Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Joint Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.
Sleep Med Rev. 2023 Apr;68:101741. doi: 10.1016/j.smrv.2022.101741. Epub 2022 Dec 30.
Upper airway (UA) collapsibility is one of the key factors that determine the severity of obstructive sleep apnea (OSA). Interventions for OSA are aimed at reducing UA collapsibility, but selecting the optimal alternative intervention for patients who fail CPAP is challenging because currently no validated method predicts how anatomical changes affect UA collapsibility. The gold standard objective measure of UA collapsibility is the pharyngeal critical pressure (P). A systematic literature review and meta-analysis were performed to identify the anatomical factors with the strongest correlation with P. A search using the PRISMA methodology was performed on PubMed for English language scientific papers that correlated P to anatomic variables and OSA severity as measured by the apnea-hypopnea index (AHI). A total of 29 papers that matched eligibility criteria were included in the quantitative synthesis. The meta-analysis suggested that AHI has only a moderate correlation with P (estimated Pearson correlation coefficient r = 0.46). The meta-analysis identified four key anatomical variables associated with UA collapsibility, namely hyoid position (r = 0.53), tongue volume (r = 0.51), pharyngeal length (r = 0.50), and waist circumference (r = 0.49). In the future, biomechanical models that quantify the relative importance of these anatomical factors in determining UA collapsibility may help identify the optimal intervention for each patient. Many anatomical and structural factors such as airspace cross-sectional areas, epiglottic collapse, and palatal prolapse have inadequate data and require further research.
上呼吸道（UA）塌陷性是决定阻塞性睡眠呼吸暂停（OSA）严重程度的关键因素之一。OSA 的干预措施旨在降低 UA 塌陷性，但对于 CPAP 治疗失败的患者，选择最佳的替代干预措施具有挑战性，因为目前尚无经过验证的方法可以预测解剖结构变化如何影响 UA 塌陷性。UA 塌陷性的金标准客观测量指标是咽腔临界压（P）。本研究通过系统文献回顾和荟萃分析，确定与 P 相关性最强的解剖学因素。采用 PRISMA 方法，在 PubMed 上检索了将 P 与解剖变量和 OSA 严重程度（以呼吸暂停低通气指数（AHI）衡量）相关的英文科学文献。共有 29 篇符合纳入标准的文献被纳入定量综合分析。荟萃分析表明，AHI 与 P 仅有中度相关性（估计皮尔逊相关系数 r = 0.46）。荟萃分析确定了与 UA 塌陷性相关的四个关键解剖学变量，即舌骨位置（r = 0.53）、舌体积（r = 0.51）、咽腔长度（r = 0.50）和腰围（r = 0.49）。未来，量化这些解剖学因素在确定 UA 塌陷性中的相对重要性的生物力学模型可能有助于为每位患者确定最佳干预措施。许多解剖学和结构因素，如气腔横截面积、会厌塌陷和腭下垂，数据不足，需要进一步研究。
