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山东大学学报 (医学版) ›› 2025, Vol. 63 ›› Issue (7): 44-53.doi: 10.6040/j.issn.1671-7554.0.2025.0618

• 临床医学 • 上一篇    下一篇

儿童三维颅颌面及上气道结构与呼吸暂停低通气指数的相关性

沈薇1,金晨曦1,李娜2,李潇旋1,郭泾1,2   

  1. 1.浙江中医药大学口腔医学院, 浙江 杭州 310053;2.宁波口腔医院正畸科, 浙江 宁波 315016
  • 发布日期:2025-07-08
  • 通讯作者: 郭泾. E-mail:guojing@sdu.edu.cn
  • 基金资助:
    宁波市科学技术局公益性计划(2022S053)

Correlation between 3D craniofacial and upper airway structures and apnea hypopnea index in children

SHEN Wei1, JIN Chenxi1, LI Na2, LI Xiaoxuan1, GUO Jing1,2   

  1. 1. School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China;
    2. Department of Orthodontics, Ningbo Stomatology Hospital, Ningbo 315016, Zhejiang, China
  • Published:2025-07-08

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摘要： 目的 通过锥形束计算机断层扫描(cone beam computed tomography, CBCT)三维定量分析儿童颅颌面及上气道解剖特征,探讨其与呼吸暂停低通气指数(apnea hypopnea index, AHI)之间的相关性,以期筛选出能够预测阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)严重程度的关键指标。 方法 连续纳入2022年6月至2024年6月因错牙合畸形或口呼吸主诉就诊于宁波口腔医院正畸科儿童患者80例,男53例,女27例,8~11岁,平均9.36岁。采用便携式睡眠监测获取AHI,行CBCT扫描测量腺样体体积率(adenoid volume/nasopharyngeal volume, AV/NPV)、上下颌骨宽度及位置、舌骨位置、上气道大小。通过分层回归分析控制患者的性别、体质量指数(body mass index, BMI)及腺样体大小后,评估颅颌面及上气道解剖变量对AHI的独立预测效能。 结果 Spearman 相关性分析结果显示,AV/NPV与AHI呈正相关(P<0.05),而下颌升支长度(mandibular ramus length, Ar-Go)、 上颌骨宽度(maxillary width, Mx-Mx)、下颌骨宽度(mandibular width, Go-Go)、气道最小截面积(minimum axial airway area, MAA)、鼻咽容积(retronasal airway volume, V-RNA)、腭咽容积(retropalatal airway volume, V-RPA)和舌咽容积(retrolingual airway volume, V-RLA)与AHI呈负相关(P<0.05)。分层回归分析首先纳入性别和BMI作为控制变量,结果显示性别和BMI所占方差(R2)等于0.002,模型差异无统计学意义(F(2,77)=0.067, P=0.935)。第二步将AV/NPV纳入分层回归模型,结果显示较第一步的方差变化(ΔR2)等于0.179,AV/NPV(β=0.441, P<0.001)具有正向预测AHI的作用。第三步将与AHI相关的CBCT测量指标纳入模型,结果显示ΔR2=0.273,其中Mx-Mx(β=-0.207, P=0.041)、Go-Go(β=-0.263, P=0.018)和MAA(β=-0.346, P<0.001)是AHI的独立预测因子。 结论 上气道及上下颌骨狭窄是儿童OSA的独立危险因素,其可为临床早期识别高风险患儿提供理论依据。

关键词: 锥形束计算机断层扫描, 阻塞性睡眠呼吸暂停, 呼吸暂停低通气指数, 腺样体, 分层回归分析

Abstract: Objective To investigate craniofacial and upper airway anatomical characteristics in children using cone beam computed tomography(CBCT)and their association with apnea hypopnea index(AHI), aiming to identify key predictive indicators for assessing the severity of obstructive sleep apnea(OSA). Methods A total of 80 pediatric patients who visited the Department of Orthodontics at Ningbo Stomatological Hospital between June 2022 and June 2024 with chief complaints of malocclusion or mouth breathing were consecutively enrolled in the study. The sample included 53 boys and 27 girls with a mean age of 9.36 years. Portable home polysomnography was performed to obtain AHI values, followed by CBCT scans to measure adenoid-to-nasopharynx volume ratio(AV/NPV), maxillary and mandibular width and position, hyoid bone position, and upper airway dimensions. Hierarchical regression analysis was conducted to evaluate the independent predictive value of craniofacial and upper airway variables for AHI after controlling for sex, body mass index(BMI), and adenoid size. Results Spearman correlation analysis showed a significant positive correlation between AV/NPV and AHI(P<0.05). In contrast, mandibular ramus length(Ar-Go), maxillary width(Mx-Mx),mandibular width(Go-Go), minimum axial airway area(MAA), retronasal airway volume(V-RNA), retropalatal airway volume(V-RPA)and retrolingual airway volume(V-RLA)were negatively correlated with AHI(P<0.05). In the hierarchical regression analysis, sex and BMI were entered as control variables in Step 1, accounting for only 0.2% of the variance in AHI(R2=0.002), with the model being non-significant(F(2,77)=0.067, P=0.935). In Step 2, the addition of AV/NPV significantly improved the model, with an increase in explained variance(ΔR2=0.179). AV/NPV was a significant positive predictor of AHI(β=0.441, P<0.001). In Step 3, CBCT-derived variables significantly associated with AHI were added to the model. This step further increased the explained variance(ΔR2=0.273). Among these, Mx-Mx(β=-0.207, P=0.041),Go-Go(β=-0.263, P=0.018)and MAA(β=-0.346, P<0.001)were identified as independent predictors of AHI. Conclusion Upper airway constriction, maxillary and mandibular deficiency serve as independent risk factors for pediatric OSA. These three-dimensional anatomical variables may provide a theoretical basis for early clinical identification of high-risk children.

Key words: Cone beam computed tomography, Obstructive sleep apnea, Apnea hypopnea index, Adenoid, Hierarchical regression analysis

中图分类号: 

  • R788
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