Virkkula Paula, Hurmerinta Kirsti, Löytönen Markku, Salmi Tapani, Malmberg Henrik, Maasilta Paula
Department of Otorhinolaryngology, University Central Hospital, University of Helsinki, Haartmaninkatu 4E, PO Box 220, FIN-00029 HUS, Finland.
Laryngoscope. 2003 Jul;113(7):1166-74. doi: 10.1097/00005537-200307000-00012.
The study was designed to compare upright and supine cephalometric measurements in snorers and to evaluate the effects of mandibular position and nasal resistance on pharyngeal dimensions. Anthropometric, rhinomanometric, and cephalometric measurements were used to investigate predictors of apnea-hypopnea index.
Prospective, cross-sectional.
Forty consecutive habitually snoring men waiting for nasal surgery (mean age, 44 y; mean body mass index, 28 kg/m2) underwent an overnight polysomnographic, anterior rhinomanometric, and cephalometric analysis in upright and supine positions.
Nasal resistance correlated positively with minimal pharyngeal airspace at the level of tongue. The opening of jaws after voluntary relaxation of the mandibular position on lying down correlated with decrease in pharyngeal airway measurements at both velopharyngeal and tongue-base levels. In stepwise multiple regression analysis the overall patient model explained 68% of the variation in apnea-hypopnea index with body mass index as the largest predictor. In the nonobese patients, the model explained 86% of variation in apnea-hypopnea index with change in anteroposterior position of the lower jaw in upright and supine measurements and combined nasal resistance after mucosal decongestion as independent determinants. In selected skeletal subtypes the models predicted 83%, 79%, 61%, and 90% of the variation in apnea-hypopnea index.
In the nonobese patients nasal resistance and change in mandibular position on lying down were found to be independent contributing factors to the apnea-hypopnea index. Further research on supine cephalometry and relaxed mandibular position may improve prediction of sleep-disordered breathing in snorers.
本研究旨在比较打鼾者直立位和仰卧位的头影测量结果，并评估下颌位置和鼻阻力对咽部尺寸的影响。采用人体测量、鼻阻力测量和头影测量来研究呼吸暂停低通气指数的预测因素。
前瞻性横断面研究。
40名连续的习惯性打鼾男性等待鼻部手术（平均年龄44岁；平均体重指数28kg/m²），在直立位和仰卧位接受了整夜多导睡眠图、前鼻阻力测量和头影测量分析。
鼻阻力与舌水平的最小咽部气道空间呈正相关。躺下时下颌位置自愿放松后下颌张开与腭咽和舌根水平的咽部气道测量值减小相关。在逐步多元回归分析中，总体患者模型以体重指数为最大预测因素解释了呼吸暂停低通气指数变异的68%。在非肥胖患者中，该模型以直立位和仰卧位测量时下颌前后位置的变化以及黏膜减充血后的联合鼻阻力作为独立决定因素，解释了呼吸暂停低通气指数变异的86%。在选定的骨骼亚型中，模型预测了呼吸暂停低通气指数变异的83%、79%、61%和90%。
在非肥胖患者中，鼻阻力和躺下时下颌位置的变化是呼吸暂停低通气指数的独立影响因素。对仰卧位头影测量和放松下颌位置的进一步研究可能会改善对打鼾者睡眠呼吸障碍的预测。
