Oral and Maxillofacial Department, Oulu University Hospital, Oulu, Finland.
Sleep Breath. 2012 Sep;16(3):737-46. doi: 10.1007/s11325-011-0569-y. Epub 2011 Aug 9.
The aim of this study was to compare the pharyngeal airway size in different cranio-cervical postures in children with sleep-disordered breathing (SDB) and asymptomatic control children. We tested the hypothesis that the site of the most constricted pharyngeal airway in SDB children is not affected by head posture.
The study group comprised 29 children (14 boys, 15 girls, mean age 7.3 ± 1.37 years, range 4.8-9.8 years) with SDB. A control group of 29 age- and gender-matched healthy children was recruited. The pharyngeal airway of the children was imaged with a low-field 0.23-T open-configuration magnetic resonance imaging scanner in three different head postures: neutral, extension, and flexion. Inter-group differences in pharyngeal variables were analyzed using two-sided paired t test and intra-group differences using Bonferroni and Šidak correlations for multiple comparisons.
Nasopharyngeal airway was not affected by head posture. Head extension had no significant effect on the most constricted retropalatal airway in the SDB group, but it increased the hypopharyngeal airway (P = 0.000) significantly when compared to neutral head posture. The hypopharyngeal airway increased more in the SDB group than in the asymptomatic children (P = 0.031). The retropalatal oropharynx was on the whole significantly narrower in the SDB children compared with the controls in all head postures (neutral P = 0.000, extended P = 0.001, flexed P = 0.000).
Head posture is an important factor in maintaining airway patency. We suggest that the effectiveness of neuromuscular compensation may be compromised in constricted retropalatal airways. Instead, the hypopharyngeal airway is enlarged suggesting possible neuromuscular compensation for oropharyngeal narrowing in children with SDB.
本研究旨在比较患有睡眠呼吸障碍（SDB）和无症状对照儿童在不同颅颈姿势下的咽腔大小。我们检验了这样一个假设，即 SDB 儿童咽腔最狭窄部位的位置不受头部姿势的影响。
研究组包括 29 名儿童（14 名男孩，15 名女孩，平均年龄 7.3±1.37 岁，范围 4.8-9.8 岁），均患有 SDB。招募了 29 名年龄和性别匹配的健康儿童作为对照组。使用低场 0.23-T 开放式磁共振成像扫描仪，在 3 种不同头部姿势（中立位、伸展位和屈曲位）下对儿童的咽腔进行成像。使用双侧配对 t 检验分析组间咽腔变量的差异，使用 Bonferroni 和Šidak 相关性检验分析组内差异。
鼻咽气道不受头部姿势的影响。头部伸展对 SDB 组最狭窄的腭后气道没有显著影响，但与中立头位相比，显著增加了下咽气道（P=0.000）。与无症状儿童相比，SDB 组的下咽气道增加更多（P=0.031）。在所有头部姿势下（中立位 P=0.000，伸展位 P=0.001，屈曲位 P=0.000），SDB 儿童的腭后口咽腔明显比对照组狭窄。
头部姿势是维持气道通畅的一个重要因素。我们认为，在腭后狭窄的气道中，神经肌肉补偿的有效性可能受到影响。相反，下咽部气道扩大，这表明 SDB 儿童可能通过神经肌肉补偿口咽狭窄。
