Clavel Louis, Rémy-Neris Ségolène, Skalli Wafa, Rouch Philippe, Lespert Yoann, Similowski Thomas, Sandoz Baptiste, Attali Valérie
Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak (IBHGC), Paris, France.
Front Med (Lausanne). 2020 Feb 7;7:30. doi: 10.3389/fmed.2020.00030. eCollection 2020.
Obstructive sleep apnea syndrome (OSAS) is associated with postural dysfunction characterized by abnormal spinal curvature and disturbance of balance and walking, whose pathophysiology is poorly understood. We hypothesized that it may be the result of a pathological interaction between postural and ventilatory functions. Twelve patients with OSAS (4 women, age 53 years [51-63] (median [quartiles]), apnea hypopnea index 31/h [24-41]) were compared with 12 healthy matched controls. Low dose biplanar X-rays (EOS® system) were acquired and personalized three-dimensional models of the spine and pelvis were reconstructed. We also estimated posturo-respiratory coupling by measurement of respiratory emergence, obtaining synchronized center of pressure data from a stabilometric platform and ventilation data recorded by an optico-electronic system of movement analysis. Compared with controls, OSAS patients, had cervical hyperextension with anterior projection of the head (angle OD-C7 12° [8; 14] vs. 5° [4; 8]; = 0.002), and thoracic hyperkyphosis (angle T1-T12 65° [51; 71] vs. 49° [42; 59]; = 0.039). Along the mediolateral axis: (1) center of pressure displacement was greater in OSAS patients, whose balance was poorer (19.2 mm [14.2; 31.5] vs. 8.5 [1.4; 17.8]; = 0.008); (2) respiratory emergence was greater in OSAS patients, who showed increased postural disturbance of respiratory origin (19.2% [9.9; 24.0] vs. 8.1% [6.4; 10.4]; = 0.028). These results are evidence for the centrally-mediated and primarily respiratory origin of the postural dysfunction in OSAS. It is characterized by an hyperextension of the cervical spine with a compensatory hyperkyphosis, and an alteration in posturo-respiratory coupling, apparently secondary to upper airway instability.
阻塞性睡眠呼吸暂停综合征（OSAS）与姿势功能障碍有关，其特征为脊柱弯曲异常、平衡和行走障碍，其病理生理学尚不清楚。我们推测这可能是姿势功能和通气功能之间病理相互作用的结果。将12例OSAS患者（4名女性，年龄53岁[51 - 63]（中位数[四分位数]），呼吸暂停低通气指数31次/小时[24 - 41]）与12名匹配的健康对照者进行比较。采集低剂量双平面X线片（EOS®系统）并重建脊柱和骨盆的个性化三维模型。我们还通过测量呼吸起始来估计姿势 - 呼吸耦合，从稳定测力平台获得同步压力中心数据，并通过运动分析的光电系统记录通气数据。与对照组相比，OSAS患者颈椎过度伸展且头部向前突出（OD - C7角12°[8; 14] 对比5°[4; 8]; P = 0.002），胸椎后凸增加（T1 - T12角65°[51; 71] 对比49°[42; 59]; P = 0.039）。沿内外侧轴：（1）OSAS患者压力中心位移更大，其平衡更差（19.2 mm [14.2; 31.5] 对比8.5 [1.4; 17.8]; P = 0.008）；（2）OSAS患者呼吸起始更大，其呼吸源性姿势干扰增加（19.2% [9.9; 24.0] 对比8.1% [6.4; 10.4]; P = 0.028）。这些结果证明了OSAS中姿势功能障碍的中枢介导和主要呼吸源性。其特征为颈椎过度伸展伴代偿性胸椎后凸增加，以及姿势 - 呼吸耦合改变，显然继发于上气道不稳定。
