青少年阻塞性睡眠呼吸障碍与颞下颌关节髁突吸收的相关性研究

doi:10.3969/j.issn.1674-8115.2026.02.006

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (2): 181-187.doi: 10.3969/j.issn.1674-8115.2026.02.006

• 论著 · 临床研究 • 上一篇

青少年阻塞性睡眠呼吸障碍与颞下颌关节髁突吸收的相关性研究

沈佩, 张大河, 陈欣慰, 张善勇, 杨驰()

上海交通大学医学院附属第九人民医院口腔外科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海市口腔医学研究所，上海 200011

收稿日期:2025-06-19 接受日期:2025-09-08 出版日期:2026-02-28 发布日期:2026-02-28
通讯作者: 杨驰，教授，主任医师，博士；电子信箱：yangchi6318@163.com。
基金资助:
国家自然科学基金(82370980,82071134)

Correlation between obstructive sleep-disordered breathing and temporomandibular joint condylar absorption in adolescents

Shen Pei, Zhang Dahe, Chen Xinwei, Zhang Shanyong, Yang Chi()

Department of Oral Surgery, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai 200011, China

Received:2025-06-19 Accepted:2025-09-08 Online:2026-02-28 Published:2026-02-28
Contact: Yang Chi, E-mail: yangchi6318@163.com.
Supported by:
National Natural Science Foundation of China(82370980,82071134)

摘要/Abstract

摘要：

目的·探索青少年阻塞性睡眠呼吸障碍（obstructive sleep-disordered breathing，OSDB）与颞下颌关节（temporomandibular joint，TMJ）髁突吸收的相关性。方法·纳入2018年9月至2023年12月首次就诊于上海交通大学医学院附属第九人民医院口腔外科TMJ专家门诊、年龄10~19岁的青少年连续初诊病例。根据打鼾频率是否≥3晚/周，将研究对象分为OSDB组和无OSDB组。收集2组人口统计学信息、上气道相关疾病史、不良舌习惯史和口呼吸习惯史，评估有无TMJ髁突吸收并测量髁突高度。比较上述变量的组间差异，为进一步探索各因素与OSDB的相关性，将差异有统计学意义的变量纳入Logistic回归模型进行多因素分析。结果·研究期间共纳入439例青少年患者，其中OSDB组30例，无OSDB组409例。2组人群基本人口统计学信息差异无统计学意义（P>0.05）。腺样体扁桃体疾病史和不良舌习惯史患者在OSDB组中的比例显著高于无OSDB组（P=0.001，P=0.040）。OSDB组TMJ髁突吸收的发生率远高于无OSDB组（P=0.004），OSDB组中患者髁突高度显著低于无OSDB组（P<0.001）。多因素Logistic回归分析显示TMJ髁突吸收（OR=4.837，95%CI 1.889~12.336，P<0.001）及髁突高度下降（OR=0.547，95%CI 0.426~0.678，P<0.001）与OSDB的发生密切相关。结论·TMJ髁突吸收与青少年OSDB的发生密切相关。

关键词: 颞下颌关节, 髁突吸收, 阻塞性睡眠呼吸障碍, 青少年

Abstract:

Objective ·To investigate the correlation between obstructive sleep-disordered breathing (OSDB) and temporomandibular joint (TMJ) condylar resorption in adolescents. Methods ·From September 2018 to December 2023, consecutive adolescents (aged 10 to 19 years) who visited the TMJ Clinic at Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine, were recruited in the present study. Patients were divided into the OSDB group and the non-OSDB group based on whether the frequency of snoring was ≥3 nights per week. Demographic information, history of upper airway-related diseases, tongue habits, and mouth-breathing habits were collected for both groups. The presence or absence of TMJ condylar absorption was assessed, and condylar height was measured. Intergroup differences in the above variables were compared. To further explore the association between various factors and OSDB, variables with statistical significance in the univariate analysis were included in a logistic regression model for multivariable analysis. Results ·A total of 439 adolescent patients were enrolled during the study period, including 30 cases in the OSDB group and 409 cases in the non-OSDB group. There was no significant difference in demographic information between the two groups (P>0.05). The proportions of patients with a history of adenoid and tonsil diseases and adverse tongue habits in the OSDB group were significantly higher than those in the non-OSDB group (P=0.001 and P=0.040, respectively). The incidence of TMJ condylar resorption was significantly higher in the OSDB group than that in the non-OSDB group (P=0.004), and condylar height in the OSDB group was significantly lower than that in the non-OSDB group (P<0.001). Multivariate logistic regression analysis revealed that condylar resorption (OR=4.837, 95%CI 1.889‒12.336, P<0.001) and decreased condylar height (OR=0.547, 95%CI 0.426‒0.678, P<0.001) were closely associated with the occurrence of OSDB. Conclusion ·These results suggest that TMJ condylar resorption is closely related to the occurrence of OSDB in adolescents.

