严重睡眠呼吸暂停患者肌肉无力评估：一项前瞻性研究。

Assessment of Muscular Weakness in Severe Sleep Apnea Patients: A Prospective Study.

机构信息

Otorhinolaryngology Department, Hospital Quironsalud Marbella, Marbella, Spain.

Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, Palmones, Spain.

出版信息

Otolaryngol Head Neck Surg. 2023 Sep;169(3):725-733. doi: 10.1002/ohn.283. Epub 2023 Feb 7.

DOI:10.1002/ohn.283

PMID:36939539

Abstract

OBJECTIVE

There are no official diagnostic tools to evaluate the weakness of the genioglossus muscle. We have developed a protocol for muscular assessment in patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS) and evaluated its effectiveness.

STUDY DESIGN

Case and controls prospective study.

SETTING

Sleep Unit Hospital Quironsalud Marbella (Spain).

METHODS

Twenty-nine cases and 20 controls were recruited. Patients were examined by a phonoaudiologist that performed biometric measurements and the Orofacial Myofunctional Evaluation With Scores (OMES), Friedman, and Epworth Sleepiness Scale (ESS). In addition, upper airway muscle strength measures were performed using the Iowa Oral Performance Instrument (IOPI) and Tongue Digital Spoon (TDS).

RESULTS

The final cohort consisted of 49 subjects, including 29 cases and 20 controls. According to the univariate and multivariate logistic regression analyses, ESS, OMES protocol, IOPI score, and TDS were associated with severe OSAHS. Multivariate regression revealed an IOPI score below 48 kps with an adjusted odds ratio (OR) of 9.96 (95% confidence interval [CI] 2.5-39.1, p = .001), and a 0.72 specificity (Spe), a 0.79 sensitivity (Sens), and a 0.82 area under the curve (AUC). Similarly, an OMES score lower than 200 had an adjusted risk ratio of 4.02 (95% CI 2-7, p < .001), 1 Spe, 0.79 Sens, and 0.98 AUC; and finally, TDS scores lower than 201 g/cm showed an adjusted OR of 27 (95% CI 4.74-153.6, p = .0001), 0.66 Spe, a 0.93 Sens, and a 0.86 AUC.

CONCLUSION

Our findings suggest that severe OSAHS patients present different muscle patterns than controls.

摘要

目的

目前尚无评估颏舌肌无力的官方诊断工具。我们制定了一项针对严重阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的肌肉评估方案，并评估了其有效性。

研究设计

病例对照前瞻性研究。

地点

西班牙 Quironsalud Marbella 睡眠单位。

方法

共纳入 29 例病例和 20 例对照。由言语治疗师进行体格测量和口面肌功能评估与评分（OMES）、Friedman 和 Epworth 睡眠量表（ESS）检查。此外，还使用爱荷华口腔功能测试仪器（IOPI）和舌数字勺（TDS）测量上气道肌肉力量。

结果

最终纳入 49 例患者，包括 29 例病例和 20 例对照。单变量和多变量逻辑回归分析显示，ESS、OMES 评分、IOPI 评分和 TDS 与严重 OSAHS 相关。多变量回归显示 IOPI 评分<48 kps 的调整优势比（OR）为 9.96（95%置信区间[CI]2.5-39.1，p=0.001），特异性（Spe）为 0.72，敏感性（Sens）为 0.79，曲线下面积（AUC）为 0.82。同样，OMES 评分<200 的调整风险比（RR）为 4.02（95%CI2-7，p<0.001），特异性（Spe）为 0.79，敏感性（Sens）为 0.79，AUC 为 0.98。最后，TDS 评分<201 g/cm 的调整 OR 为 27（95%CI4.74-153.6，p=0.0001），特异性（Spe）为 0.66，敏感性（Sens）为 0.93，AUC 为 0.86。