Brown I B, McClean P A, Boucher R, Zamel N, Hoffstein V
Am Rev Respir Dis. 1987 Sep;136(3):628-32. doi: 10.1164/ajrccm/136.3.628.
In an attempt to elucidate whether changes in posture (from sitting to supine) result in reduction in pharyngeal area, thus promoting pharyngeal occlusion during sleep in so predisposed persons, we studied 12 snoring apneic patients and 6 snoring nonapneic control subjects. in all subjects, we employed acoustic reflection technique to measure pharyngeal area at FRC sitting and supine. We also examined changes in pharyngeal area resulting from the application of positive intrapharyngeal pressure in sitting and supine posture. We found that (1) pharyngeal cross-sectional area at FRC was similar in both groups, (2) decrease in pharyngeal area with assumption of supine posture was also similar in both groups (21 +/- 11% in patients with OSA versus 15 +/- 13% in nonapneic control subjects), and (3) pharyngeal distensibility was significantly higher in apneic snorers than in nonapneic control subjects (0.090 +/- 0.039 cm H2O-1 in apneic snorers versus 0.032 +/- 0.027 cm H2O-1 in nonapneic control subjects; p less than 0.005). We conclude that changes in posture alone are not sufficient to convert a snorer into a patient with OSA; however, when physiologic abnormalities ("floppy" pharynx) are superimposed on postural reduction in pharyngeal area, airway occlusion results.
为了阐明姿势改变（从坐姿到仰卧位）是否会导致咽部面积减小，从而促使易患人群在睡眠期间出现咽部阻塞，我们研究了12名打鼾伴呼吸暂停患者和6名打鼾但无呼吸暂停的对照受试者。在所有受试者中，我们采用声反射技术测量了静息坐位和仰卧位时的咽部面积。我们还检查了在坐位和仰卧位姿势下施加咽内正压所导致的咽部面积变化。我们发现：（1）两组在功能残气量时的咽部横截面积相似；（2）两组在仰卧位时咽部面积的减小也相似（阻塞性睡眠呼吸暂停患者为21±11%，无呼吸暂停的对照受试者为15±13%）；（3）呼吸暂停打鼾者的咽部扩张性显著高于无呼吸暂停的对照受试者（呼吸暂停打鼾者为0.090±0.039 cm H₂O⁻¹，无呼吸暂停的对照受试者为0.032±0.027 cm H₂O⁻¹；p<0.005）。我们得出结论，单纯的姿势改变不足以使打鼾者转变为阻塞性睡眠呼吸暂停患者；然而，当生理异常（“松弛”的咽部）叠加在姿势性咽部面积减小上时，就会导致气道阻塞。
