Segal Yosef, Malhotra Atul, Pillar Giora
Department of Otolaryngology Head and Neck Surgery, Haemek Medical Center and Technion--Israel Institute of Technology, Afula, Israel 18101.
Sleep Breath. 2008 Nov;12(4):311-6. doi: 10.1007/s11325-008-0191-9. Epub 2008 May 31.
The exact pathophysiology leading to pharyngeal collapse in obstructive sleep apnea syndrome (OSAS) remains incompletely understood. Prior research has shown that normal men have a longer pharyngeal airway than women, and it has been hypothesized that this difference may play a role in the gender-related differences in OSAS. In the current study, we sought to study the potential relationship between the length of the collapsible pharyngeal segment, the upper airway length (UAL), and the severity of OSAS.
The hospital records were searched for all patients who had had polysomnography and also had had a computed tomography of the neck. A total of 24 such patients were identified who participated (15 men and nine women).
The UAL, the distance between the lower posterior part of the hard palate bone to the upper posterior part of the hyoid bone, was measured for all participants in the midsagittal plane. A correlation coefficient (Pearson r) of 0.406 was found between Respiratory Disturbance Index (RDI) and UAL (p = 0.049). When UAL was normalized to body height, a correlation coefficient (r) of 0.423 was found (p = 0.039). A gender-related difference in UAL was also found. Men with OSAS were found to have longer UAL even when normalized to body height (p = 0.003, unpaired t test) as compared with OSAS women.
This study provides potential clinical relevance to prior studies in normal subjects, by demonstrating that men with OSAS have longer UAL than women with OSAS, independent of body size. In addition, the significant correlation between UAL and OSAS severity suggests that UAL may play a role in the pathophysiology of OSAS. These findings are consistent with our predictions from computational modeling studies.
导致阻塞性睡眠呼吸暂停综合征（OSAS）患者咽部塌陷的确切病理生理机制仍未完全明确。先前的研究表明，正常男性的咽部气道比女性长，据推测，这种差异可能在OSAS的性别差异中起作用。在本研究中，我们试图探究可塌陷咽部节段长度、上气道长度（UAL）与OSAS严重程度之间的潜在关系。
检索医院记录，查找所有接受过多导睡眠监测且进行过颈部计算机断层扫描的患者。共确定了24名参与研究的患者（15名男性和9名女性）。
在正中矢状面测量所有参与者的UAL，即硬腭骨后下部至舌骨后上部之间的距离。呼吸紊乱指数（RDI）与UAL之间的相关系数（Pearson r）为0.406（p = 0.049）。当UAL与身高进行标准化处理后，相关系数（r）为0.423（p = 0.039）。还发现了UAL存在性别差异。与OSAS女性相比，即使将OSAS男性的UAL与身高进行标准化处理后，其UAL仍更长（p = 0.003，非配对t检验）。
本研究通过证明OSAS男性的UAL比OSAS女性长，且与体型无关，为先前针对正常受试者的研究提供了潜在的临床意义。此外，UAL与OSAS严重程度之间的显著相关性表明，UAL可能在OSAS的病理生理过程中起作用。这些发现与我们从计算模型研究中得出的预测结果一致。
