顎位，頭位，体位の変化が上気道形態および最大中間吸気速度に及ぼす影響
本研究の目的は，顎位，頭位および体位の変化が上気道形態及び最大中間吸気速度にどの様な影響を及ぼすかについて検討することである．いびきや睡眠障害を認めない健康男性成人15名を被験者とし，習慣性閉口位（下顎0%前方位）と下顎最前方位（下顎100%前方位）における2種のバイトブロックを作製した．被験者に各バイトブロックを装着させ，5種の顎位，頭位，体位（下顎0%前方位-頭位回転-仰臥位，下顎75%前方位-頭位回転-仰臥位，下顎75%前方位-頭位回転-側臥位，下顎75%前方位-頭位側方回転-仰臥位，下顎75%前方位-頭位側方回転-背臥位）における上気道MRIを撮像し，上気道断面積と体積を計測するととも...
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| Published in | 九州歯科学会雑誌 Vol. 63; no. 1; pp. 8 - 17 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
九州歯科学会
2009
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0368-6833 1880-8719 |
| DOI | 10.2504/kds.63.8 |
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| Abstract | 本研究の目的は，顎位，頭位および体位の変化が上気道形態及び最大中間吸気速度にどの様な影響を及ぼすかについて検討することである．いびきや睡眠障害を認めない健康男性成人15名を被験者とし，習慣性閉口位（下顎0%前方位）と下顎最前方位（下顎100%前方位）における2種のバイトブロックを作製した．被験者に各バイトブロックを装着させ，5種の顎位，頭位，体位（下顎0%前方位-頭位回転-仰臥位，下顎75%前方位-頭位回転-仰臥位，下顎75%前方位-頭位回転-側臥位，下顎75%前方位-頭位側方回転-仰臥位，下顎75%前方位-頭位側方回転-背臥位）における上気道MRIを撮像し，上気道断面積と体積を計測するとともに，電子スパイロメータを用いて，上述5種の顎位，頭位，体位における最大中間吸気速度を計測した．得られたデータを分析し，顎位，頭位，体位の変化による上気道形態および最大中間吸気速度の関連性について検討したところ，下顎75%前方位-頭位側方回転-仰臥位において上気道の断面積，体積および最大中間吸気速度が有意に増加した．以上のことから，睡眠時の呼吸をスムーズに保つ姿勢としては，下顎75%前方位-頭位側方回転-仰臥位が最適であることがわかった．この結果は，睡眠時無呼吸症候群患者の睡眠姿勢の参考となり，患者の症状を軽減する方法として有効であることが示唆された． |
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| AbstractList | 本研究の目的は，顎位，頭位および体位の変化が上気道形態及び最大中間吸気速度にどの様な影響を及ぼすかについて検討することである．いびきや睡眠障害を認めない健康男性成人15名を被験者とし，習慣性閉口位（下顎0%前方位）と下顎最前方位（下顎100%前方位）における2種のバイトブロックを作製した．被験者に各バイトブロックを装着させ，5種の顎位，頭位，体位（下顎0%前方位-頭位回転-仰臥位，下顎75%前方位-頭位回転-仰臥位，下顎75%前方位-頭位回転-側臥位，下顎75%前方位-頭位側方回転-仰臥位，下顎75%前方位-頭位側方回転-背臥位）における上気道MRIを撮像し，上気道断面積と体積を計測するとともに，電子スパイロメータを用いて，上述5種の顎位，頭位，体位における最大中間吸気速度を計測した．得られたデータを分析し，顎位，頭位，体位の変化による上気道形態および最大中間吸気速度の関連性について検討したところ，下顎75%前方位-頭位側方回転-仰臥位において上気道の断面積，体積および最大中間吸気速度が有意に増加した．以上のことから，睡眠時の呼吸をスムーズに保つ姿勢としては，下顎75%前方位-頭位側方回転-仰臥位が最適であることがわかった．この結果は，睡眠時無呼吸症候群患者の睡眠姿勢の参考となり，患者の症状を軽減する方法として有効であることが示唆された． |
| Author | 張, い 槙原, 絵理 鱒見, 進一 森本, 泰宏 田中, 達朗 |
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| References | 2) Peppard, P. E., Young, T., Palta, M. and Skatrud, J.: Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 342:1378-1384, 2000. 11) Welch, K. C., Foster, G. D., Ritter, C. T., Wadden, T. A., Arens, R., Maislin, G., and Schwab, R. J.: A novel volumetric magnetic resonance imaging paradigm to study upper airway anatomy. Sleep. 25:532-542, 2002. 19) Martin, S. E., Marshall, I. and Douglas, N. J.: The effect of posture on airway caliber with the sleep-apnea/hypopnea syndrome. Am J Respir Crit Care Med. 152:721-724, 1995. 22) Tsuiki, S., Almeida, F. R., Bhalla, P. S., A, Lowe, A. A. and Fleetham, J. A.: Supine-dependent changes in upper airway size in awake obstructive sleep apnea patients. Sleep Breath. 7:43-50, 2003. 13) Tsuda, H., Tsuda, T. and Masumi, S.: Effec of jaw position on maximum forced inspiratory airflow in normal japanese subjects and in japanese patients with sleep apnea syndrome. Int J Prosthodont. 20:25-30, 2007. 15) Masumi, S., Nishigawa, K., Williams, A. J., Yan-Go, F. L. and Clark, G. T.: Effect of jaw position and posture on forced inspiratory airflow in normal subjects and patients with obstructive sleep apnea. Chest. 109:1484-1489, 1996. 18) Wildhaber, J. H. and Moeller, A.: Sleep and respiration in children: time to wake up. Swiss Med Wkly. 137:689-694, 2007. 24) Bucca, C., Cicolin, A., Brussino, L., Arienti, A., Graziano, A., Erovigni, F., Pera, P., Gai, V., Mutani, R., Preti, G., Rolla, G. and Carossa, S.: Tooth loss and obstructive sleep apnoea. Respir Res. 7:8, 2006. 14) Fietze, I., Dingli, K., Diefenbach, K., Douglas, N. J., Glos, M., Tallafuss, M., Terhalle, W. and Witt, C.: Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome. Eur Respir J. 24:987-993, 2004. 