Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Laboratorio do Sono, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Laboratorio do Sono, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Respir Physiol Neurobiol. 2018 Dec;258:98-103. doi: 10.1016/j.resp.2018.06.008. Epub 2018 Jun 18.
We hypothesized that preferential retropalatal as compared to retroglossal collapse in patients with obstructive sleep apnea was due to a narrower retropalatal area and a higher retropalatal compliance. Patients with a greater retropalatal compliance would exhibit a recognizable increase in negative effort dependence (NED).
Fourteen patients underwent upper airway endoscopy with simultaneous recordings of airflow and pharyngeal pressure during natural sleep. Airway areas were obtained by manually outlining the lumen. Compliance was calculated by the change of airway area from end-expiration to a pressure swing of -5 cm HO. NED was quantified for each breath as [peak inspiratory flow minus flow at -5 cm HO]/[peak flow] × 100.
Compared to the retroglossal airway, the retropalatal airway was smaller at end-expiration (p < 0.001), and had greater absolute and relative compliances (p < 0.001). NED was positively associated with retropalatal relative area change (r = 0.47; p < 0.001).
Retropalatal airway is narrower and more collapsible than retroglossal airway. Retropalatal compliance is reflected in the clinically-available NED value.
我们假设与舌根后坠相比，阻塞性睡眠呼吸暂停患者的后咽塌陷更倾向于后咽塌陷，这是由于后咽区较窄和后咽顺应性较高。后咽顺应性较高的患者将表现出明显的负努力依赖（NED）增加。
14 名患者在自然睡眠期间接受了上气道内镜检查，并同时记录气流和咽压。气道面积通过手动勾勒管腔获得。顺应性通过气道面积从呼气末到-5cmHO 压力摆动的变化来计算。对于每一次呼吸，NED 都被量化为[吸气峰流量减去-5cmHO 时的流量]/[峰流量]×100。
与舌根后气道相比，后咽气道在呼气末更小（p<0.001），并且具有更大的绝对和相对顺应性（p<0.001）。NED 与后咽相对面积变化呈正相关（r=0.47；p<0.001）。
后咽气道比舌根后气道更窄，更易塌陷。后咽顺应性反映在临床可用的 NED 值中。
