Xiao Ying, Chen Xiong, Shi Heshui, Yang Yang, He Liechun, Dong Jiaqi, Kong Weijia
Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
J Huazhong Univ Sci Technolog Med Sci. 2011 Jun;31(3):413. doi: 10.1007/s11596-011-0392-5. Epub 2011 Jun 14.
This study examined the dynamic characteristics of upper airway collapse at soft palate level in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) by using dynamic 3-Dimensional (3-D) CT imaging. A total of 41 male patients who presented with 2 of the following symptoms, i.e., daytime sleepiness and fatigue, frequent snoring, and apnea with witness, were diagnosed as having OSAHS. They underwent full-night polysomnography and then dynamic 3-D CT imaging of the upper airway during quiet breathing and in Muller's maneuver. The soft palate length (SPL), the minimal cross-sectional area of the retropalatal region (mXSA-RP), and the vertical distance from the hard palate to the upper posterior part of the hyoid (hhL) were compared between the two breathing states. These parameters, together with hard palate length (HPL), were also compared between mild/moderate and severe OSAHS groups. Association of these parameters with the severity of OSAHS [as reflected by apnea hypopnea index (AHI) and the lowest saturation of blood oxygen (LSaO(2))] was examined. The results showed that 31 patients had severe OSAHS, and 10 mild/moderate OSAHS. All the patients had airway obstruction at soft palate level. mXSA-RP was significantly decreased and SPL remarkably increased during Muller's maneuver as compared with the quiet breathing state. There were no significant differences in these airway parameters (except the position of the hyoid bone) between severe and mild/moderate OSAHS groups. And no significant correlation between these airway parameters and the severity of OSAHS was found. The position of hyoid was lower in the severe OSAHS group than in the mild/moderate OSAHS group. The patients in group with body mass index (BMI)≥26 had higher collapse ratio of mXSA-RP, greater neck circumference and smaller mXSA-RP in the Muller's maneuver than those in group with BMI<26 (P<0.05 for all). It was concluded that dynamic 3-D CT imaging could dynamically show the upper airway changes at soft palate level in OSAHS patients. All the OSAHS patients had airway obstruction of various degrees at soft palate level. But no correlation was observed between the airway change at soft palate level and the severity of OSAHS. The patients in group with BMI≥26 were more likely to develop airway obstruction at soft palate level than those with BMI<26.
本研究通过动态三维（3-D）CT成像，探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者软腭水平上气道塌陷的动态特征。共有41例男性患者出现以下两种症状，即白天嗜睡和疲劳、频繁打鼾以及有目击者证实的呼吸暂停，被诊断为患有OSAHS。他们接受了整夜多导睡眠监测，然后在安静呼吸和Muller动作时对上气道进行动态3-D CT成像。比较了两种呼吸状态下的软腭长度（SPL）、腭后区最小横截面积（mXSA-RP）以及硬腭至舌骨上后部的垂直距离（hhL）。还比较了轻度/中度和重度OSAHS组之间的这些参数以及硬腭长度（HPL）。研究了这些参数与OSAHS严重程度[以呼吸暂停低通气指数（AHI）和最低血氧饱和度（LSaO₂）反映]的相关性。结果显示，31例患者患有重度OSAHS，10例患有轻度/中度OSAHS。所有患者在软腭水平均存在气道阻塞。与安静呼吸状态相比，Muller动作时mXSA-RP显著降低，SPL显著增加。重度和轻度/中度OSAHS组之间这些气道参数（舌骨位置除外）无显著差异。并且未发现这些气道参数与OSAHS严重程度之间存在显著相关性。重度OSAHS组舌骨位置低于轻度/中度OSAHS组。体重指数（BMI）≥26组患者在Muller动作时mXSA-RP的塌陷率更高、颈围更大且mXSA-RP更小，比BMI<26组患者更明显（所有P<0.05）。得出结论，动态3-D CT成像可动态显示OSAHS患者软腭水平的上气道变化。所有OSAHS患者在软腭水平均存在不同程度的气道阻塞。但未观察到软腭水平气道变化与OSAHS严重程度之间的相关性。BMI≥26组患者比BMI<26组患者更易在软腭水平发生气道阻塞。