6) Schwab, R. J.: Imaging for the snoring and sleep apnea patient. Dent Clin North Am. 45:759-796, 2001. 7) Schwab, R. J.: Upper airway imaging. Clin Chest Med. 19:33-54, 1998. 23) Ye, J., Han, D., Wang, J., Yang, Q., Lin, Y., Wang, J. and Li, Y.: Computer-assisted fiberoptic pharyngoscopy in obstructive sleep apnea syndrome. ORL J Otorhinolaryngol Relat Spec. 69:153-158, 2007. 10) Abbott, M. B., Donnelly, L. F., Dardzinski, B. J., Poe, S. A., Chini, B. A. and Amin, R. S.: Obstructive sleep apnea: MR imaging volume segmentation analysis. Radiology. 232:889-895, 2004. 20) Kushida, C. A., Sherrill, C. M., Hong, S. C., Palombini, L., Hyde, P. and Dement, W. C.: Cervical positioning for reduction of sleep-disordered breathing in mild-to-moderate OSAS. Sleep Breath. 5:71-78, 2001. 8) Virkkula, P., Hurmerinta, K., Löytönen, M., Salmi, T., Malmberg, H. and Maasilta, P.: Postural cephalometric analysis and nasal resistance in sleep-disordered breathing. Laryngoscope. 113:1166-1174, 2003. 9) Hsu, PP.: A new method of evaluation of upper airway in patients with obstructive sleep apnoea—computer-assisted quantitative videoendoscopic analysis. Ann Acad Med Singapore. 31:393-398, 2002. 5) Ono, T., Otsuka, R., Kuroda, T., Honda, E. and Sasaki, T.: Effects of head and body position on two- and three-dimensional configurations of the upper airway. J Dent Res. 79:1879-1884, 2000. 17) Gao, X. M., Zeng, X. L., Fu, M. K. and Huang, X. Z.: Magnetic resonance imaging of the upper airway in obstructive sleep apnea before and after oral appliance therapy. Chin J Dent Res. 2:27-35, 1999. 3) Itasaka, Y., Miyazaki, S., Ishikawa, K. and Togawa, K.: The influence of sleep position and obesity on sleep apnea. Psychiatry Clin Neurosci. 54:340-341, 2000. 21) White, D. P.: Pathophysiology of obstructive sleep apnoea. Thorax. 50:797-804, 1995. 1) Young, T., Peppard, P. E. and Gottlieb, D. J.: Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 165:1217-1239, 2002. 16) Walker-Engström, M. L., Ringqvist, I., Vestling, O., Wilhelmsson, B. and Tegelberg, A.: A prospective randomized study comparing two different degrees of mandibular advancement with a dental appliance in treatment of severe obstructive sleep apnea. Sleep Breath. 7:119-130, 2003. 12) Stuck, B. A., Neff, W., Hörmann, K., Verse, T., Bran, G., Baisch, A., Düber, C. and Maurer, J. T.: Anatomic changes after hyoid suspension for obstructive sleep apnea: an MRI study. Otolaryngol Head Neck Surg. 133:397-402, 2005. 4) Paal, P., von Goedecke, A., Brugger, H., Niederklapfer, T., Lindner, K. H. and Wenzel, V.: Head position for opening the upper airway. Anaesthesia. 62:227-230, 2007. |
| References_xml | – reference: 7) Schwab, R. J.: Upper airway imaging. Clin Chest Med. 19:33-54, 1998. – reference: 14) Fietze, I., Dingli, K., Diefenbach, K., Douglas, N. J., Glos, M., Tallafuss, M., Terhalle, W. and Witt, C.: Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome. Eur Respir J. 24:987-993, 2004. – reference: 3) Itasaka, Y., Miyazaki, S., Ishikawa, K. and Togawa, K.: The influence of sleep position and obesity on sleep apnea. Psychiatry Clin Neurosci. 54:340-341, 2000. – reference: 18) Wildhaber, J. H. and Moeller, A.: Sleep and respiration in children: time to wake up. Swiss Med Wkly. 137:689-694, 2007. – reference: 4) Paal, P., von Goedecke, A., Brugger, H., Niederklapfer, T., Lindner, K. H. and Wenzel, V.: Head position for opening the upper airway. Anaesthesia. 62:227-230, 2007. – reference: 17) Gao, X. M., Zeng, X. L., Fu, M. K. and Huang, X. Z.: Magnetic resonance imaging of the upper airway in obstructive sleep apnea before and after oral appliance therapy. Chin J Dent Res. 2:27-35, 1999. – reference: 24) Bucca, C., Cicolin, A., Brussino, L., Arienti, A., Graziano, A., Erovigni, F., Pera, P., Gai, V., Mutani, R., Preti, G., Rolla, G. and Carossa, S.: Tooth loss and obstructive sleep apnoea. Respir Res. 7:8, 2006. – reference: 20) Kushida, C. A., Sherrill, C. M., Hong, S. C., Palombini, L., Hyde, P. and Dement, W. C.: Cervical positioning for reduction of sleep-disordered breathing in mild-to-moderate OSAS. Sleep Breath. 