Zhou Peng, Shen Ping, Liu Wen, Li Peihua, Xu Xuegu, Li Hongquan, Hua Xia
Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China. Email:
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Jan;49(1):58-61.
To identify the patterns of airway collapse in patients with obstructive sleep apnea hypopnea syndrome(OSAHS) by dexmedetomidine induced sleep endoscopy.
Forty-five obstructive sleep apnea patients diagnosed by polysomnography were given dexmedetomidine intravenously. Once the patient was sedated in dorsal position, the electronic nasopharyngoscope was inserted transnasally and positioned on five levels of the upper airway sequentially (velum, oropharyngeal lateral wall, tongue base, epiglottis and larynx) to observe and document the collapse. Each level should be observed no less than three apneas. The degree of airway narrowing was calculated by using the ImageTool. No obstruction was defined when the degree of airway narrowing <50%, and complete obstruction when ≥ 75%.
In 45 patients with OSAHS, 1 case showed no obstruction on any level, 6 cases demonstrated obstructions on single level only, and 38 cases demonstrated complete obstructions on multilevel, including 17 cases with complete obstructions on two levels, 15 cases complete obstructions on three levels, and 6 cases complete obstructions on four levels. The patterns of collapse found in the trial were: (1) circumferential stricture by velum collapse was found in 43 patients, and 41 cases showed complete obstructions; (2) the side wall of oropharynx all collapsed in a lateral configuration, and 32 cases showed complete obstructions on this level; (3) anteroposterior swallowing tongue base was common, 11 cases showed partial obstructions on level of tongue base, and 10 cases complete; (4) epiglottic collapses occurred in lateral configuration folding as V shape; in anteroposterior configuration, epiglottis met posterior wall of the pharynx due to swallowing tongue base; the server soften epiglottis obstructed the entrance of the larynx, while the mild soften epiglottis and the collapsed side wall of pharynx came into being obstructions in concentric configuration; (5) the arytenoid area and aryepiglottic fold mucosa inwardly covered the glottis when the obstruction occurred in the larynx.
The patterns of hypopharynx obstructions in OSAHS patients are multifarious. Lateral oropharyngeal wall, epiglottic and tone base collapse play an important role in the obstructions. The laryngeal obstruction can also be observed.
通过右美托咪定诱导睡眠内镜检查确定阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者气道塌陷的模式。
对45例经多导睡眠图诊断的阻塞性睡眠呼吸暂停患者静脉注射右美托咪定。患者仰卧位镇静后，经鼻插入电子鼻咽镜，依次对上气道的五个水平（软腭、口咽侧壁、舌根、会厌和喉部）进行定位，观察并记录塌陷情况。每个水平应观察不少于三次呼吸暂停。使用ImageTool计算气道狭窄程度。气道狭窄程度<50%时定义为无阻塞，≥75%时定义为完全阻塞。
45例OSAHS患者中，1例在任何水平均无阻塞，6例仅在单一水平有阻塞，38例在多个水平有完全阻塞，其中17例在两个水平有完全阻塞，15例在三个水平有完全阻塞，6例在四个水平有完全阻塞。试验中发现的塌陷模式为：（1）43例患者存在软腭塌陷导致的环形狭窄，41例显示完全阻塞；（2）口咽侧壁均呈外侧塌陷，32例在此水平显示完全阻塞；（3）舌根前后位吞咽常见，11例在舌根水平有部分阻塞，10例完全阻塞；（4）会厌塌陷呈外侧V形折叠；前后位时，会厌因舌根吞咽而与咽后壁相遇；严重软化的会厌阻塞喉入口，而轻度软化的会厌和塌陷的咽侧壁形成同心构型阻塞；（5）喉部阻塞时，杓状软骨区域和声门襞黏膜向内覆盖声门。
OSAHS患者下咽阻塞模式多样。口咽外侧壁、会厌和舌根塌陷在阻塞中起重要作用。也可观察到喉部阻塞。