Key words: temporomandibular joint, condylar resorption, obstructive sleep-disordered breathing, adolescent

中图分类号:

R782.4

沈佩, 张大河, 陈欣慰, 张善勇, 杨驰. 青少年阻塞性睡眠呼吸障碍与颞下颌关节髁突吸收的相关性研究[J]. 上海交通大学学报（医学版）, 2026, 46(2): 181-187.

Shen Pei, Zhang Dahe, Chen Xinwei, Zhang Shanyong, Yang Chi. Correlation between obstructive sleep-disordered breathing and temporomandibular joint condylar absorption in adolescents[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(2): 181-187.

图/表 7

图1 TMJ髁突吸收的MRI图像Note： A. MRI image of a patient without condylar resorption. B. MRI image of a patient with condylar resorption.

Fig 1 MRI images of condylar resorption of the TMJ

图2 TMJ髁突高度的MRI测量示意图Note： CH—condylar height.

Fig 2 Schematic diagram of MRI measurement of TMJ condylar height

表1 青少年OSDB组和无OSDB组基线资料比较

Tab 1 Comparison of baseline data between adolescent OSDB and non-OSDB groups

Characteristic	OSDB group (n=30)	non-OSDB group (n=409)	P value
Gender/n(%)			0.158
Male	9 (30.0)	79 (19.3)
Female	21 (70.0)	330 (80.7)
Age/year	17 (14, 19)	16 (14, 18)	0.397
Height/cm	162 (159, 169)	163 (159, 167)	0.867
Weight/kg	51.5 (45.0, 57.5)	50.1 (45.0, 56.2)	0.567
BMI/(kg·m^-2)	19.01 (17.64, 20.29)	19.00 (17.65, 20.31)	0.879

表2 青少年OSDB组和无OSDB组病史及不良习惯的比较

Tab 2 Comparison of medical history and adverse habits between the adolescent OSDB group and non-OSDB group

Characteristic	OSDB group (n=30)	non-OSDB group (n=409)	P value
Adenoid and tonsil diseases/n(%)	3 (10.0)	1 (0.2)	0.001
Mouth-breathing habits/n(%)	2 (6.7)	6 (1.5)	0.098
Adverse tongue habits/n(%)	4 (13.3)	16 (3.9)	0.040
Rhinitis/n(%)	2 (6.7)	15 (3.7)	0.326

表3 青少年OSDB组和无OSDB组TMJ测量指标比较

Tab 3 Comparison of TMJ measurement indices between the adolescent OSDB group and non-OSDB group

Characteristic	OSDB group (n=30)	non-OSDB group (n=409)	P value
Condylar resorption/n(%)	11 (36.7)	66 (16.1)	0.004
Condylar height/mm	18.19±1.80	21.20±2.69	<0.001

图3 OSDB组和无OSDB组上气道及下颌升支轮廓的头颅侧位片表现Note： A. Patients in the OSDB group exhibit a narrow upper airway and a shorter mandibular ramus. B. Patients in the non-OSDB group exhibit a wider upper airway and a higher mandibular ramus. Yellow: contour of the upper airway. Red: contour of the mandibular ramus and mandibular body.

Fig 3 Lateral cephalometric radiographic manifestations of the upper airway and mandibular ramus in OSDB and non-OSDB groups

表4 青少年OSDB患者的单因素和多因素Logistic回归分析

Tab 4 Univariate and multivariate Logistic regression analyses of adolescent OSDB patients

Variable	Univariate analysis			Multivariate analysis
Variable	OR	95%CI	P value	OR	95%CI	P value
Gender	0.604	0.236‒1.654	0.305
Age	1.076	0.905‒1.295	0.419
BMI	1.064	0.859‒1.270	0.532
Adenoid and tonsil diseases	56.502	2.097‒3 649.685	0.046	55.576	1.385‒5 521.400	0.112
Adverse tongue habits	3.292	0.560‒14.906	0.145	3.275	0.671‒12.517	0.102
Mouth-breathing habits	2.391	0.277‒15.467	0.378
Rhinitis	0.996	0.093‒5.799	0.997
Condylar resorption	4.871	1.842‒12.904	0.001	4.837	1.889‒12.336	<0.001
Decreased condylar height	0.559	0.436‒0.692	<0.001	0.547	0.426‒0.678	<0.001

