Lee Eun Jung, Cho Jae Hoon
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konkuk University, Seoul, Republic of Korea.
Laryngoscope. 2019 May;129(5):1235-1243. doi: 10.1002/lary.27320. Epub 2018 Oct 3.
To perform a meta-analysis on the distribution and characteristics of the obstructive site in patients with obstructive sleep apnea (OSA) using data from a variety of published studies that evaluated the obstruction with drug-induced sleep endoscopy (DISE).
A literature search was performed to identify studies in which DISE was used to identify the obstruction site in adult patients with OSA, and the obstruction site was described in sufficient detail. Four items were evaluated in the meta-analysis: the obstruction site, closing direction of the soft palate, degree of closure, and percentage of single-level obstructions.
A total of 2,950 patients from 19 studies were included. In the two-level classification system, the rate of obstruction was 91.6% for the soft palate and 58.0% for the tongue base. In the four-level classification system, the rate of obstruction was 84.1% for soft palate, 32.8% for the tonsil, 51.6% for the tongue base, and 34.3% for the epiglottis. The soft palate closed in the anteroposterior direction at a rate of 44.4% and in the concentric direction at a rate of 46.5%. The rate of a closure of 75% or more was 69.3% for the soft palate and 56.8% for the hypopharynx. The percentage of single-level obstructions was 42.5%.
The soft palate is obstructed in most patients with OSA, and the tongue base is obstructed in half of the patients. In addition, multilevel obstructions including the tonsil, lateral pharyngeal wall, or epiglottis are common; thus, these areas must be checked carefully.
NA Laryngoscope, 129:1235-1243, 2019.
利用多项已发表研究的数据，对采用药物诱导睡眠内镜检查（DISE）评估阻塞情况的阻塞性睡眠呼吸暂停（OSA）患者阻塞部位的分布及特征进行荟萃分析。
进行文献检索，以确定使用DISE识别成年OSA患者阻塞部位且对阻塞部位描述足够详细的研究。荟萃分析中评估了四个项目：阻塞部位、软腭闭合方向、闭合程度以及单水平阻塞的百分比。
纳入了来自19项研究的共2950例患者。在两级分类系统中，软腭阻塞率为91.6%，舌根阻塞率为58.0%。在四级分类系统中，软腭阻塞率为84.1%，扁桃体阻塞率为32.8%，舌根阻塞率为51.6%，会厌阻塞率为34.3%。软腭在前后方向闭合的比例为44.4%，在同心方向闭合的比例为46.5%。软腭闭合75%或以上的比例为69.3%，下咽为56.8%。单水平阻塞的百分比为42.5%。
大多数OSA患者存在软腭阻塞，半数患者存在舌根阻塞。此外，包括扁桃体、咽侧壁或会厌在内的多水平阻塞很常见；因此，必须仔细检查这些区域。
NA 《喉镜》，2019年，第129卷，第1235 - 1243页
