Ahn Sang Hyeon, Kim Jinna, Min Hyun Jin, Chung Hyo Jin, Hong Jae Min, Lee Jeung-Gweon, Kim Chang-Hoon, Cho Hyung-Ju
Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
PLoS One. 2015 Aug 17;10(8):e0135796. doi: 10.1371/journal.pone.0135796. eCollection 2015.
The aim of this study was to identify correlations between sleep apnea severity and tongue volume or posterior airway space measured via three-dimensional reconstruction of volumetric computerized tomography (CT) images in patients with obstructive sleep apnea (OSA) for use in predicting OSA severity and in surgical treatment. We also assessed associations between tongue volume and Mallampati score.
Snoring/OSA male patients (n = 64) who underwent polysomnography, cephalometry, and CT scans were enrolled in this retrospective study. OSA was diagnosed when the apnea-hypopnea index (AHI) was greater than 5 (mild 5-14; moderate 15-29; severe>30). The patients were also categorized into the normal-mild group (n = 22) and the moderate-severe group (n = 42). Using volumetric CT images with the three-dimensional reconstruction technique, the volume of the tongue, posterior airway space volume, and intra-mandibular space were measured. The volumes, polysomnographic parameters, and physical examination findings were compared, and independent factors that are related to OSA were analysed.
No associations between tongue volume or posterior airway space and the AHI were observed. However, multivariate linear analyses showed that tongue volume had significantly negative association with lowest O2 saturation (r = 0.365, p = 0.027). High BMI was related to an increase in tongue volume. Modified Mallampati scores showed borderline significant positive correlations with absolute tongue volume (r = 0.251, p = 0.046) and standardized tongue volume (absolute tongue volume / intramandibular area; r = 0.266, p = 0.034). Between the normal-mild and moderate-severe groups, absolute tongue volumes were not different, although the standardized tongue volume in the moderate-severe group was significantly higher.
Absolute tongue volume showed stronger associations with lowest O2 saturation during sleep than with the severity of AHI. We also found that high BMI was a relevant factor for an increase in absolute tongue volume and modified Mallampati grading was a useful physical examination to predict tongue size.
本研究旨在确定阻塞性睡眠呼吸暂停（OSA）患者睡眠呼吸暂停严重程度与通过容积计算机断层扫描（CT）图像三维重建测量的舌体积或后气道空间之间的相关性，以用于预测OSA严重程度和手术治疗。我们还评估了舌体积与Mallampati评分之间的关联。
本回顾性研究纳入了64例接受多导睡眠图、头影测量和CT扫描的打鼾/OSA男性患者。当呼吸暂停低通气指数（AHI）大于5时诊断为OSA（轻度5 - 14；中度15 - 29；重度>30）。患者还被分为正常 - 轻度组（n = 22）和中度 - 重度组（n = 42）。使用三维重建技术的容积CT图像测量舌体积、后气道空间体积和下颌内空间。比较体积、多导睡眠图参数和体格检查结果，并分析与OSA相关的独立因素。
未观察到舌体积或后气道空间与AHI之间的关联。然而，多变量线性分析显示舌体积与最低氧饱和度呈显著负相关（r = 0.365，p = 0.027）。高体重指数与舌体积增加有关。改良Mallampati评分与绝对舌体积（r = 0.251，p = 0.046）和标准化舌体积（绝对舌体积/下颌内面积；r = 0.266，p = 0.034）呈临界显著正相关。在正常 - 轻度组和中度 - 重度组之间，绝对舌体积没有差异，尽管中度 - 重度组的标准化舌体积显著更高。
绝对舌体积与睡眠期间最低氧饱和度的关联比与AHI严重程度的关联更强。我们还发现高体重指数是绝对舌体积增加的相关因素，改良Mallampati分级是预测舌大小的有用体格检查方法。
