Stuck Boris A, Maurer Joachim T
Department of Otorhinolaryngology, Head and Neck Surgery, Sleep Disorders Center, University Hospital Mannheim, 68135 Mannheim, Germany.
Sleep Med Rev. 2008 Dec;12(6):411-36. doi: 10.1016/j.smrv.2007.08.009. Epub 2007 Nov 28.
As the interest in sleep-disordered breathing has increased, various attempts have been made to assess upper airway anatomy in patients with this relatively frequent disorder. The aim is not only to reveal potential differences in upper airway anatomy to better understand origin and pathophysiology of the disease but also to improve patient management and treatment success. The present review is based on a systematic literature search with regard to upper airway evaluation in sleep-disordered breathing; the articles were selected and discussed in light of our clinical experiences. Based on clinical assessment including endoscopy during wakefulness, the value of the Mueller Maneuver, static radiologic imaging techniques (X-ray cephalometry, computed tomography (CT) scanning and magnetic resonance imaging (MRI)), dynamic scanning protocols (e.g. ultrafast CT or cine MRI), upper airway endoscopy during sleep and sedated sleep, pressure measurements and the assessment of the critical closing pressure are discussed. Each technique itself and its history in the field of sleep medicine are briefly reviewed and problems of standardization and interpretation are discussed when appropriate. Insights into the pathophysiology of the disease gained with the help of the investigational techniques are presented and the impact of the techniques on patient management is reported. Although all these additional techniques for upper airway assessment have substantially improved our understanding of sleep-disordered breathing, their significance in daily practice is limited. In contrast to the widespread use of the Mueller maneuver and sedated endoscopy, convincing data supporting their use in terms of treatment outcome are lacking. So far, there is only very limited evidence that selected techniques improve treatment outcome for selected indications. In general, there is not enough evidence that these techniques are superior to the routine clinical assessment.
随着对睡眠呼吸障碍的关注度不断提高，人们已进行了各种尝试来评估患有这种相对常见疾病的患者的上气道解剖结构。目的不仅是揭示上气道解剖结构的潜在差异，以便更好地理解该疾病的起源和病理生理学，还在于改善患者管理和治疗效果。本综述基于对睡眠呼吸障碍患者上气道评估的系统文献检索；根据我们的临床经验对文章进行了筛选和讨论。基于包括清醒时内镜检查在内的临床评估，讨论了米勒动作、静态放射成像技术（X线头颅测量、计算机断层扫描（CT）和磁共振成像（MRI））、动态扫描方案（如超快CT或电影MRI）、睡眠和镇静睡眠期间的上气道内镜检查、压力测量以及临界关闭压评估的价值。简要回顾了每种技术本身及其在睡眠医学领域的发展历程，并在适当的时候讨论了标准化和解读方面的问题。介绍了借助这些研究技术对该疾病病理生理学的认识，并报告了这些技术对患者管理的影响。尽管所有这些用于上气道评估的额外技术都极大地增进了我们对睡眠呼吸障碍的理解，但它们在日常实践中的意义有限。与米勒动作和镇静内镜检查的广泛应用形成对比的是，缺乏支持其在治疗结果方面应用的令人信服的数据。到目前为止，仅有非常有限的证据表明特定技术对特定适应症能改善治疗结果。总体而言，没有足够的证据表明这些技术优于常规临床评估。
