Rubinstein I, Slutsky A S, Zamel N, Hoffstein V
Department of Medicine, St. Michael's Hospital, Ontario, Canada.
J Clin Invest. 1988 Apr;81(4):1051-5. doi: 10.1172/JCI113416.
Most patients with obstructive sleep apnea have increased pharyngeal collapsibility (defined in the present study as an increased lung volume dependence of pharyngeal area), which predisposes them to upper airway occlusion during sleep. However, there are patients with severe obstructive sleep apnea who have low-normal pharyngeal collapsibility. The factors leading to nocturnal upper airway obstruction in such patients have not been ascertained. We studied 10 overweight male patients with severe obstructive sleep apnea and low-normal pharyngeal collapsibility to determine the site of upper airway pathology in these patients. We found that all 10 patients exhibited paradoxical inspiratory narrowing of the glottis during quiet tidal breathing. This phenomenon was not observed in a matched group of 10 snoring, nonapneic male controls. We conclude that paradoxical glottic narrowing may be a contributing factor in the pathogenesis of upper airway obstruction in patients with severe obstructive sleep apnea who have low-normal pharyngeal collapsibility.
大多数阻塞性睡眠呼吸暂停患者的咽部可塌陷性增加（在本研究中定义为咽部面积对肺容积的依赖性增加），这使他们在睡眠期间易发生上气道阻塞。然而，有一些重度阻塞性睡眠呼吸暂停患者的咽部可塌陷性处于正常低限。导致这类患者夜间上气道阻塞的因素尚未明确。我们研究了10名超重的重度阻塞性睡眠呼吸暂停且咽部可塌陷性处于正常低限的男性患者，以确定这些患者上气道病变的部位。我们发现，所有10例患者在平静潮气呼吸时均表现出声门吸气相矛盾性狭窄。在10名打呼、无呼吸暂停的男性对照匹配组中未观察到这种现象。我们得出结论，声门矛盾性狭窄可能是咽部可塌陷性处于正常低限的重度阻塞性睡眠呼吸暂停患者上气道阻塞发病机制中的一个促成因素。
