Department of Ear, Nose, and Throat-Head and Neck Surgery, University Hospital of Nancy, Hospitals of Brabois, Vandoeuvre-lès-Nancy, France.
Faculty of Medicine, University of Lorraine, Lorraine, France.
Laryngoscope. 2019 Dec;129(12):2782-2788. doi: 10.1002/lary.27851. Epub 2019 Feb 5.
OBJECTIVES/HYPOTHESIS: To assess the relationships between laryngeal and hypopharyngeal morphology and obstructive sleep apnea-hypopnea syndrome (OSAHS) in awake patients.
Prospective study.
Awake flexible fiberoptic laryngoscopy and sleep studies were performed in 80 patients for snoring or OSAHS suspicion. Endoscopic videos were reviewed by two examiners to assess morphological characteristics of hypopharynx and larynx using a standardized examination of appearance, shape and position of epiglottis, shape of retropharyngeal-epiglottic aerospace (RPEA), modified Cormack-Lehane score, and length ratios of the hypopharynx and epiglottis. The multivariate logistic regression model was used to assess independent predictors of moderate/severe OSAHS.
The interrater agreements were moderate for epiglottis appearance (κ = 0.52), epiglottis form (κ = 0.66), and epiglottis position (κ = 0.49), but fair for the shape of RPEA (κ = 0.26) and modified Cormack-Lehane scoring (κ = 0.38). The presence of a mega-epiglottis was significantly correlated with the severity of OSAHS (P < .05). By multivariate logistic regression analysis, independent predictors of moderate/severe obstructive sleep apnea were mega-epiglottis (adjusted odds ratio [aOR]: = 4.78, 95% confidence interval [CI]: 1.23-18.56, P = .024), modified Cormack-Lehane score of 2 (aOR: 15.3, 95% CI: 1.8-130.3, P = .012), or modified Cormack-Lehane score of 3 (aOR: 10.03, 95% CI: 1.3-78.2, P = .03) and aging (aOR = 1.07, 95% CI: 1.01-1.14, P = .025).
Routine flexible fiberoptic laryngoscopy performed by otorhinolaryngologists in awake patients may help to detect some predictors of OSAHS such as presence of mega-epiglottis, and modified Cormack-Lehane score of 2 or more. Investigation of sleep disorders should be proposed in these patients.
2 Laryngoscope, 129:2782-2788, 2019.
目的/假设：评估清醒患者的喉和下咽形态与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）之间的关系。
前瞻性研究。
对 80 例因打鼾或 OSAHS 可疑而进行清醒纤维喉镜和睡眠研究的患者进行了研究。通过两位检查者对内镜录像进行了回顾，使用外观、会厌形状和位置、咽后-会厌航空航天形状（RPEA）、改良 Cormack-Lehane 评分以及下咽和会厌长度比的标准化检查，评估下咽和喉的形态特征。使用多元逻辑回归模型评估中重度 OSAHS 的独立预测因子。
会厌外观（κ=0.52）、会厌形态（κ=0.66）和会厌位置（κ=0.49）的观察者间一致性为中度，但 RPEA 形状（κ=0.26）和改良 Cormack-Lehane 评分（κ=0.38）的观察者间一致性为差。大会厌的存在与 OSAHS 的严重程度显著相关（P<.05）。通过多元逻辑回归分析，中重度阻塞性睡眠呼吸暂停的独立预测因子为大会厌（调整后的优势比[aOR]：=4.78，95%置信区间[CI]：1.23-18.56，P=0.024）、改良 Cormack-Lehane 评分 2（aOR：15.3，95%CI：1.8-130.3，P=0.012）或改良 Cormack-Lehane 评分 3（aOR：10.03，95%CI：1.3-78.2，P=0.03）和年龄（aOR=1.07，95%CI：1.01-1.14，P=0.025）。
耳鼻喉科医生在清醒患者中进行常规纤维喉镜检查，可能有助于检测到一些 OSAHS 的预测因子，例如大会厌的存在，以及改良 Cormack-Lehane 评分≥2。应向这些患者提出睡眠障碍的调查。
2 级喉镜，129：2782-2788，2019。
