Zonato Adriane I, Bittencourt Lia Rita, Martinho Fernanda Louise, Júnior João Ferreira Santos, Gregório Luiz Carlos, Tufik Sergio
Sleep Center of the Department of Psychobiology, Universidade Federal de São Paulo, Brazil.
Laryngoscope. 2003 Jun;113(6):973-80. doi: 10.1097/00005537-200306000-00011.
OBJECTIVES/HYPOTHESIS: To identify upper airway and craniofacial abnormalities is the principal goal of clinical examination in patients with obstructive sleep apnea-hypopnea syndrome. The aim was to identify anatomical abnormalities that could be seen during a simple physical examination and determine their correlation with apnea-hypopnea index (AHI).
Consecutive patients with obstructive sleep apnea-hypopnea syndrome who were evaluated in a public otorhinolaryngology center were studied.
Adult patients evaluated previously with polysomnography met the inclusion criteria. All subjects underwent clinical history and otolaryngological examination and filled out a sleepiness scale. Physical examination included evaluation of pharyngeal soft tissue, facial skeletal development, and anterior rhinoscopy.
Two hundred twenty-three patients (142 men and 81 women) were included (mean age, 48 +/- 12 y; body mass index, 29 +/- 5 kg/m2; AHI, 23.8 +/- 24.8 events per hour). Patients were distributed into two groups according to the AHI: snorers (18.4%) and patients with sleep apnea (81.7%). Sleepiness and nasal obstruction were reported by approximately half of patients, but the most common complaint was snoring. There was a statistically significant correlation between AHI and body mass index (P <.000), modified Mallampati classification (P =.002), and ogivale-palate (P <.001). The retrognathia was not correlated to AHI, but the presence of this anatomical alteration was much more frequent in patients with severe apnea when compared with the snorers (P =.05). Other correlations with AHI were performed considering multiple factors divided into two groups of anatomical abnormalities: pharyngeal (three or more) and craniofacial (two or more) abnormalities. There was a statistically significant correlation between pharyngeal landmarks and AHI (correlation coefficient [r] = 0.147, P =.027), but not between craniofacial landmarks and AHI. The combination of pharyngeal anatomical abnormalities, modified Mallampati classification, and body mass index were also predictive of apnea severity.
Systematic physical examination that was used in the present study indicated that, in combination, body mass index, modified Mallampati classification, and pharyngeal anatomical abnormalities are related to both presence and severity of obstructive sleep apnea-hypopnea syndrome. Hypertrophied tonsils were observed in only a small portion of the patients. The frequency of symptoms of nasal obstruction was high in sleep apnea patients. Further studies are needed to find the best combination of anatomical and other clinical landmarks that are related to obstructive sleep apnea.
目的/假设：识别上气道和颅面异常是阻塞性睡眠呼吸暂停低通气综合征患者临床检查的主要目标。目的是识别在简单体格检查中可见的解剖学异常，并确定它们与呼吸暂停低通气指数（AHI）的相关性。
对在一家公立耳鼻喉科中心接受评估的阻塞性睡眠呼吸暂停低通气综合征连续患者进行研究。
先前经多导睡眠图评估的成年患者符合纳入标准。所有受试者均接受临床病史和耳鼻喉科检查，并填写嗜睡量表。体格检查包括咽部软组织评估、面部骨骼发育评估和前鼻镜检查。
纳入223例患者（142例男性和81例女性）（平均年龄，48±12岁；体重指数，29±5kg/m²；AHI，每小时23.8±24.8次事件）。根据AHI将患者分为两组：打鼾者（18.4%）和睡眠呼吸暂停患者（81.7%）。约一半患者报告有嗜睡和鼻塞，但最常见的主诉是打鼾。AHI与体重指数（P<.000）、改良马兰帕蒂分级（P=.002）和腭帆-腭（P<.001）之间存在统计学显著相关性。下颌后缩与AHI无相关性，但与打鼾者相比，这种解剖学改变在重度呼吸暂停患者中更为常见（P=.05）。考虑分为两组解剖学异常的多个因素与AHI进行了其他相关性分析：咽部（三个或更多）和颅面（两个或更多）异常。咽部标志与AHI之间存在统计学显著相关性（相关系数[r]=0.147，P=.027），但颅面标志与AHI之间无相关性。咽部解剖学异常、改良马兰帕蒂分级和体重指数的组合也可预测呼吸暂停严重程度。
本研究中使用的系统体格检查表明，体重指数、改良马兰帕蒂分级和咽部解剖学异常相结合与阻塞性睡眠呼吸暂停低通气综合征的存在和严重程度均相关。仅一小部分患者观察到扁桃体肥大。睡眠呼吸暂停患者中鼻塞症状的发生率较高。需要进一步研究以找到与阻塞性睡眠呼吸暂停相关的解剖学和其他临床标志的最佳组合。
