Abramson Zachary, Susarla Srinivas, August Meredith, Troulis Maria, Kaban Leonard
Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA.
J Oral Maxillofac Surg. 2010 Feb;68(2):354-62. doi: 10.1016/j.joms.2009.09.087. Epub 2010 Jan 15.
To identify abnormalities in airway size and shape that correlate with the presence and severity of obstructive sleep apnea (OSA).
This was a retrospective case series of patients undergoing treatment of OSA who had preoperative computed tomographic (CT) scans of the upper airway available. Patients who had undergone CT scanning for nonairway pathologic features during the same period served as the controls. Digital 3D-CT reconstructions were made and 12 parameters of airway size and 4 of shape were analyzed. The posterior airway space, middle airway space, and hyoid to mandibular plane distance were measured on the lateral cephalograms of the patients with OSA. Bivariate analysis was used to identify the factors associated with the presence and severity of OSA as measured by the respiratory disturbance index (RDI). Multiple regression analysis identified the factors that correlated with the RDI.
Of the 44 patients with OSA, 15 (10 men and 5 women) had pre- and postoperative CT scans available. In addition, 17 patients (11 men and 6 women) were used as controls. The airway length was significantly increased in the patients with OSA (P < .01). On bivariate analysis, the length, lateral/retroglossal anteroposterior dimension ratio and genial tubercle to hyoid bone distance were associated with the RDI (P < .03). On multiple regression analysis, length (P < .01) had a positive correlation and the lateral/retroglossal anteroposterior dimension ratio (P = .04) an inverse correlation with the RDI.
The results of this study indicate that the presence of OSA is associated with an increase in airway length. Airways that were more elliptical in shape and mediolaterally oriented (greater lateral/retroglossal anteroposterior dimension ratio) had a decreased tendency toward obstruction.
确定与阻塞性睡眠呼吸暂停（OSA）的存在及严重程度相关的气道大小和形状异常。
这是一项回顾性病例系列研究，纳入接受OSA治疗且术前有上气道计算机断层扫描（CT）图像的患者。同期因非气道病理特征进行CT扫描的患者作为对照。进行了数字3D-CT重建，并分析了12个气道大小参数和4个形状参数。在OSA患者的头颅侧位片上测量后气道间隙、中气道间隙以及舌骨至下颌平面的距离。采用双变量分析确定与呼吸紊乱指数（RDI）所衡量的OSA存在及严重程度相关的因素。多元回归分析确定与RDI相关的因素。
44例OSA患者中，15例（10例男性和5例女性）有术前和术后CT扫描图像。此外，17例患者（11例男性和6例女性）作为对照。OSA患者的气道长度显著增加（P < .01）。双变量分析显示，气道长度、外侧/舌后前后径比值以及颏结节至舌骨距离与RDI相关（P < .03）。多元回归分析表明，气道长度（P < .01）与RDI呈正相关，外侧/舌后前后径比值（P = .04）与RDI呈负相关。
本研究结果表明，OSA的存在与气道长度增加有关。形状更呈椭圆形且在内外侧方向上更开阔（外侧/舌后前后径比值更大）的气道阻塞倾向降低。
