Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Lu, Xicheng District, Beijing, 100050, China.
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tsinghua Chang Gung Hospital, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
Eur Arch Otorhinolaryngol. 2022 Jan;279(1):425-432. doi: 10.1007/s00405-021-06795-5. Epub 2021 May 30.
This study aims to evaluate the combination of myoelectric characteristics of tensor palatini muscle (TP) and collapsibility of upper airway in obstructive sleep apnea (OSA) patients with different external phenotypes of collapse pattern at velum level under drug-induced sleep endoscopy (DISE).
Case series with planned data collection.
Operation room.
36 mainly collapse pattern at velum level OSA subjects underwent DISE with synchronous tensor palatini electromyograms (TP EMG), and polysomnography (ALICE 6). According to the phenotype of collapse pattern at velum level in DISE, the subjects were divided into group 1 (concentric collapse), group 2 (anteroposterior collapse), and group 3 (lateral collapse). Each group consisted of 13, 14, and 9 subjects, respectively, and was observed the electromyographic indexes at awake, sleep onset, during apnea and the third respiratory cycle after apnea. The active and passive upper airway critical closing pressure (Pcrit) of each group were measured at the same time, and the difference of neuromuscular response between different groups was evaluated.
In tonic TPEMG, group 1 showed the highest value during awake and sleep onset, while group 2 was the highest during apnea and after apnea. In peak TPEMG, group 1 showed the highest value during awake. Group 2 showed the highest value during other states. In passive Pcrit and D value (difference between passive Pcrit and active Pcrit), group 2 was the highest, while group 1 was the highest in active Pcrit. Difference was statistically significant.
Under different states of awake, sleep onset, apnea and after apnea, the response force of tensor palatini muscle of OSA subjects with different phenotypes under DISE was different. Group 1 showed the highest EMG values only when awake and sleep onset, and it was most prone to collapse. Group 2 had the highest anatomical load (passive Pcrit) and the highest neuromuscular compensatory effect (D value).
本研究旨在评估在药物诱导睡眠内窥镜检查（DISE）下，腭帆提肌（TP）肌电特征与上气道塌陷性相结合，对不同悬雍垂塌陷模式外部表型的阻塞性睡眠呼吸暂停（OSA）患者的影响。
病例系列，计划数据收集。
手术室。
36 名主要以悬雍垂水平塌陷模式为特征的 OSA 患者在 DISE 下同步进行腭帆提肌肌电图（TP EMG）和多导睡眠图（ALICE 6）检查。根据 DISE 中悬雍垂水平塌陷模式的表型，将受试者分为 1 组（向心性塌陷）、2 组（前后向塌陷）和 3 组（侧向塌陷）。每组分别有 13、14 和 9 名受试者，观察清醒、睡眠起始、呼吸暂停期间和呼吸暂停后第三个呼吸周期的肌电图指标。同时测量各组主动和被动上气道临界关闭压（Pcrit），评价不同组间神经肌肉反应的差异。
在 TPEMG 紧张状态下，1 组在清醒和睡眠起始时的数值最高，而 2 组在呼吸暂停和呼吸暂停后时的数值最高。在峰值 TPEMG 中，1 组在清醒时的数值最高。2 组在其他状态下的数值最高。在被动 Pcrit 和 D 值（被动 Pcrit 与主动 Pcrit 之间的差异）方面，2 组的数值最高，而 1 组的主动 Pcrit 数值最高。差异有统计学意义。
在 DISE 下，不同表型的 OSA 患者在清醒、睡眠起始、呼吸暂停和呼吸暂停后等不同状态下，腭帆提肌的反应力不同。1 组仅在清醒和睡眠起始时表现出最高的肌电图值，且最容易塌陷。2 组具有最高的解剖负荷（被动 Pcrit）和最高的神经肌肉代偿效应（D 值）。
