Schwab Richard J, Kim Christopher, Bagchi Sheila, Keenan Brendan T, Comyn François-Louis, Wang Stephen, Tapia Ignacio E, Huang Shirley, Traylor Joel, Torigian Drew A, Bradford Ruth M, Marcus Carole L
1 Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Am J Respir Crit Care Med. 2015 Jun 1;191(11):1295-309. doi: 10.1164/rccm.201501-0169OC.
Structural risk factors for obstructive sleep apnea syndrome (OSAS) in adolescents have not been well characterized. Because many adolescents with OSAS are obese, we hypothesized that the anatomic OSAS risk factors would be more similar to those in adults than those in children.
To investigate the anatomic risk factors in adolescents with OSAS compared with obese and lean control subjects using magnetic resonance imaging (MRI).
Three groups of adolescents (age range: 12-16 yr) underwent MRI: obese individuals with OSAS (n = 49), obese control subjects (n = 38), and lean control subjects (n = 50).
We studied 137 subjects and found that (1) obese adolescents with OSAS had increased adenotonsillar tissue compared with obese and lean control subjects; (2) obese OSAS adolescents had a smaller nasopharyngeal airway than control subjects; (3) the size of other upper airway soft tissue structures (volume of the tongue, parapharyngeal fat pads, lateral walls, and soft palate) was similar between subjects with OSAS and obese control subjects; (4) although there were no major craniofacial abnormalities in most of the adolescents with OSAS, the ratio of soft tissue to craniofacial space surrounding the airway was increased; and (5) there were sex differences in the pattern of lymphoid proliferation.
Increased size of the pharyngeal lymphoid tissue, rather than enlargement of the upper airway soft tissue structures, is the primary anatomic risk factor for OSAS in obese adolescents. These results are important for clinical decision making and suggest that adenotonsillectomy should be considered as the initial treatment for OSAS in obese adolescents, a group that has poor continuous positive airway pressure adherence and difficulty in achieving weight loss.
青少年阻塞性睡眠呼吸暂停综合征（OSAS）的结构危险因素尚未得到充分描述。由于许多患有OSAS的青少年肥胖，我们推测OSAS的解剖学危险因素与成年人的更相似，而与儿童的不同。
使用磁共振成像（MRI）研究患有OSAS的青少年与肥胖和瘦对照受试者相比的解剖学危险因素。
三组青少年（年龄范围：12 - 16岁）接受了MRI检查：患有OSAS的肥胖个体（n = 49）、肥胖对照受试者（n = 38）和瘦对照受试者（n = 50）。
我们研究了137名受试者，发现：（1）与肥胖和瘦对照受试者相比，患有OSAS的肥胖青少年的腺样体扁桃体组织增加；（2）患有OSAS的肥胖青少年的鼻咽气道比对照受试者小；（3）OSAS受试者与肥胖对照受试者之间其他上气道软组织结构的大小（舌体积、咽旁脂肪垫、侧壁和软腭）相似；（4）尽管大多数患有OSAS的青少年没有重大颅面异常，但气道周围软组织与颅面空间的比例增加；（5）淋巴组织增生模式存在性别差异。
咽部淋巴组织增大而非上气道软组织结构增大是肥胖青少年OSAS的主要解剖学危险因素。这些结果对临床决策很重要，并表明腺样体扁桃体切除术应被视为肥胖青少年OSAS的初始治疗方法，这一群体持续气道正压通气依从性差且难以实现体重减轻。
