Effects of mandibular advancement device (MAD) for obstructive sleep apnea syndrome (OSAS) on occlusal function, dentition and maxillofacial morphology

概要




ㄽ ᩥ ඲ ᩥ せ ⣙
Effects of mandibular advancement device (MAD) for obstructive
sleep apnea syndrome (OSAS) on occlusal function,
dentition and maxillofacial morphology
㸦㛢ሰᛶ╧╀᫬↓࿧྾⑕ೃ⩌㸦OSAS㸧࡟ᑐࡍࡿୗ㢡๓᪉఩ᆺཱྀ⭍ෆ
⿦⨨㸦MAD㸧࡟ࡼࡿညྜᶵ⬟࠾ࡼࡧṑิ࣭㢡㢦㠃ᙧែ࡬ࡢᙳ㡪㸧



୺ᣦᑟᩍဨ㸸㇂ᮏ ᖾኴ㑻 ᩍᤵ
㸦་⣔⛉Ꮫ◊✲⛉ ṑ⛉▹ṇᏛ㸧
๪ᣦᑟᩍဨ㸸஧ᕝ ᾈᶞ ᩍᤵ
㸦་⣔⛉Ꮫ◊✲⛉ ཱྀ⭍⏕≀ᕤᏛ㸧
๪ᣦᑟᩍဨ㸸ᅧᯇ ு ෸ᩍᤵ
㸦་⣔⛉Ꮫ◊✲⛉ ṑ⛉▹ṇᏛ㸧


