Sakakibara H, Tong M, Matsushita K, Hirata M, Konishi Y, Suetsugu S
Dept of Internal Medicine, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan.
Eur Respir J. 1999 Feb;13(2):403-10. doi: 10.1183/09031936.99.13240399.
The aim of this work was to comprehensively evaluate the cephalometric features in Japanese patients with obstructive sleep apnoea (OSA) and to elucidate the relationship between cephalometric variables and severity of apnoea. Forty-eight cephalometric variables were measured in 37 healthy males and 114 male OSA patients, who were classed into 54 non-obese (body mass index (BMI) <27 kg x m(-2), apnoea-hypopnoea index (AHI)=25.3+/-16.1 events x h(-1)) and 60 obese (BMI > or = 27 kg x m(-2), AHI=45.6+/-28.0 events h(-1)) groups. Diagnostic polysomnography was carried out in all of the OSA patients and in 19 of the normal controls. The non-obese OSA patients showed several cephalometric defects compared with their BMI-matched normal controls: 1) decreased facial A-P distance at cranial base, maxilla and mandible levels and decreased bony pharynx width; 2) enlarged tongue and inferior shift of the tongue volume; 3) enlarged soft palate; 4) inferiorly positioned hyoid bone; and 5) decreased upper airway width at four different levels. More extensive and severe soft tissue abnormalities with a few defects in craniofacial bony structures were found in the obese OSA group. For the non-obese OSA group, the stepwise regression model on AHI was significant with two bony structure variables as determinants: anterior cranial base length (S-N) and mandibular length (Me-Go). Although the regression model retained only linear distance between anterior vertebra and hyoid bone (H-VL) as an explainable determinant for AHI in the obese OSA group, H-VL was significantly correlated with soft tissue measurements such as overall tongue area (Ton), inferior tongue area (Ton2) and pharyngeal airway length (PNS-V). In conclusion, Japanese obstructive sleep apnoea patients have a series of cephalometric abnormalities similar to those described in Caucasian patients, and that the aetiology of obstructive sleep apnoea in obese patients may be different from that in non-obese patients. In obese patients, upper airway soft tissue enlargement may play a more important role in the development of obstructive sleep apnoea, whereas in non-obese patients, bony structure discrepancies may be the dominant contributing factors for obstructive sleep apnoea.
这项研究的目的是全面评估日本阻塞性睡眠呼吸暂停（OSA）患者的头影测量特征，并阐明头影测量变量与呼吸暂停严重程度之间的关系。对37名健康男性和114名男性OSA患者测量了48个头影测量变量，这些患者被分为54名非肥胖者（体重指数（BMI）<27 kg·m⁻²，呼吸暂停低通气指数（AHI）=25.3±16.1次·小时⁻¹）和60名肥胖者（BMI≥27 kg·m⁻²，AHI=45.6±28.0次·小时⁻¹）两组。对所有OSA患者和19名正常对照者进行了诊断性多导睡眠图检查。与BMI匹配的正常对照相比，非肥胖OSA患者表现出一些头影测量缺陷：1）颅底、上颌和下颌水平的面部前后距离减小，骨性咽宽度减小；2）舌体增大且舌体积向下移位；3）软腭增大；4）舌骨位置下移；5）四个不同水平的上气道宽度减小。肥胖OSA组发现更广泛、更严重的软组织异常，颅面骨结构有一些缺陷。对于非肥胖OSA组，以两个骨结构变量作为决定因素的AHI逐步回归模型具有显著性：前颅底长度（S-N）和下颌长度（Me-Go）。虽然回归模型在肥胖OSA组中仅保留了前椎体与舌骨之间的线性距离（H-VL）作为AHI的可解释决定因素，但H-VL与软组织测量值如总舌面积（Ton）、舌下部面积（Ton2）和咽气道长度（PNS-V）显著相关。总之，日本阻塞性睡眠呼吸暂停患者存在一系列与白种人患者相似的头影测量异常，并且肥胖患者阻塞性睡眠呼吸暂停的病因可能与非肥胖患者不同。在肥胖患者中，上气道软组织增大可能在阻塞性睡眠呼吸暂停的发生中起更重要的作用，而在非肥胖患者中，骨结构差异可能是阻塞性睡眠呼吸暂停的主要促成因素。
