accident risk in heavy equipment operators[J]. Medicina, 2019, 55(9): 599.
[21]	赵竹, 孙家强, 别远志, 等. 阻塞性睡眠呼吸暂停低通气综合征相关危险因素研究和Nomogram预测模型建立[J]. 实用医院临床杂志, 2023, 20(4): 45-49.
[22]	Riley RW, Powell NB, Li KK, et al. Surgery and obstructive sleep apnea: Long-term clinical outcomes[J]. Otolaryngol Head Neck Surg, 2000, 122(3): 415-421. pmid: 10699820
[23]	陈裕桦, 高媛, 王连城, 等. 成人阻塞性睡眠呼吸暂停治疗研究进展[J]. 临床口腔医学杂志, 2023, 39(3): 186-189.
[24]	Ruangsri S, Jorns TP, Puasiri S, et al. Which oropharyngeal factors are significant risk factors for obstructive sleep apnea? An age-matched study and dentist perspectives[J]. Nat Sci Sleep, 2016, 8: 215-219. doi: 10.2147/NSS.S96450 pmid: 27468254
[25]	Valarelli LP, Corradi AMB, Grechi TH, et al. Cephalometric, muscular and swallowing changes in patients with OSAS[J]. J Oral Rehabil, 2018, 45(9): 692-701. doi: 10.1111/joor.12666 pmid: 29889982
[26]	Pollis M, Lobbezoo F, Aarab G, et al. Correlation between apnea severity and sagittal cephalometric features in a population of patients with polysomnographically diagnosed obstructive sleep apnea[J]. J Clin Med, 2022, 11(15): 4572.
[27]	Mustafa R, Priaminiarti M, Iskandar HHB, et al. Lateral cephalometric radiograph analysis on obstructive sleep apnea patients[J]. J Radiol Dentomaksilofasial Indonesia, 2022, 6(2): 81.
[28]	Venere DD, Corsalini M, Nardi GM, et al. Obstructive site localization in patients with Obstructive Sleep Apnea Syndrome: A comparison between otolaryngologic data and cephalometric values[J]. Oral Implantol, 2017, 10(3): 295-310.
[29]	Stipa C, Cameli M, Sorrenti G, et al. Relationship between cephalometric parameters and the apnoea-hypopnoea index in OSA patients: A retrospective cohort study[J]. Eur J Orthod, 2020, 42(1): 101-106.
[30]	Joy A, Park J, Chambers DW, et al. Airway and cephalometric changes in adult orthodontic patients after premolar extractions[J]. Angle Orthod, 2020, 90(1): 39-46. doi: 10.2319/021019-92.1 pmid: 31403835
[31]	万呼春, 周学东, 邹淑娟, 等. 阻塞性睡眠呼吸暂停综合征的口腔治疗[J]. 华西口腔医学杂志, 2018, 36(6): 581-589.
[32]	Kale SS, Kakodkar P, Shetiya SH. Assessment of oral findings of dental patients who screen high and no risk for obstructive sleep apnea (OSA) reporting to a dental college: A cross sectional study[J]. Sleep Sci, 2018, 11(2): 112-117.
[33]	Campos-Juanatey F, Fernandez-Barriales M, Gonzalez M, et al. Effects of obstructive sleep apnea and its treatment over the erectile function: A systematic review[J]. Asian J Androl, 2017, 19(3): 303-310. doi: 10.4103/1008-682X.170440 pmid: 26763546
[34]	Tepedino M, Illuzzi G, Laurenziello M, et al. Craniofacial morphology in patients with obstructive sleep apnea: Cephalometric evaluation[J]. Braz J Otorhinolaryngol, 2022, 88(2): 228-234.
[35]	梁晓, 刘婷婷, 赵越, 等. 成人骨性Ⅱ类均、高角患者的上气道结构三维分析[J]. 中国美容医学, 2019, 28(3): 109-111.
[36]	Huang LP, Xu Y, Gong X, et al. Anatomical phenotype of obstructive sleep apnea patients based on cluster analysis[J/OL]. Orthod Craniofac Res, 2023[2023-07-15].doi: 10.1111/ocr.12653.
[37]	陶丽, 朱敏. 正颌手术对骨性Ⅲ类患者上气道及周围结构影响的研究[J]. 口腔颌面外科杂志, 2014, 24(1): 72-76.
[38]	Irani SK, Oliver DR, Movahed R, et al. Pharyngeal airway evaluation after isolated mandibular setback surgery using cone-beam computed tomography[J]. Am J Orthod Dentofacial Orthop, 2018, 153(1): 46-53.
[39]	Chen FS, Terada K, Hua YM, et al. Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with Class Ⅲ skeletal deformities[J]. Am J Orthod Dentofacial Orthop, 2007, 131(3): 372-377.
[40]	Carvalho AA, Amorim FF, Santana LA, et al. STOP-Bang questionnaire should be used in all adults with Down Syndrome to screen for moderate to severe obstructive sleep apnea[J]. PLoS One, 2020, 15(5): e0232596.
[41]	Semensato MM, Trindade SHK, Marzano-Rodrigues MN, et al. Screening for obstructive sleep apnea and associated risk factors in adolescents and adults with isolated robin sequence[J/OL]. Cleft Palate Craniofac J, 2022[2023-07-15].doi: 10.1177/10556656221119078.
[42]	张子奇, 王舒泽, 张斌, 等. 上气道形态评估与阻塞性睡眠呼吸暂停关系的研究进展[J]. 实用临床医药杂志, 2022, 26(6): 139-144.
[43]	Behrents RG, Shelgikar AV, Conley RS, et al. Obstructive sleep apnea and orthodontics: An American association of orthodontists white paper[J]. Am J Orthod Dentofacial Orthop, 2019, 156(1): 13-28.e1.
[44]	O'Driscoll DM, Landry SA, Pham J, et al. The physiological phenotype of obstructive sleep apnea differs between Caucasian and Chinese patients[J]. Sleep, 2019, 42(11): zsz186.
[45]	Zheng ZZ, Sun XS, Chen RK, et al. Comparison of six assessment tools to screen for obstructive sleep apnea in patients with hypertension[J]. Clin Cardiol, 2021, 44(11): 1526-1534.
[46]	Tan A, Yin JDC, Tan LWL, et al. Using the berlin questionnaire to predict obstructive sleep apnea in the general population[J]. J Clin Sleep Med, 2017, 13(3): 427-432. doi: 10.5664/jcsm.6496 pmid: 27855742
[47]	吴欢, 周建荣. STOP-Bang问卷联合Epworth嗜睡量表在预测OSA中的价值[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(4): 319-321.
[48]	Zhang ZG, Yang D, Wang HY, et al. Effects of age and sex on the performance of the NoSAS score as a screening tool for obstructive sleep apnea: A hospital-based retrospective study in China[J]. Sleep Breath, 2021, 25(3): 1407-1417. doi: 10.1007/s11325-020-02254-3 pmid: 33222029
[49]	Costa CJ, Rebelo-Marques A, Machado J, et al. Validation of NoSAS (Neck, Obesity, Snoring, Age, Sex) score as a screening tool for obstructive sleep apnea: Analysis in a sleep clinic[J]. Pulmonol, 2019, 25(5): 263-270.
[50]	Duarte RLM, Silveira FJMD, Sá TSOE, et al. Using the No-Apnea score to screen for obstructive sleep apnea in adults referred to a sleep laboratory: Comparative study of the performance of the instrument by gender[J]. J Bras Pneumol, 2020, 46(5): e20190297.