▼⏣ ᜨⳀ
㸦་ṑ⸆ಖ೺Ꮫ◊✲⛉ ་ṑ⸆Ꮫᑓᨷ㸧



 ╧╀㛵㐃࿧྾㞀ᐖࡣࠊᚠ⎔ჾ⑌ᝈࡸ௦ㅰ⑌ᝈࢆྜేࡋࠊᝈ⪅ᮏேࡢ⏕࿨ணᚋ࡟ᙳ㡪ࢆ୚࠼ࡿࡔ
ࡅ࡛࡞ࡃࠊ᪥୰ࡢ㞟୰ຊࡢపୗࡸᒃ╀ࡾࢆច㉳ࡉࡏࠊ㔜኱࡞஺㏻஦ᨾࡸ⏘ᴗ஦ᨾࡢཎᅉ࡜࡞ࡿࡇ
࡜ࡶ࠶ࡾࠊ♫఍ⓗ࡟ࡶᝏᙳ㡪ࢆཬࡰࡍࠋ╧╀㛵㐃࿧྾㞀ᐖࡢ࠺ࡕࠊ᭱ࡶᝈ⪅ᩘࡀከ࠸⑌ᝈࡀ㛢ሰ
ᛶ╧╀᫬↓࿧྾⑕ೃ⩌㸦OSAS㸧࡛࠶ࡿࠋᡂே OSAS ࡢデ᩿ࡣࠊ⤊ኪ╧╀࣏ࣜࢢࣛࣇ᳨ᰝ
㸦polysomnography: PSG㸧ࢆ⏝࠸࡚ࠊ↓࿧྾ప࿧྾ᣦᩘ㸦apnea hypopnea index: AHI㸧ࢆ ᐃࡋࠊ
5≦AHI㸺15 ࡣ㍍⑕ࠊ15≦AHI㸺30 ࡣ୰➼⑕ࠊ30≦AHI ࡣ㔜⑕࡜ᐃ⩏ࡉࢀ࡚࠸ࡿࠋ㔜⑕ OSAS ᝈ⪅
࡬ࡢ἞⒪࡜ࡋ࡚ࡣࠊ⤒㰯ⓗᣢ⥆㝧ᅽ࿧྾⒪ἲ㸦nasal continuous positive airway pressure: nCPAP㸧ࡀ
㐺⏝ࡉࢀࡿࠋ୍᪉ࠊ
㍍ᗘ࠿ࡽ୰➼ᗘࡢ OSAS ᝈ⪅࡟ᑐࡋ࡚ࡣࠊୗ㢡๓᪉఩ᆺཱྀ⭍ෆ⿦⨨
㸦mandibular
advancement device: MAD㸧࡟ࡼࡿ἞⒪ἲࡀ㑅ᢥࡉࢀࡿࠋMAD ࡟ࡣࠊ୍యᆺ MAD ࡜ศ㞳ᆺ MAD
ࡢ 2 ✀㢮ࡀᏑᅾࡋࠊMAD ࡢ▷ᮇⓗ࡞๪స⏝࡜ࡋ࡚ࡣࠊ౑⏝᫬ࡢ㐪࿴ឤࠊ㉳ᗋ᫬ࡢညྜࡢ㐪࿴ឤ
ࡸ㢡㛵⠇ࡢ⑊③➼ࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋ㛗ᮇⓗ࡞๪స⏝࡜ࡋ࡚ࡣࠊညྜࡸṑิࡢኚ໬ࡀ♧၀ࡉࢀ࡚
࠸ࡿࠋࡋ࠿ࡋ࡞ࡀࡽࠊOSAS ᝈ⪅࡟ᑐࡍࡿ୍యᆺ MAD ࠾ࡼࡧศ㞳ᆺ MAD ࡟ࡼࡿ๪స⏝࡟㛵ࡍ
ࡿሗ࿌ࡣᑡ࡞࠸ࠋࡑࡇ࡛ࠊᮏ◊✲࡛ࡣࠊOSAS ᝈ⪅࡟୍యᆺ࠾ࡼࡧศ㞳ᆺ MAD ࢆ౑⏝ࡉࡏࠊ᧔
ཤᚋࡢညྜᶵ⬟ࡢ⤒᫬ⓗኚ໬࡟ࡘ࠸࡚ࠊညྜຊ ᐃࢩࢫࢸ࣒⏝ࣇ࢕࣒ࣝ࠾ࡼࡧညྜຊศᯒࢯࣇ
ࢺࢆ⏝࠸࡚ࠊẚ㍑᳨࣭ウࡍࡿࠋࡉࡽ࡟ࠊMAD ࢆ㸲ᖺ௨ୖ౑⏝ࡋ࡚࠸ࡿᝈ⪅࡟ᑐࡋ࡚ࠊഃ㠃㢌㒊
࢚ࢵࢡࢫ⥺つ᱁෗┿ศᯒ࠾ࡼࡧཱྀ⭍ᶍᆺࡢ 3D ศᯒࢆ⾜࠸ࠊṑิ࣭㢡㢦㠃ᙧែࡢኚ໬ࢆヲ⣽࡟᳨
ウࡍࡿࡇ࡜࡜ࡋࡓࠋ
ᐇ㦂㸯࡛ࡣࠊ୍యᆺ࠾ࡼࡧศ㞳ᆺ MAD ࡢ▷ᮇⓗ࡞๪స⏝࡟ࡘ࠸࡚ࠊẚ㍑᳨࣭ウࢆ⾜ࡗࡓࠋ⿕
