Department of Otolaryngology - Head and Neck Surgery, Sleep Center, Linkou-Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan ROC; Department of Otorhinolaryngology - Head and Neck Surgery, East Avenue Medical Center, East Avenue, Diliman, Quezon City, Philippines.
Department of Otolaryngology - Head and Neck Surgery, Sleep Center, Linkou-Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan ROC; College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan ROC.
Auris Nasus Larynx. 2020 Oct;47(5):828-836. doi: 10.1016/j.anl.2020.02.012. Epub 2020 Apr 3.
The aims of this study are to examine the changes of tongue thickness and distance of two lingual arteries through drug-induced sleep ultrasound, and explore the relationship between sonographic measurements and clinical data.
A total of 26 confirmed obstructive sleep apnea patients were recruited in this one-year study. All patients received ultrasound examination twice (wakefulness and drug-induced sleep) in sleep center under level 1 polysomnographic monitor. Drug-induced sleep was performed by administration of one Stilnox (Zolpidem, 2 mg/tablet) and ultrasound procedure commenced once stage 2 sleep shown in polysomnography. Ultrasound imaging was implemented via submental approach with transducer position at the sagittal midline of the submental area (sagittal view) to measure thickness of the tongue. Transducer was then moved at a transverse midpoint between the inferior border of the mandible and the hyoid bone (transverse view) to measure the distance between 2 lingual arteries.
The distance between 2 lingual arteries elongated significantly (p < .001) and thickness of tongue muscle became thinner during drug-induced sleep. The distance between 2 lingual arteries (sleep) had positive correlation with apnea/hypopnea index (AHI, r = 0.51, p = .008) and body mass index (BMI, r = 0.46, p = .018).
Drug-induced sleep ultrasound is feasible to measure changes of tongue in OSA patients. Ultrasound imaging showed that tongue muscle became thinner in conjunction with significant widening in distance between two lingual arteries during hypnotic-induced sleep and that was positively correlated with AHI and BMI. Drug-induced sleep ultrasound may be helpful to enhance safety in tongue surgery for OSA patients.
本研究旨在通过药物诱导睡眠超声检查观察舌厚度和两条舌动脉间距的变化，并探讨超声测量值与临床资料的关系。
本为期一年的研究共纳入 26 例确诊阻塞性睡眠呼吸暂停患者。所有患者均在睡眠中心接受 1 次清醒状态和 1 次药物诱导睡眠状态下的超声检查（1 级多导睡眠图监测）。药物诱导睡眠时给予唑吡坦（思诺思，2 毫克/片）1 片，多导睡眠图显示进入 2 期睡眠后开始进行超声检查。超声检查采用颏下途径，探头置于颏下区正中矢状位（矢状位）测量舌厚度；然后探头移至下颌骨下缘和舌骨中点的横切位（横切位）测量两条舌动脉之间的距离。
药物诱导睡眠时两条舌动脉间距明显延长（p<0.001），舌肌厚度变薄。两条舌动脉间距（睡眠）与呼吸暂停/低通气指数（AHI，r=0.51，p=0.008）和体重指数（BMI，r=0.46，p=0.018）呈正相关。
药物诱导睡眠超声检查可用于测量 OSA 患者舌的变化。超声成像显示，在催眠诱导睡眠时，舌肌变薄，两条舌动脉间距显著增宽，与 AHI 和 BMI 呈正相关。药物诱导睡眠超声检查可能有助于提高 OSA 患者舌部手术的安全性。