5:71-78, 2001. – reference: 15) Masumi, S., Nishigawa, K., Williams, A. J., Yan-Go, F. L. and Clark, G. T.: Effect of jaw position and posture on forced inspiratory airflow in normal subjects and patients with obstructive sleep apnea. Chest. 109:1484-1489, 1996. – reference: 21) White, D. P.: Pathophysiology of obstructive sleep apnoea. Thorax. 50:797-804, 1995. – reference: 11) Welch, K. C., Foster, G. D., Ritter, C. T., Wadden, T. A., Arens, R., Maislin, G., and Schwab, R. J.: A novel volumetric magnetic resonance imaging paradigm to study upper airway anatomy. Sleep. 25:532-542, 2002. – reference: 19) Martin, S. E., Marshall, I. and Douglas, N. J.: The effect of posture on airway caliber with the sleep-apnea/hypopnea syndrome. Am J Respir Crit Care Med. 152:721-724, 1995. – reference: 12) Stuck, B. A., Neff, W., Hörmann, K., Verse, T., Bran, G., Baisch, A., Düber, C. and Maurer, J. T.: Anatomic changes after hyoid suspension for obstructive sleep apnea: an MRI study. Otolaryngol Head Neck Surg. 133:397-402, 2005. – reference: 9) Hsu, PP.: A new method of evaluation of upper airway in patients with obstructive sleep apnoea—computer-assisted quantitative videoendoscopic analysis. Ann Acad Med Singapore. 31:393-398, 2002. – reference: 1) Young, T., Peppard, P. E. and Gottlieb, D. J.: Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 165:1217-1239, 2002. – reference: 10) Abbott, M. B., Donnelly, L. F., Dardzinski, B. J., Poe, S. A., Chini, B. A. and Amin, R. S.: Obstructive sleep apnea: MR imaging volume segmentation analysis. Radiology. 232:889-895, 2004. – reference: 16) Walker-Engström, M. L., Ringqvist, I., Vestling, O., Wilhelmsson, B. and Tegelberg, A.: A prospective randomized study comparing two different degrees of mandibular advancement with a dental appliance in treatment of severe obstructive sleep apnea. Sleep Breath. 7:119-130, 2003. – reference: 23) Ye, J., Han, D., Wang, J., Yang, Q., Lin, Y., Wang, J. and Li, Y.: Computer-assisted fiberoptic pharyngoscopy in obstructive sleep apnea syndrome. ORL J Otorhinolaryngol Relat Spec. 69:153-158, 2007. – reference: 22) Tsuiki, S., Almeida, F. R., Bhalla, P. S., A, Lowe, A. A. and Fleetham, J. A.: Supine-dependent changes in upper airway size in awake obstructive sleep apnea patients. Sleep Breath. 7:43-50, 2003. – reference: 13) Tsuda, H., Tsuda, T. and Masumi, S.: Effec of jaw position on maximum forced inspiratory airflow in normal japanese subjects and in japanese patients with sleep apnea syndrome. Int J Prosthodont. 20:25-30, 2007. – reference: 5) Ono, T., Otsuka, R., Kuroda, T., Honda, E. and Sasaki, T.: Effects of head and body position on two- and three-dimensional configurations of the upper airway. J Dent Res. 79:1879-1884, 2000. – reference: 2) Peppard, P. E., Young, T., Palta, M. and Skatrud, J.: Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 342:1378-1384, 2000. – reference: 6) Schwab, R. J.: Imaging for the snoring and sleep apnea patient. Dent Clin North Am. 45:759-796, 2001. – reference: 8) Virkkula, P., Hurmerinta, K., Löytönen, M., Salmi, T., Malmberg, H. and Maasilta, P.: Postural cephalometric analysis and nasal resistance in sleep-disordered breathing. Laryngoscope. 113:1166-1174, 2003. |
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| SubjectTerms | MRI 上気道形態 体位 最大吸気速度 睡眠時無呼吸症候群 |
| Title | 顎位，頭位，体位の変化が上気道形態および最大中間吸気速度に及ぼす影響 |
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