Department of Ear, Nose and Throat, Head and Neck Surgery and Sleep Medicine, Lovisenberg Diaconal Hospital, Norway; Medical Faculty, University of Lund, Sweden.
Department of Ear, Nose and Throat, Head and Neck Surgery and Sleep Medicine, Lovisenberg Diaconal Hospital, Norway.
Sleep Med. 2023 Mar;103:131-137. doi: 10.1016/j.sleep.2023.01.028. Epub 2023 Feb 3.
Increased nasal resistance as measured by 4-phase rhinomanometry is associated with a paucity of apneas relative to hypopneas in obstructive sleep apnea (OSA) patients. The ratio of hypopneas to apneas for a given apnea hypopnea index (AHI) may influence treatment choice. This study aimed to investigate if OSA patients with an elevated hypopnea apnea ratio are associated with differences in acoustic rhinometry measurements.
One hundred and thirty-nine (n = 139) OSA patients (AHI >5) were enrolled in this prospective case-control study (all male). OSA Diagnosis was established through a type three sleep study. Both acoustic rhinometry and 4-phase rhinomanometry were performed on all patients at baseline and after decongestion. Possible associations between apnea-hypopnea index, oxygen desaturation index, nadir oxygen saturation, apnea index, hypopnea index, hypopnea to apnea ratio and body mass index and were analysed using multiple logistic and linear regression models.
The acoustic rhinometry measurements minimal cross-sectional area, total volume and minimal cross-sectional areas are significantly smaller in patients with increased nasal resistance as measured by 4-phase rhinomanometry (P < 0.01). No consistent statistically significant associations were found between the acoustic rhinometry variables, and the respiratory variables analysed in the sleep studies. OSA patients with an elevated hypopnea apnea ratio are more than 4 times more likely to present with increased nasal resistance measured by 4-phase rhinomanometry (OR = 4.4, 95% CI [1.5-13.2], P < 0.01).
Acoustic rhinometry is significantly associated with 4-phase rhinomanometry. However, acoustic rhinometry measurements are not associated with the respiratory indices routinely measured in OSA in a clinical setting. 4-phase rhinomanometry is a more suitable method for detecting clinically relevant nasal obstruction in obstructive sleep apnea patients.
通过 4 相鼻阻力测量法（rhinomanometry）测量得出的鼻腔阻力增加与阻塞性睡眠呼吸暂停（OSA）患者的呼吸暂停相比，呼吸暂停低通气指数（apnea hypopnea index，AHI）中的低通气次数相对较少。给定 AHI 下的低通气与呼吸暂停的比例可能会影响治疗选择。本研究旨在探讨 AHI 较高的 OSA 患者是否与声鼻测量（acoustic rhinometry）结果的差异有关。
这项前瞻性病例对照研究纳入了 139 名（n=139）OSA 患者（AHI>5）（均为男性）。通过 III 型睡眠研究确立 OSA 诊断。所有患者均在基线和去充血后进行声鼻测量和 4 相鼻阻力测量。使用多变量逻辑回归和线性回归模型分析 AHI、氧减饱和度指数、最低氧饱和度、呼吸暂停指数、低通气指数、低通气与呼吸暂停比值和体重指数（body mass index，BMI）与呼吸暂停-低通气指数之间的可能相关性。
4 相鼻阻力测量法显示鼻腔阻力增加的患者，其最小横截面积、总容积和最小横截面积的声鼻测量结果明显更小（P<0.01）。在睡眠研究中，未发现声鼻变量与呼吸变量之间存在一致的统计学显著相关性。与通过 4 相鼻阻力测量法发现的鼻腔阻力正常的 OSA 患者相比，呼吸暂停-低通气比值升高的 OSA 患者出现鼻腔阻力增加的可能性高出 4 倍（OR=4.4，95%CI[1.5-13.2]，P<0.01）。
声鼻测量与 4 相鼻阻力测量法显著相关。然而，在临床环境中，声鼻测量结果与 OSA 中常规测量的呼吸指数无关。4 相鼻阻力测量法是一种更适合检测阻塞性睡眠呼吸暂停患者临床相关鼻腔阻塞的方法。