㦂⪅ࡣࠊ㍍⑕ࡲࡓࡣ୰➼⑕ OSAS ࡜デ᩿ࡉࢀࡓ MAD ἞⒪ࢆཷࡅ࡚࠸ࡿᝈ⪅ 15 ྡ㸦⏨ᛶ 9 ྡࠊ
ዪᛶ 6 ྡࠊᖹᆒᖺ㱋 61.4 ṓ㸧࡜ࡋࡓࠋศ㞳ᆺ୍࣭యᆺ MAD ࢆస〇ࡋࠊ༑ศㄪᩚࡋࡓᚋࠊ༗ᚋ᮶
㝔ࡉࡏࠊࢹࣥࢱࣝࣉࣞࢫࢣ࣮ࣝⅡࡢ᥇ᚓࢆ⾜࠸ࠊࡇࢀࢆᝈ⪅ࡢᖹᖖ᫬ࡢညྜᶵ⬟ࡢ࣮࣋ࢫࣛ࢖ࣥ
࡜ࡋࡓࠋᖐᏯᚋ࡟ศ㞳ᆺ MAD ࢆ⿦╔ࡋ࡚╧╀ࡉࡏࡓࠋ⩣ᮅࠊMAD ᧔ཤ᫬ࢆ 0 ศ࡜ࡋࠊ30 ศ᫬ࠊ
60 ศ᫬ࠊ120 ศ᫬ࠊ720 ศ᫬࡟࠾࠸࡚ࠊࣉࣞࢫࢣ࣮ࣝࡢ᥇ᚓࢆᐇ᪋ࡋࡓࠋࡲࡓࠊࡑࡢᬌ࡟୍యᆺ
MAD ⿦╔ࢆᣦ♧ࡋࠊMAD ᧔ཤᚋ࡟ࠊࣉࣞࢫࢣ࣮ࣝ࡟ࡼࡿညྜຊࡢ⤒᫬ⓗኚ໬ࢆゎᯒࡋࡓࠋ
 ᐇ㦂 2 ࡛ࡣࠊศ㞳ᆺ MAD ౑⏝ᚋ⣙ 4 ᖺࡢᝈ⪅࡟ᑐࡋࠊഃ㠃㢌㒊࢚ࢵࢡࢫ⥺つ᱁෗┿ศᯒ࠾
ࡼࡧཱྀ⭍ᶍᆺ 3D ศᯒࢆ⾜࠸ࠊMAD ἞⒪㛤ጞ๓㸦T0㸧࠾ࡼࡧ἞⒪㛤ጞ⣙ 4 ᖺᚋ㸦T1㸧࡟࠾ࡅࡿ
ṑิ࣭㢡㢦㠃ᙧែࡢኚ໬ࢆẚ㍑᳨࣭ウࡋࡓࠋࢭࣇ࢓ࣟศᯒ࡛ࡣࠊ㦵᱁⣔ࠊṑ⣔ࠊ㢦㠃㧗ࡢ ᐃ㡯
┠࡜ࡋࡓࠋ3D ᶍᆺศᯒ࡛ࡣࠊୖ㢡ࡢṑิᘪᖜᚄࠊṑᵴᇶᗏ㒊ᖜᚄࠊཱྀ⵹῝ࡉࠊࡑࡋ࡚ overjetࠊ
overbite ࡜ࡋࡓࠋࡇࢀࡽࢆࡑࢀࡒࢀ⤫ィᏛⓗ࡟ẚ㍑᳨࣭ウࡋࡓࠋ
ࡇࢀࡽࡢศᯒ࡟ࡼࡾ᫂ࡽ࠿࡜࡞ࡗࡓᡤぢࢆ௨ୗ࡟♧ࡍࠋศ㞳ᆺ୍࣭యᆺ MAD ࡜ࡶ࡟⿦╔⩣ᮅ
ࡢညྜ᥋ゐ㠃✚࠾ࡼࡧညྜຊࡣ࣮࣋ࢫࣛ࢖ࣥ࡜ẚ㍑ࡋ࡚పୗࡋ࡚࠸ࡓࠋ୧⿦⨨ࢆẚ㍑ࡍࡿ࡜ࠊศ
㞳ᆺࡢ࡯࠺ࡀపୗࡢ๭ྜࡀᑡ࡞ࡃࠊ⤒᫬ⓗᅇ᚟ࡶ᪩ᮇ࡟㉳ࡇࡗࡓࠋࡲࡓࠊ୧⿦⨨࡜ࡶ࡟⿦╔⩣ᮅ
ࡢညྜ㔜ᚰࡣ࣮࣋ࢫࣛ࢖ࣥࡼࡾࡶ๓᪉࡟఩⨨ࡋ࡚࠸ࡓࠋ୧⿦⨨ࡢẚ㍑࡛ࡣ᭷ពᕪࡣぢࡽࢀ࡞࠿
ࡗࡓࠋࡲࡓࠊMAD ࡢ㛗ᮇ౑⏝࡟ࡼࡾࠊୖ㢡๓ṑࡢ⯉ഃഴᩳࠊୗ㢡๓ṑࡢ၁ഃഴᩳࠊୖ㢡๓ṑⴌ
ฟᗘࡢቑຍࠊୗ㢡๓ṑⴌฟᗘࡢῶᑡࠊoverjet ࡜ overbite ࡢῶᑡࠊୗ㢡㛤ཱྀᗘࡢቑຍࠊୗ๓㢦㠃㧗
࠾ࡼࡧ⥲๓㢦㠃㧗ࡢቑຍࡀㄆࡵࡽࢀࡓࠋࡉࡽ࡟ࠊMAD ࡟ࡼࡾ AHI ࠾ࡼࡧ௚ࡢ╧╀ホ౯ᣦᩘࡣ᭷

ព࡟పୗࡋ࡚࠸ࡓࠋ
௨ୖࡢ⤖ᯝࡼࡾࠊMAD ἞⒪ࡢ㛗ᮇ๪స⏝࡜ࡋ࡚ṑࡸ㦵᱁ࡢኚ໬ࡀㄆࡵࡽࢀࡓࡀࠊMAD ἞⒪ࡣ
ᐈほⓗ࡟฼┈ࢆᥦ౪ࡍࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