矫治器治疗阻塞性睡眠呼吸暂停低通气综合征对颏舌肌的影响

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a disease of high incidence and high risk. OSAHS only occurs during sleep and the airway can keep open during awake, which is mainly due to compensatory contraction of the genioglossus. Genioglossus is the key to study etiological mechanism and reasonable treatment of OSAHS. In recent years, the treatment of OSAHS aimed at genioglossus gradually increased, but the effect was different. Blind treatment aimed at genioglossus was not satisfactory, because the damage of OSAHS itself on genioglossus was ignored. Therefore, it was necessary to fundamentally treat OSAHS. As a conventional treatment method for mild to moderate OSAHS, there was no report on the effect of mandibular advancement device on genioglossus. A hypothesis was made that OSAHS could lead to functional and structural damage of genioglossus, and early treatment of OSAHS with mandibular advancement device could prevent the functional and structural damage of genioglossus. In this study, the changes of genioglossal function and structure pre- and post- treatment with appliance were investigated by OSAHS rabbits and clinical trials, to provide references for clinical treatment of OSAHS and to provide a theoretical basis for OSAHS treated by mandibular advancement device.

阻塞性睡眠呼吸暂停低通气综合征（Obstructive Sleep Apnea Hypopnea Syndrome，OSAHS）发病率高且危害性大，但OSAHS仅在睡眠时发病，清醒时能保持气道开放，这与颏舌肌代偿性收缩有关。颏舌肌是研究OSAHS病因机制与合理治疗的关键，近年来，针对颏舌肌治疗OSAHS的方法很多，但疗效不一。人们盲目针对颏舌肌治疗OSAHS，却忽略了OSAHS对颏舌肌的损伤，导致疗效不理想。因此，从根本上治疗OSAHS，才能取得满意疗效。下颌前移矫治器作为治疗轻中度OSAHS的方法，其治疗OSAHS对颏舌肌的影响未见报道。因此，提出假说OSAHS会导致颏舌肌功能及结构受损，矫治器治疗OSAHS可预防颏舌肌损伤。本研究拟通过OSAHS兔模型和临床实验，观察矫治器治疗前后颏舌肌功能和结构的改变，为临床上OSAHS治疗方法的选择提供参考以及为矫治器治疗OSAHS提供理论依据。

阻塞性睡眠呼吸暂停低通气综合征（Obstructive Sleep Apnea Hypopnea Syndrome，OSAHS）发病率高且危害性大，但OSAHS仅在睡眠时发病，清醒时能保持气道开放，这与颏舌肌代偿性收缩有关。颏舌肌是研究OSAHS病因机制与合理治疗的关键，近年来，针对颏舌肌治疗OSAHS的方法很多，但疗效不一。人们盲目针对颏舌肌治疗OSAHS，却忽略了OSAHS对颏舌肌的损伤，导致疗效不理想。因此，从根本上治疗OSAHS，才能取得满意疗效。下颌前移矫治器作为治疗轻中度OSAHS的方法，其治疗OSAHS对颏舌肌的影响未见报道。因此，本研究通过兔软腭注射凝胶的方法建立上气道阻塞OSAHS模型，应用张力换能器测量颏舌肌体外收缩功能，透射电镜观察颏舌肌超微结构、应用激光共聚焦显微镜和流式细胞术观察线粒体膜电位，应用试剂盒测量复合物I、IV活性，同时通过应用下颌前移矫治器治疗OSAHS观察下颌前移矫治器治疗OSAHS后颏舌肌体外收缩功能，超微结构，线粒体膜电位，复合物I、IV活性。结果发现OSAHS可导致颏舌肌疲劳性增加，线粒体超微结构紊乱，线粒体嵴消失，线粒体嵴和线粒体膜融合，线粒体膜电位下降及复合物I、IV活性下降，矫治器治疗可预防OSAHS对颏舌肌功能、结构及能量代谢的损害。本研究为临床上OSAHS治疗方法的选择提供参考，避免盲目针对颏舌肌进行治疗导致效果不理想，同时为矫治器治疗OSAHS提供理论依据。