癌症患者的睡眠呼吸障碍与夜间低氧血症：口腔医学与气道评估框架

文献信息

中文摘要

背景： 癌症患者经常出现睡眠相关症状和生理紊乱，这些可能与睡眠呼吸障碍（SDB）和夜间低氧血症有关。尽管这些情况在肿瘤学中受到越来越多的关注，但颅面限制和上气道功能障碍的潜在作用在常规临床实践中仍未得到充分认识。
目的： 提出一个口腔医学和上气道评估框架，用于识别可能导致成人癌症患者睡眠呼吸障碍和夜间低氧血症的解剖因素。
方法： 本叙述性综述整合了关于睡眠呼吸障碍、夜间低氧血症、颅面发育和上气道功能障碍的当前证据。所提出的框架基于成人癌症患者中反复出现的临床观察以及现有文献的叙述性综合，重点是在常规口腔医学检查中可识别的解剖发现。
主要发现： 当前证据表明，上颌骨狭窄、鼻气道狭窄、颅面发育改变和舌系带过短等解剖特征可能导致上气道功能障碍和夜间低氧血症。尽管夜间低氧血症的全身后果日益受到认识，但这些上游解剖因素很少被纳入常规肿瘤学评估。基于现有证据，提出了一个实用的临床框架，以促进早期识别可能受益于进一步呼吸评估的患者。
结论： 将口腔医学和上气道评估整合到成人癌症患者的多学科评估中，可能提高对先前未被识别的睡眠呼吸障碍和夜间低氧血症的认识。该框架提供了一种临床适用的方法，用于识别呼吸功能障碍中可能可改变的解剖因素，并可能支持未来评估其在支持性癌症护理中相关性的研究。

英文摘要

BACKGROUND: Patients with cancer frequently experience sleep-related symptoms and physiological disturbances that may be associated with sleep-disordered breathing (SDB) and nocturnal hypoxia. Although these conditions have attracted increasing attention in oncology, the potential contribution of craniofacial restriction and upper airway dysfunction remains insufficiently recognized in routine clinical practice.
OBJECTIVE: To propose a stomatological and upper airway assessment framework for the identification of anatomical factors that may contribute to sleep-disordered breathing and nocturnal hypoxia in adults with cancer.
METHODS: This narrative review integrates current evidence on sleep-disordered breathing, nocturnal hypoxia, craniofacial development, and upper airway dysfunction. The proposed framework was developed from recurrent clinical observations in adults with cancer together with a narrative synthesis of the available literature, with emphasis on anatomical findings identifiable during routine stomatological examination.
MAIN FINDINGS: Current evidence indicates that anatomical features such as maxillary constriction, nasal airway narrowing, altered craniofacial development, and ankyloglossia may contribute to upper airway dysfunction and nocturnal hypoxia. Despite increasing recognition of the systemic consequences of nocturnal hypoxia, these upstream anatomical factors are rarely incorporated into routine oncological assessment. Based on the available evidence, a practical clinical framework is proposed to facilitate early identification of patients who may benefit from further respiratory evaluation.
CONCLUSION: Integrating stomatological and upper airway assessment into the multidisciplinary evaluation of adults with cancer may improve recognition of previously unrecognized sleep-disordered breathing and nocturnal hypoxia. This framework provides a clinically applicable approach for identifying potentially modifiable anatomical contributors to respiratory dysfunction and may support future research evaluating their relevance in supportive cancer care.