Fajdiga Igor
University Clinic for Otorhinolaryngology and Cervicofacial Surgery, Zaloska 2, 1000 Ljubljana, Slovenia.
Chest. 2005 Aug;128(2):896-901. doi: 10.1378/chest.128.2.896.
To identify upper airway changes in snoring using CT scanning, to clarify the snoring mechanism, and to identify the key structures involved.
Forty patients underwent CT examination of the head and neck region according to snoring habits; patients were classified into non-snoring (n = 14), moderately loud snoring (n = 13), and loud snoring (n = 13) groups.
Comparative analysis.
Using CT images, areas, the anteroposterior and transversal distances of the pharyngeal space at different levels, and the thickness and length of the soft palate and uvula and their angle against the hard palate were measured; evidence of impaired nasal passages was noted; the extent of pharyngeal inspiratory narrowing was the ratio between the area at the hard palate level and most narrow area; and expiratory narrowing was the ratio between the area behind the root of the tongue and the most narrow area.
Greater pharyngeal inspiratory narrowing (p = 0.0015) proportional to the loudness of snoring (p = 0.0016), and a longer soft palate with uvula (p = 0.0173) were significant for snoring. Impaired nasal breathing was significantly related (p = 0.029) only to the loud snoring group. The body mass index and age of snoring persons were also significantly higher.
Snoring is associated with typical changes that can be revealed by CT scanning. Greater pharyngeal narrowing is the most important factor. Given the "Venturi tube" shape of the pharynx, the Bernoulli pressure principle plays a major role in snoring. The key structure in snoring is the soft palate: it defines the constriction and is sucked into vibrating by negative pressure that develops at this site. Its repetitive closures present an obstruction to breathing, producing the snoring sound, and should therefore be the target for causal treatment of snoring. Obstacles in the upper airway that increase negative inspiratory pressure could not be confirmed as important for the development of snoring, although they may increase its loudness.
通过CT扫描确定打鼾时上呼吸道的变化，阐明打鼾机制，并确定相关的关键结构。
40例患者根据打鼾习惯接受了头颈部CT检查；患者被分为不打鼾组（n = 14）、中度大声打鼾组（n = 13）和大声打鼾组（n = 13）。
对比分析。
利用CT图像，测量不同层面咽腔的面积、前后径和横径，软腭和悬雍垂的厚度、长度及其与硬腭的夹角；记录鼻道受损情况；咽吸气性狭窄程度为硬腭水平面积与最窄面积之比；呼气性狭窄为舌根后面积与最窄面积之比。
咽吸气性狭窄程度增加（p = 0.0015）与打鼾响度成正比（p = 0.0016），软腭伴悬雍垂较长（p = 0.0173）对打鼾有显著意义。鼻呼吸受损仅与大声打鼾组显著相关（p = 0.029）。打鼾者的体重指数和年龄也显著更高。
打鼾与CT扫描可显示的典型变化有关。咽腔狭窄程度增加是最重要的因素。鉴于咽腔呈“文氏管”形状，伯努利压力原理在打鼾中起主要作用。打鼾的关键结构是软腭：它界定了狭窄部位，并被该部位产生的负压吸进振动。其反复关闭对呼吸造成阻碍，产生打鼾声，因此应作为打鼾病因治疗的靶点。上呼吸道中增加吸气负压的障碍物虽可能增加打鼾响度，但未被证实对打鼾的发生发展很重要。
