Schwab Richard J, Leinwand Sarah E, Bearn Cary B, Maislin Greg, Rao Ramya Bhat, Nagaraja Adithya, Wang Stephen, Keenan Brendan T
Division of Sleep Medicine, Philadelphia, PA; Center for Sleep & Circadian Neurobiology, Philadelphia, PA.
Center for Sleep & Circadian Neurobiology, Philadelphia, PA.
Chest. 2017 Aug;152(2):330-342. doi: 10.1016/j.chest.2017.05.005. Epub 2017 May 17.
OSA is associated with changes in pharyngeal anatomy. The goal of this study was to objectively and reproducibly quantify pharyngeal anatomy by using digital morphometrics based on a laser ruler and to assess differences between subjects with OSA and control subjects and associations with the apnea-hypopnea index (AHI). To the best of our knowledge, this study is the first to use digital morphometrics to quantify intraoral risk factors for OSA.
Digital photographs were obtained by using an intraoral laser ruler and digital camera in 318 control subjects (mean AHI, 4.2 events/hour) and 542 subjects with OSA (mean AHI, 39.2 events/hour).
The digital morphometric paradigm was validated and reproducible over time and camera distances. A larger modified Mallampati score and having a nonvisible airway were associated with a higher AHI, both unadjusted (P < .001) and controlling for age, sex, race, and BMI (P = .015 and P = .018, respectively). Measures of tongue size were larger in subjects with OSA vs control subjects in unadjusted models and controlling for age, sex, and race but nonsignificant controlling for BMI; similar results were observed with AHI severity. Multivariate regression suggests photography-based variables capture independent associations with OSA.
Measures of tongue size, airway visibility, and Mallampati scores were associated with increased OSA risk and severity. This study shows that digital morphometrics is an accurate, high-throughput, and noninvasive technique to identify anatomic OSA risk factors. Morphometrics may also provide a more reproducible and standardized measurement of the Mallampati score. Digital morphometrics represent an efficient and cost-effective method of examining intraoral crowding and tongue size when examining large populations, genetics, or screening for OSA.
阻塞性睡眠呼吸暂停（OSA）与咽部解剖结构的改变有关。本研究的目的是通过基于激光尺的数字形态测量法客观且可重复地量化咽部解剖结构，并评估OSA患者与对照受试者之间的差异以及与呼吸暂停低通气指数（AHI）的相关性。据我们所知，本研究是首次使用数字形态测量法来量化OSA的口腔内危险因素。
使用口腔内激光尺和数码相机对318名对照受试者（平均AHI为4.2次/小时）和542名OSA患者（平均AHI为39.2次/小时）拍摄数码照片。
数字形态测量范式经过了验证，并且在不同时间和相机距离下具有可重复性。改良Mallampati评分较高和气道不可见与较高的AHI相关，在未调整时（P <.001）以及在控制年龄、性别、种族和BMI后（分别为P =.015和P =.018）均如此。在未调整模型以及控制年龄、性别和种族时，OSA患者的舌体大小测量值大于对照受试者，但在控制BMI时无显著差异；AHI严重程度也观察到类似结果。多变量回归表明，基于摄影的变量与OSA存在独立关联。
舌体大小、气道可见性和Mallampati评分的测量与OSA风险和严重程度增加相关。本研究表明，数字形态测量法是一种准确、高通量且无创的技术，可用于识别OSA的解剖学危险因素。形态测量法还可能为Mallampati评分提供更可重复和标准化的测量。在研究大量人群、遗传学或进行OSA筛查时，数字形态测量法是一种检查口腔拥挤和舌体大小的有效且经济高效的方法。
