Kuzucu Ihsan, Parlak Izzet Selcuk, Baklaci Deniz, Guler Ismail, Kum Rauf Oguzhan, Ozcan Muge
Department of Otolaryngology, Numune Training and Research Hospital, 931st Avenue 945 Street No: 5/3, Ilker, Ankara, Turkey.
Department of Radiology, Numune Training and Research Hospital, Ankara, Turkey.
Surg Radiol Anat. 2020 May;42(5):489-496. doi: 10.1007/s00276-019-02314-8. Epub 2019 Aug 30.
Many anatomical factors are known to cause obstructive sleep apnea syndrome (OSAS), but only few studies have examined the relationship between the morphology of pterygoid hamulus (PH), upper airway, and OSAS severity. This study aimed to investigate the relationship between the severity of OSAS and PH morphology and other anatomical variations of the upper airway.
The data of the patients who underwent polysomnography and diagnosed with OSAS were retrospectively reviewed, and those who underwent paranasal sinus computed tomography were determined. The patients were divided into three groups according to the apnea-hypopnea index (AHI) scores obtained from the polysomnography (mild, moderate, and severe). The relationship between PH thickness, length and interpterygoid distance, and the severity of AHI was investigated.
Seventy-four patients were included in the study. In patients with severe OSAS (1.83 ± 0.29 mm), the PH bone thickness was significantly thicker compared to those with mild OSAS (1.59 ± 0.36 mm) (p = 0.03). When the interpterygoid distance and its ratio to the velopharyngeal length were examined, it was found significantly shorter in patients with severe OSAS than mild cases (p < 0.001; p = 0.045, respectively).
Our results showed that OSAS severity was associated with hamulus thickness, interpterygoid distance, and the ratio of interpterygoid distance to VL. Our study provides further insight into the pathophysiology of sleep apnea, suggesting that morphometric evaluation of the pterygoid hamulus and upper airway measurements can assist clinicians in stratifying and determining the best treatment options for patients with OSAS.
已知许多解剖学因素会导致阻塞性睡眠呼吸暂停综合征（OSAS），但仅有少数研究探讨了翼钩（PH）形态、上气道与OSAS严重程度之间的关系。本研究旨在调查OSAS严重程度与PH形态及上气道其他解剖学变异之间的关系。
回顾性分析接受多导睡眠监测并诊断为OSAS的患者数据，并确定那些接受了鼻窦计算机断层扫描的患者。根据多导睡眠监测获得的呼吸暂停低通气指数（AHI）评分将患者分为三组（轻度、中度和重度）。研究了PH厚度、长度和翼内肌间距与AHI严重程度之间的关系。
本研究共纳入74例患者。重度OSAS患者的PH骨厚度（1.83±0.29mm）明显厚于轻度OSAS患者（1.59±0.36mm）（p=0.03）。在检查翼内肌间距及其与腭咽长度的比值时，发现重度OSAS患者明显短于轻度患者（分别为p<0.001；p=0.045）。
我们的结果表明，OSAS严重程度与翼钩厚度、翼内肌间距以及翼内肌间距与腭咽长度的比值有关。我们的研究为睡眠呼吸暂停的病理生理学提供了进一步的见解，表明翼钩的形态测量评估和上气道测量可以帮助临床医生对OSAS患者进行分层并确定最佳治疗方案。