参考文献 25

[1]	Kaditis A G, Alonso Alvarez M L, Boudewyns A, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management[J]. Eur Respir J, 2016, 47(1): 69-94.
[2]	Lo Bue A, Salvaggio A, Insalaco G. Obstructive sleep apnea in developmental age. A narrative review[J]. Eur J Pediatr, 2020, 179(3): 357-365.
[3]	Semelka M, Wilson J, Floyd R. Diagnosis and treatment of obstructive sleep apnea in adults[J]. Am Fam Physician, 2016, 94(5): 355-360.
[4]	中国儿童OSA诊断与治疗指南制订工作组, 中华医学会耳鼻咽喉头颈外科学分会小儿学组, 中华医学会儿科学分会呼吸学组, 等. 中国儿童阻塞性睡眠呼吸暂停诊断与治疗指南(2020)[J]. 中国循证医学杂志, 2020, 20(8): 883-900.
	Working Group of Chinese Guideline for the Diagnosis and Treatment of Childhood OSA, Subspecialty Group of Pediatrics, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association, Subspecialty Group of Respiratory Diseases, Society of Pediatrics, Chinese Medical Association, et al. Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020)[J]. Chinese Journal of Evidence-Based Medicine, 2020, 20(8): 883-900.
[5]	Lumeng J C, Chervin R D. Epidemiology of pediatric obstructive sleep apnea[J]. Proc Am Thorac Soc, 2008, 5(2): 242-252.
[6]	Xu Z, Wu Y, Tai J, et al. Risk factors of obstructive sleep apnea syndrome in children[J]. J Otolaryngol Head Neck Surg, 2020, 49(1): 11.
[7]	Bhatt S P, Guleria R, Kabra S K. Metabolic alterations and systemic inflammation in overweight/obese children with obstructive sleep apnea[J]. PLoS One, 2021, 16(6): e0252353.
[8]	Chan K C, Au C T, Hui L L, et al. How OSA evolves from childhood to young adulthood: natural history from a 10-year follow-up study[J]. Chest, 2019, 156(1): 120-130.
[9]	Monzon A D, Patton S R, Koren D. Childhood diabetes and sleep[J]. Pediatr Pulmonol, 2022, 57(8): 1835-1850.
[10]	Mercuri L G, Handelman C S. Idiopathic condylar resorption: what should we do?[J]. Oral Maxillofac Surg Clin North Am, 2020, 32(1): 105-116.
[11]	Wolford L M, Galiano A. Adolescent internal condylar resorption (AICR) of the temporomandibular joint, part 1: a review for diagnosis and treatment considerations[J]. Cranio, 2019, 37(1): 35-44.
[12]	吕政展, 朱柏恺, 郑美里, 等. 55例特发性髁突吸收患者临床特点与颅颌面结构特征分析[J]. 中国口腔颌面外科杂志, 2022, 20(6): 541-547.
	Lyu Z Z, Zhu B K, Chung M, et al. Clinical features and cranio-maxillofacial structure in 55 patients with idiopathic condyle resorption[J]. China Journal of Oral and Maxillofacial Surgery, 2022, 20(6): 541-547.
[13]	Niu X, Moland J, Pedersen T K, et al. Restricted upper airway dimensions in patients with dentofacial deformity from juvenile idiopathic arthritis[J]. Pediatr Rheumatol Online J, 2022, 20(1): 32.
[14]	Wolford L M, Gonçalves J R. Condylar resorption of the temporomandibular joint: how do we treat it?[J]. Oral Maxillofac Surg Clin North Am, 2015, 27(1): 47-67.
[15]	Borgström A, Nerfeldt P, Friberg D. Questionnaire OSA-18 has poor validity compared to polysomnography in pediatric obstructive sleep apnea[J]. Int J Pediatr Otorhinolaryngol, 2013, 77(11): 1864-1868.
[16]	Marcus C L, Brooks L J, Draper K A, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome[J]. Pediatrics, 2012, 130(3): 576-584.
[17]	Shen P, Xie Q, Ma Z, et al. Yang's classification of juvenile TMJ anterior disc displacement contributing to treatment protocols[J]. Sci Rep, 2019, 9(1): 5644.
[18]	Liu Z, Xie Q, Chen M, et al. Measurement of mandibular condylar height based on magnetic resonance imaging[J]. J Craniofac Surg, 2020, 31(4): e415-e418.
[19]	Neelapu B C, Kharbanda O P, Sardana H K, et al. Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: a systematic review and meta-analysis of cephalometric studies[J]. Sleep Med Rev, 2017, 31: 79-90.
[20]	Lv R, Liu X, Zhang Y, et al. Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome[J]. Signal Transduct Target Ther, 2023, 8(1): 218.
[21]	Mitsimponas K, Mehmet S, Kennedy R, et al. Idiopathic condylar resorption[J]. Br J Oral Maxillofac Surg, 2018, 56(4): 249-255.
[22]	Pereira L, Monyror J, Almeida F T, et al. Prevalence of adenoid hypertrophy: a systematic review and meta-analysis[J]. Sleep Med Rev, 2018, 38: 101-112.
[23]	Gulotta G, Iannella G, Vicini C, et al. Risk factors for obstructive sleep apnea syndrome in children: state of the art[J]. Int J Environ Res Public Health, 2019, 16(18): 3235.
[24]	Wang H, Qiao X, Qi S, et al. Effect of adenoid hypertrophy on the upper airway and craniomaxillofacial region[J]. Transl Pediatr, 2021, 10(10): 2563-2572.
[25]	Kumar S, Kelly A S. Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment[J]. Mayo Clin Proc, 2017, 92(2): 251-265.

