口腔矫治器治疗阻塞性睡眠呼吸暂停期间后牙开合的频率及相关骨骼因素：一项回顾性研究。

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中文摘要

背景： 后牙开合（POB）可能作为长期口腔矫治器（OA）治疗阻塞性睡眠呼吸暂停（OSA）的咬合不良效应而出现。然而，其发生频率、临床记录时间以及相关的骨骼和牙齿因素仍未被充分描述。本研究调查了POB的发生频率和临床特征，并探讨了OA治疗期间与其发生相关的因素。
方法： 这项回顾性研究纳入了96例在2015年8月至2025年5月期间接受OA治疗且具有足够临床和头影测量数据可供分析的OSA患者。患者被分为POB组和非POB组。根据情况使用非配对t检验和Fisher精确检验比较患者特征、治疗相关因素、牙齿变量和头影测量参数。在单变量分析中满足预设筛选标准p < 0.20的变量被纳入多变量logistic回归模型。
结果： 96例患者中有16例（16.7%）记录了POB。从开始OA治疗到首次记录POB的平均间隔为1,265.3天（约3.5年），患者间差异较大。16例患者中有7例（43.8%）在首次记录POB时报告意识到咬合变化。初始呼吸暂停低通气指数、剩余牙齿数量、覆盖、SNA和SNB在单变量分析中满足预设筛选标准，其中较高的SNB与POB显示出统计学显著的非调整关联。然而，这些变量在多变量分析中均未达到统计学显著性。
结论： 在最终分析队列中，16.7%的患者记录了POB，并且在OA治疗期间的不同时间首次被发现。尽管未确定统计学显著的独立预测因素，但较高的SNB可能与POB相关。这些探索性发现需要在更大规模的前瞻性研究中得到证实。在长期OA治疗期间，应进行仔细的咬合监测。

英文摘要

BACKGROUND: Posterior open bite (POB) may develop as an occlusal adverse effect of long-term oral appliance (OA) therapy for obstructive sleep apnea (OSA). However, its frequency, time to clinical documentation, and associated skeletal and dental factors remain insufficiently characterized. This study investigated the frequency and clinical characteristics of POB and explored factors associated with its development during OA therapy.
METHODS: This retrospective study included 96 patients with OSA who received OA therapy between August 2015 and May 2025 and had sufficient clinical and cephalometric data for analysis. Patients were categorized into POB and non-POB groups. Patient characteristics, treatment-related factors, dental variables, and cephalometric parameters were compared using unpaired t-tests and Fisher's exact tests, as appropriate. Variables meeting the prespecified screening criterion of p < 0.20 in univariate analyses were entered into a multivariable logistic regression model.
RESULTS: POB was documented in 16 of 96 patients (16.7%). The mean interval from the initiation of OA therapy to the first documentation of POB was 1,265.3 days (approximately 3.5 years), with considerable variation among patients. Seven of the 16 patients (43.8%) reported awareness of occlusal changes when POB was first documented. Initial apnea-hypopnea index, number of remaining teeth, overjet, SNA, and SNB met the prespecified screening criterion in univariate analyses, with higher SNB showing a statistically significant unadjusted association with POB. However, none of these variables reached statistical significance in the multivariable analysis.
CONCLUSIONS: POB was documented in 16.7% of patients in the final analytical cohort and was first identified at variable times during OA therapy. Although no statistically significant independent predictors were identified, higher SNB may be associated with POB. These exploratory findings require confirmation in larger prospective studies. Careful occlusal monitoring is warranted throughout long-term OA therapy.