Busetto Luca, Enzi Giuliano, Inelmen Emine Meral, Costa Gabriella, Negrin Valentina, Sergi Giuseppe, Vianello Andrea
Obesity Unit, University of Padova, Padova, Italy.
Chest. 2005 Aug;128(2):618-23. doi: 10.1378/chest.128.2.618.
In obese patients, obstructive sleep apnea syndrome (OSAS) is attributed to a reduction in pharyngeal cross-sectional area due to peripharyngeal fat deposition. The effect of weight loss on the size of the upper airways of obese subjects is still unknown. We analyzed the pharyngeal cross-sectional area before and after weight loss in morbidly obese patients with OSAS.
DESIGN, SETTING, AND SUBJECTS: A group of 17 middle-aged, morbidly obese men was evaluated by anthropometry and cardiorespiratory sleep studies before and after weight loss obtained by insertion of an intragastric balloon. The pharyngeal cross-sectional area was measured by acoustic pharyngometry.
The mean (+/- SD) body mass index was 55.8 +/- 9.9 kg/m2 at baseline and 48.6 +/- 11.2 kg/m2 at the time of balloon removal (6 months after insertion) [p < 0.001]. At baseline, patients had visceral obesity, large necks, and severe OSAS. Weight loss was associated with a significant mean reduction of waist circumference (156.4 +/- 17.6 vs 136.7 +/- 18.4 cm, respectively; p < 0.001), sagittal abdominal diameter (37.8 +/- 3.0 vs 32.3 +/- 4.0 cm, respectively; p < 0.001), and neck circumference (51.1 +/- 3.7 vs 47.9 +/- 4.3 cm, respectively; p < 0.001). Moreover, weight loss induced a nearly complete resolution of OSAS (apnea-hypopnea index, 52.1 +/- 14.9 vs 14.0 +/- 12.4 events/h, respectively; p < 0.001). At baseline, obese patients had significantly lower pharyngeal cross-sectional areas compared to a group of 20 nonobese male control subjects, both in the upright and supine position, at different levels of the pharynx. In obese patients, the weight loss induced by the positioning of the intragastric balloon was associated with an increase in the size of the upper airway passage. After weight loss, both the mean pharyngeal cross-sectional area and the area at glottis level were still lower in obese subjects than in nonobese subjects; however, the pharyngeal cross-sectional area at the oropharyngeal junction was similar in the two groups.
Morbidly obese men with OSAS have a reduced pharyngeal cross-sectional area. A weight reduction of about 15% of baseline body weight may substantially increase the pharyngeal cross-sectional area and substantially improve the severity of OSAS in morbidly obese subjects with sleep apnea.
在肥胖患者中，阻塞性睡眠呼吸暂停综合征（OSAS）归因于咽周脂肪沉积导致的咽部横截面积减小。体重减轻对肥胖受试者上气道大小的影响仍不清楚。我们分析了患有OSAS的病态肥胖患者体重减轻前后的咽部横截面积。
设计、地点和受试者：一组17名中年病态肥胖男性，在通过置入胃内球囊实现体重减轻前后，接受了人体测量和心肺睡眠研究评估。咽部横截面积通过声学咽测量法测量。
基线时平均（±标准差）体重指数为55.8±9.9kg/m²，球囊取出时（置入后6个月）为48.6±11.2kg/m²[p<0.001]。基线时，患者存在内脏肥胖、颈部粗大和严重的OSAS。体重减轻与腰围显著平均减小相关（分别为156.4±17.6cm和136.7±18.4cm；p<0.001），腹矢状径（分别为37.8±3.0cm和32.3±4.0cm；p<0.001），以及颈围（分别为51.1±3.7cm和47.9±4.3cm；p<0.001）。此外，体重减轻使OSAS几乎完全缓解（呼吸暂停低通气指数分别为52.1±14.9次/h和14.0±12.4次/h；p<0.001）。基线时，肥胖患者在直立位和仰卧位时，在咽部不同水平的横截面积均显著低于20名非肥胖男性对照受试者。在肥胖患者中，胃内球囊置入导致的体重减轻与上气道通道大小增加相关。体重减轻后，肥胖受试者的平均咽部横截面积和声门水平面积仍低于非肥胖受试者；然而，两组在口咽交界处的咽部横截面积相似。
患有OSAS的病态肥胖男性咽部横截面积减小。体重减轻约15%的基线体重可能会显著增加咽部横截面积，并显著改善患有睡眠呼吸暂停的病态肥胖受试者的OSAS严重程度。
