Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea.
School of Medicine, KPJ University College, Nilai, Negeri Sembilan, Malaysia.
PLoS One. 2022 May 24;17(5):e0268455. doi: 10.1371/journal.pone.0268455. eCollection 2022.
Head rotation is thought to have an effect on obstructive sleep apnea (OSA) severity. However, keeping the head rotated fully during sleep is difficult to maintain, and the effect of head rotation is not the same in all OSA patients. Thus, this study aimed to identify whether less head rotation has an effect on airway patency and determine the responder characteristics to the head rotation maneuver (HRM).
We recruited 221 patients who underwent overnight polysomnography and drug-induced sleep endoscopy (DISE) in a tertiary hospital from June 2019 to July 2020. Airway patency and the site of airway collapse were determined in the supine position with the head at 0, 30, and 60 degrees of rotation (HRM0°, HRM30°, and HRM60°, respectively) during DISE. The site of collapse was determined using the VOTE classification system: the velum (palate), oropharyngeal lateral walls, tongue base, and epiglottis. Each structure was labeled as 0, 1, or 2 (patent, partially obstructed, and completely obstructed, respectively). Airway response to the HRM30° and 60° and the clinical characteristics associated with airway opening were analyzed.
The study population had a median age of 52 (25-61) years, a body mass index of 26.7(24.6-29.4) kg/m2, and the apnea-hypopnea index (AHI) of 28.2(13.7-71.9) events/h. HRM influenced airway patency positively not only with HRM60° (p<0.001) but also following limited rotation (HRM30°, p<0.001). Patients with tongue base (40.0% with HRM 60°) and epiglottic (52.6% with HRM 60°) collapse responded particularly well to HRM. Multivariate analysis revealed that lower AHI (p<0.001) and an absence of oropharyngeal lateral walls collapse (p = 0.011) were significant predictors of responders to HRM.
Head rotation improved airway obstruction in OSA patients, even with a small degree of rotation, and should be further explored as a potential form of therapy in appropriately selected patients.
头部转动被认为对阻塞性睡眠呼吸暂停（OSA）的严重程度有影响。然而，在睡眠中保持头部完全转动是很难做到的，而且头部转动的效果在所有 OSA 患者中并不相同。因此，本研究旨在确定头部转动对气道通畅性是否有影响，并确定对头部转动手法（HRM）有反应的患者的特征。
我们招募了 221 名患者，他们于 2019 年 6 月至 2020 年 7 月在一家三级医院接受了过夜多导睡眠图和药物诱导睡眠内镜检查（DISE）。在 DISE 中，患者仰卧位，头部分别旋转 0°、30°和 60°（HRM0°、HRM30°和 HRM60°），以确定气道通畅性和气道塌陷部位。塌陷部位使用 VOTE 分类系统确定：软腭（腭）、口咽侧壁、舌根和会厌。每个结构标记为 0、1 或 2（通畅、部分阻塞和完全阻塞）。分析了对 HRM30°和 60°的气道反应以及与气道开放相关的临床特征。
研究人群的中位年龄为 52（25-61）岁，体重指数为 26.7（24.6-29.4）kg/m2，呼吸暂停低通气指数（AHI）为 28.2（13.7-71.9）次/小时。HRM 不仅对 HRM60°（p<0.001），而且对有限的旋转（HRM30°，p<0.001）都有积极影响。舌根（40.0%的 HRM60°）和会厌（52.6%的 HRM60°）塌陷的患者对 HRM 反应特别好。多变量分析显示，较低的 AHI（p<0.001）和无口咽侧壁塌陷（p=0.011）是对 HRM 有反应的显著预测因素。
头部转动改善了 OSA 患者的气道阻塞，即使是小角度的转动，也应该作为一种潜在的治疗方法在适当选择的患者中进一步探索。
