Yang X P, Xie Q, Xie J, Chen X
Department of Otorhinolaryngology Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan 430071,China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jul 7;57(7):874-879. doi: 10.3760/cma.j.cn115330-20211104-00715.
To investigate the morphological characteristics of upper airway and laryngopharyngeal reflux in obese patients with obstructive sleep apnea (OSA). A retrospective analysis was performed on the clinical data of 284 adult patients who underwent polysomnography (PSG) from April 2020 to April 2021 in the Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, including 83 males and 201 females, aged (32.70±7.74) years. Patients were divided into obese group (=234) and non-obese group (=50) according to body mass index (BMI). Patients were divided into mild OSA group, moderate OSA group, severe OSA group and extremely severe OSA group by PSG.The results of sleepiness and laryngopharyngeal reflux questionnaire, nasolaryngoscopy and polysomnography were compared in each group. SPSS (version 22.0) software was used in data analysis. Compared with the non-obese OSA group, the lymphoid hyperplasia of tongue root was more heavy in the obese OSA group, and Mueller's maneuver showed that the left-right lateral collapse of the velopharyngeal plane was more serious. Meanwhile, the scores of reflux symtom index (RSI) and reflux finding score (RFS) in the obese OSA group were significantly increased, and the scores of RSI and RFS increased with the increase of OSA severity. The main respiratory events in obese patients with OSA were obstructive hypopnea, their apnea-hypopnea indices(AHI) during REM (AHI) was significantly higher than non-REM (AHI), and they had lower average blood oxygen saturation. Yet, there was no significant difference in the lowest blood oxygen saturation between the two groups. Our study suggests that lateral pharyngeal wall stenosis in velopharyngeal plane and the lymphoid hyperplasia of tongue root in glossopharyngeal plane occurs more frequently in obese patients with OSA. Laryngopharyngeal reflux is significantly increased in obese patients, and OSA increases laryngopharyngeal reflux in obese patients.
探讨肥胖阻塞性睡眠呼吸暂停（OSA）患者上气道形态特征及喉咽反流情况。对2020年4月至2021年4月在武汉大学中南医院耳鼻咽喉头颈外科行多导睡眠图（PSG）检查的284例成年患者临床资料进行回顾性分析，其中男性83例，女性201例，年龄（32.70±7.74）岁。根据体重指数（BMI）将患者分为肥胖组（=234）和非肥胖组（=50）。通过PSG将患者分为轻度OSA组、中度OSA组、重度OSA组和极重度OSA组。比较各组嗜睡及喉咽反流问卷、鼻咽喉镜检查及多导睡眠图结果。数据分析采用SPSS（22.0版）软件。与非肥胖OSA组相比，肥胖OSA组舌根淋巴组织增生更明显，Müller动作显示腭咽平面左右侧塌陷更严重。同时，肥胖OSA组反流症状指数（RSI）和反流发现评分（RFS）显著升高，且RSI和RFS评分随OSA严重程度增加而升高。肥胖OSA患者主要呼吸事件为阻塞性低通气，其快速眼动期呼吸暂停低通气指数（AHI）显著高于非快速眼动期（AHI），平均血氧饱和度较低。然而，两组最低血氧饱和度差异无统计学意义。我们的研究表明，肥胖OSA患者腭咽平面咽侧壁狭窄及舌咽平面舌根淋巴组织增生更常见。肥胖患者喉咽反流显著增加，且OSA加重肥胖患者喉咽反流。
