Lim Ju-Shin, Lee Jae Woo, Han Chun, Kwon Jang-Woo
Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Auris Nasus Larynx. 2018 Jun;45(3):499-503. doi: 10.1016/j.anl.2017.07.023. Epub 2017 Aug 12.
Our aim in this study was to analyze whether soft palate length and velum obstruction during sleep are correlated and to determine the effects of related parameters on obstructive sleep apnea syndrome (OSAS) severity. We used computed tomography to measure soft palate length and drug-induced sleep endoscopy (DISE) to evaluate velum obstruction severity. Patients also underwent polysomnography (PSG) for evaluation of OSAS severity.
A retrospective cohort of 67 patients with OSAS treated between May 1st, 2013 and July 31st, 2016 was analyzed. Each patient underwent DISE, PSG, and computed tomography. Using DISE, velum obstruction was categorized by the VOTE classification method. Using computed tomography, soft palate length was measured as the length of the posterior nasal spine to the uvula. Correlations of velum obstruction in DISE and PSG parameters (obstructive apnea, hypopnea, apnea hypopnea index (AHI), respiratory effort related arousal (RERA), respiratory disturbance index (RDI), baseline SaO, and minimum SaO) with soft palate length were also analyzed.
Among the 67 patients, the average PNS-U length was 39.90±4.19mm. Length was significantly different by age but not by other demographic characteristics such as sex, past history, or BMI. DISE revealed a statistically significant difference of velum obstruction degree; the cutoff value for PNS-U was 39.47mm. The PSG results, obstructive apnea, AHI, RDI, baseline SaO, and minimum SaO were correlated with PNS-U length, while other results such as hypopnea and RERA showed no correlation.
Analysis of soft palate length showed that increased PNS-U length was associated with higher rates of obstructive apnea, AHI, and RDI as assessed by PSG. In contrast, lower baseline SaO and minimum SaO values were seen by PSG; more severe velum obstruction was seen by DISE. We propose that when a soft palate is suspected in OSAS, computed tomography measurement of soft palate length is a valid method for estimating the degree of velum obstruction and the severity of OSAS.
本研究旨在分析软腭长度与睡眠期间软腭阻塞是否相关，并确定相关参数对阻塞性睡眠呼吸暂停综合征（OSAS）严重程度的影响。我们使用计算机断层扫描测量软腭长度，并使用药物诱导睡眠内镜检查（DISE）评估软腭阻塞严重程度。患者还接受了多导睡眠监测（PSG）以评估OSAS严重程度。
对2013年5月1日至2016年7月31日期间接受治疗的67例OSAS患者的回顾性队列进行分析。每位患者均接受了DISE、PSG和计算机断层扫描。使用DISE，根据VOTE分类方法对软腭阻塞进行分类。使用计算机断层扫描，将软腭长度测量为后鼻棘至悬雍垂的长度。还分析了DISE中的软腭阻塞与PSG参数（阻塞性呼吸暂停、呼吸浅慢、呼吸暂停低通气指数（AHI）、呼吸努力相关觉醒（RERA）、呼吸紊乱指数（RDI）、基线SaO和最低SaO）与软腭长度的相关性。
67例患者中，平均后鼻棘-悬雍垂长度为39.90±4.19mm。长度在年龄上有显著差异，但在性别、既往史或BMI等其他人口统计学特征上无显著差异。DISE显示软腭阻塞程度有统计学显著差异；后鼻棘-悬雍垂的临界值为39.47mm。PSG结果、阻塞性呼吸暂停、AHI、RDI、基线SaO和最低SaO与后鼻棘-悬雍垂长度相关，而呼吸浅慢和RERA等其他结果无相关性。
软腭长度分析表明，后鼻棘-悬雍垂长度增加与PSG评估的阻塞性呼吸暂停、AHI和RDI发生率较高相关。相比之下，PSG显示基线SaO和最低SaO值较低；DISE显示软腭阻塞更严重。我们提出，当怀疑OSAS患者存在软腭问题时，计算机断层扫描测量软腭长度是估计软腭阻塞程度和OSAS严重程度的有效方法。