青少年阻塞性睡眠呼吸障碍与颞下颌关节髁突吸收的相关性研究

Correlation between obstructive sleep-disordered breathing and temporomandibular joint condylar absorption in adolescents

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 7

参考文献 25

相关文章 15

编辑推荐

Metrics

[1]	李梓瑜, 朱泽宇, 钱家康, 陈昱璐, 陆家瑜. 碘乙酸钠诱导大鼠颞下颌关节骨关节炎模型的构建[J]. 上海交通大学学报（医学版）, 2026, 46(1): 82-89.
[2]	孙磊, 戴世锋, 陈裕华, 许新怡, 姜克乐, 李筱文, 李承靖, 吴婷婷. 颞下颌关节紊乱病患者关节盘与髁突距离的定量分析研究[J]. 上海交通大学学报（医学版）, 2025, 45(6): 684-692.
[3]	孙一丹, 杨鑫. 焦虑增强颞下颌关节疼痛的脑功能磁共振成像研究[J]. 上海交通大学学报（医学版）, 2025, 45(3): 342-348.
[4]	何山, 吕钦谕, 易正辉. 非自杀性自伤青少年执行功能障碍的研究进展[J]. 上海交通大学学报（医学版）, 2024, 44(4): 518-524.
[5]	韩瑞, 吴倩, 刘丹, 程棣, 张盈, 倪嘉成, 康飘, 陈安然, 于淑洁, 方启晨, 李华婷. 超重肥胖青少年认知功能的改变及其与血清FGF21水平的关系[J]. 上海交通大学学报（医学版）, 2024, 44(1): 87-97.
[6]	王晓玉, 彭银辉, 马文琳, 姚博爽, 李一凡, 赵莉, 杨春霞. 新冠疫情大流行期间儿童及青少年新发焦虑症状的纵向研究[J]. 上海交通大学学报（医学版）, 2023, 43(8): 963-970.
[7]	陈旭卓, 毛懿, 袁丹, 张善勇, 杨驰. 国产定制型全颞下颌关节假体的研发与应用[J]. 上海交通大学学报（医学版）, 2023, 43(5): 524-531.
[8]	俞蕾蕾, 阮洪, 夏滴, 何美娟, 孙明媛, 郑吉驷. 自我效能理论主导的居家康复方案在颞下颌关节盘复位术后的应用效果[J]. 上海交通大学学报（医学版）, 2023, 43(5): 532-539.
[9]	杨海霞, 徐丽丽, 王博成, 陈敏洁. 磁共振引导的咀嚼肌疼痛放松训练疗效评估[J]. 上海交通大学学报（医学版）, 2023, 43(5): 540-544.
[10]	王思婕, 斯佳萍, 周宇, 骆定雯, 高璐, 陈小燕. 不同矢状骨面型颞下颌关节形态的研究进展[J]. 上海交通大学学报（医学版）, 2023, 43(5): 648-654.
[11]	刘砚燕, 杨田田, 沈南平, 何梦雪, 张洪燕. 儿童青少年癌症患者多症状困扰潜在剖面分析及其对体力活动的影响[J]. 上海交通大学学报（医学版）, 2023, 43(11): 1408-1416.
[12]	张娟, 葛晓旭, 张荣, 蒋伏松, 蒋燕燕, 李鸣, 李甜甜, 刘婵薇, 陈亚婷, 刘丽梅. 青少年的成人起病型糖尿病家系NEUROD1基因突变的筛查与功能解析[J]. 上海交通大学学报（医学版）, 2023, 43(10): 1255-1261.
[13]	王斐, 龚艳, 许丽雅, 刘庆旭, 李妍, 郭盛, 李嫔. 短期GnRH脉冲治疗对先天性低促性腺激素性性腺功能减退症青少年期男性患者垂体⁃睾丸功能的作用[J]. 上海交通大学学报（医学版）, 2023, 43(1): 36-43.
[14]	何冬梅, 杨驰. 颞下颌关节强直的诊治方案：基于上海交通大学医学院附属第九人民医院颞下颌关节中心的经验[J]. 上海交通大学学报（医学版）, 2022, 42(6): 702-708.
[15]	张善勇, 杨驰. 颞下颌关节骨关节炎的诊治方案：基于上海交通大学医学院附属第九人民医院颞下颌关节中心的经验[J]. 上海交通大学学报（医学版）, 2022, 42(6): 709-716.