儿童错𬌗畸形合并阻塞性睡眠呼吸暂停综合征的诊疗研究进展

王超杰; 温和; 金欣哲; 朱亚芬

doi:10.12016/j.issn.2096-1456.2024.05.009

口腔疾病防治 ›› 2024, Vol. 32 ›› Issue (5) : 388 -394. DOI: 10.12016/j.issn.2096-1456.2024.05.009

综述

儿童错𬌗畸形合并阻塞性睡眠呼吸暂停综合征的诊疗研究进展

王超杰, 温和, 金欣哲, 朱亚芬

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Research progress on the diagnosis and treatment of pediatric malocclusion combined with obstructive sleep apnea-hypopnea syndrome

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摘要

儿童错𬌗畸形在口腔科较常见，而部分错𬌗畸形合并有阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）的儿童常由于缺乏多学科诊疗而未得到恰当的治疗，导致睡眠期间通气异常，影响儿童中枢系统、心血管发育，甚至产生神经行为问题。儿童OSAHS与上呼吸道结构变窄、面部骨骼和神经肌肉因素相关，与错𬌗畸形有一定相关性；儿童OSAHS临床表现和病因多样，因此诊断和治疗呈现多学科交叉、个性化和专业化的特点。通过问卷和体格检查能够进行初步筛查，儿童口腔科和耳鼻喉科检查则是发现该疾病的前哨。多导睡眠监测（polysomnography，PSG）是目前诊断的直接方法。儿童OSAHS治疗方法多样，对因腺样体扁桃体肥大引起的OSAHS，以腺样体扁桃体切除术为主；下颌前导装置治疗、上颌扩弓治疗等正畸治疗对合并错𬌗畸形的OSAHS儿童有较好效果。目前儿童错𬌗畸形与OSAHS相关性的研究较少，多学科联合疗法可能会提高治愈率但缺乏足够文献证明。未来应进一步阐明OSAHS的发病机制，推进多学科联合治疗的研究，以期通过多学科协作，对于潜在及已发病患者做到早干预、早治疗。

Abstract

Pediatric malocclusion is common in dentistry. Some children with malocclusion combined with obstructive sleep apnea-hypopnea syndrome (OSAHS) often fail to receive appropriate treatment due to a lack of multidisciplinary diagnosis and treatment. It can cause abnormal ventilation during sleep, affecting the central nervous system and cardiovascular development and even causing neurological and behavioral problems. Pediatric OSAHS is caused by the narrowing of the upper respiratory tract, characterized by specific facial bone characteristics and neuromuscular factors and correlated with malocclusion. Due to its diverse clinical manifestations and etiology, the diagnosis and treatment of pediatric OSAHS require an interdisciplinary, personalized, and specialized approach. Questionnaires and physical examinations can be used for preliminary screening. Moreover, children's stomatology and otorhinolaryngology examinations are the basis for disease diagnosis. Polysomnography (PSG) is currently the direct diagnostic method. There are various treatment methods for OSAHS in children, and for OSAHS caused by adenoid tonsil hypertrophy, adenoidectomy and tonsillectomy are the main treatments. Othodontic treatment including mandibular advancement and rapid maxillary expansion et al is also effective for OSAHS in children with malocclusion. Currently, there is limited research on the correlation between childhood malocclusion and OSAHS, and multidisciplinary combination therapy may improve the cure rate, but there is a lack of sufficient evidence. In the future, the pathogenesis of OSAHS should be further elucidated, and research on multidisciplinary combination therapy should be promoted to achieve early intervention and treatment for potential and existing patients.