Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan ; Yoyogi Sleep Disorder Center, Tokyo, Japan ; Department of Somnology, Tokyo Medical University, Tokyo, Japan.
Yoyogi Sleep Disorder Center, Tokyo, Japan.
J Clin Sleep Med. 2014 Feb 15;10(2):137-42. doi: 10.5664/jcsm.3438.
The aim of this study was to examine whether the upper airway anatomical balance, as reflected by tongue size relative to maxillomandibular size, is related to optimal nasal continuous positive airway pressure (PnCPAP).
Sixty-six male Japanese obstructive sleep apnea syndrome (OSAS) patients (median apnea-hypopnea index [AHI] = 33.9 episodes/h [10th/90th percentile = 19.5/59.9], median body mass index [BMI] = 25.1 kg/m(2) [10th/90th percentile = 21.2/30.4]) were recruited. All patients underwent standard polysomnography (PSG), and PnCPAP was determined by nasal continuous positive airway pressure (nCPAP) titration. The anatomical balance was defined as the tongue area (TG) divided by the lower face cage (LFC) measured on cephalometry. A predictive equation of PnCPAP was created using demographic, polysomnographic, and cephalometric variables.
Significant correlations were found between PnCPAP and descriptive variables, including BMI, AHI, lowest SpO2, distance from the anterosuperior point of the hyoid bone to the mandibular plane (MP-H), and TG/LFC. Stepwise multiple regression analysis revealed that AHI and TG/LFC were independent predictors of PnCPAP. The predictive equation was: PnCPAP = 1.000 + 0.043 × AHI + 9.699 × TG / LFC, which accounted for 28.0% of the total variance in PnCPAP (R(2) = 0.280, p < 0.01).
Anatomical balance of upper airway in addition to the severity of OSAS is an important contributing factor for PnCPAP in Japanese OSAS patients.
本研究旨在探讨上气道解剖平衡（以舌体相对于上下颌骨的大小来反映）与最佳持续气道正压通气（PnCPAP）之间的关系。
研究共纳入 66 名男性日本阻塞性睡眠呼吸暂停综合征（OSAS）患者（中位呼吸暂停低通气指数 [AHI] = 33.9 次/小时 [第 10 百分位/第 90 百分位 = 19.5/59.9]，中位体重指数 [BMI] = 25.1 kg/m2 [第 10 百分位/第 90 百分位 = 21.2/30.4]）。所有患者均接受标准多导睡眠图（PSG）检查，并通过鼻持续气道正压通气（nCPAP）滴定法确定 PnCPAP。解剖平衡定义为头影测量时舌体面积（TG）与下颌骨面下区（LFC）的比值。通过多变量逐步回归分析，建立了包含人口统计学、多导睡眠图和头影测量学变量的 PnCPAP 预测方程。
PnCPAP 与包括 BMI、AHI、最低 SpO2、舌骨前上点至下颌平面（MP-H）的距离和 TG/LFC 在内的描述性变量呈显著相关。多元逐步回归分析显示，AHI 和 TG/LFC 是 PnCPAP 的独立预测因子。预测方程为：PnCPAP = 1.000 + 0.043×AHI + 9.699×TG/LFC，可解释 PnCPAP 总方差的 28.0%（R2=0.280，p < 0.01）。
除了 OSAS 的严重程度外，上气道解剖平衡也是日本 OSAS 患者 PnCPAP 的重要影响因素。
