药物诱导睡眠内镜下口腔矫治器治疗结果的咽腔测量

Quantitative Measurement of Pharyngeal Dimensions During Drug-induced Sleep Endoscopy for Oral Appliance Outcome.

机构信息

Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.

ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.

出版信息

Laryngoscope. 2023 Dec;133(12):3619-3627. doi: 10.1002/lary.30823. Epub 2023 Jun 27.

DOI:10.1002/lary.30823

PMID:37366240

Abstract

OBJECTIVE

To quantitatively investigate the effect of mandibular advancement devices (MADs) on pharyngeal airway dimensions in a transverse plane as measured during drug-induced sleep endoscopy (DISE).

METHODS

Data from 56 patients, treated with MAD at 75% maximal protrusion and with baseline Apnea-Hypopnea Index ≥10 events/h, were analyzed. For each patient, three snapshots were selected from DISE video footage at baseline, with MAD presence, and during chin lift, resulting in 498 images (168/168/162, baseline/MAD/chin lift). Cross-sectional areas, anteroposterior (AP) and laterolateral (LL) dimensions on both retroglossal and retro-epiglottic levels were measured. To define the effect of MAD and chin lift on pharyngeal dimensions, linear mixed-effect models were built. Associations between MAD treatment response and pharyngeal expansion (MAD/chin lift) were determined.

RESULTS

Significant differences were found between retroglossal cross-sectional areas, AP, and LL dimensions at baseline and with MAD presence. At a retro-epiglottic level, only LL dimensions differed significantly with MAD presence compared to baseline, with significant relation of LL expansion ratio to treatment response (p = 0.0176). After adjusting the response definition for the sleeping position, greater retroglossal expansion ratios were seen in responders (1.32 ± 0.48) compared to non-responders (1.11 ± 0.32) (p = 0.0441). No significant association was found between response and pharyngeal expansion by chin lift.

CONCLUSION

Our observations highlight the additional value of quantitative pharyngeal airway measurements during DISE with MAD presence in evaluating MAD treatment outcome. These findings demonstrate an increase in retroglossal airway dimensions during DISE, with MAD presence, and more pronounced increase in retroglossal expansion ratios in MAD treatment responders compared to non-responders after sleeping position correction.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:3619-3627, 2023.

摘要

目的

通过药物诱导睡眠内镜（DISE）定量研究下颌前伸装置（MADs）对横向平面咽腔气道尺寸的影响。

方法

分析了 56 名接受 MAD（最大前伸 75%）治疗且基线呼吸暂停低通气指数（Apnea-Hypopnea Index，AHI）≥10 次/h 的患者的数据。对于每位患者，从 DISE 视频片段中选择基线、MAD 存在和颏下提升时的 3 个快照，共获得 498 张图像（168/168/162，基线/MAD/颏下提升）。测量了会厌后和会厌后水平的横截面积、前后径（anteroposterior，AP）和左右径（laterolateral，LL）。为了定义 MAD 和颏下提升对咽腔尺寸的影响，建立了线性混合效应模型。确定 MAD 治疗反应与咽腔扩张（MAD/颏下提升）之间的关系。

结果

与基线和 MAD 存在时相比，会厌后横截面积、AP 和 LL 尺寸在基线和 MAD 存在时存在显著差异。在会厌后水平，与基线相比，只有 LL 尺寸在 MAD 存在时差异显著，LL 扩张率与治疗反应呈显著相关（p=0.0176）。调整睡眠体位后，反应者的会厌后扩张率更高（1.32±0.48），而非反应者的会厌后扩张率更低（1.11±0.32）（p=0.0441）。颏下提升与反应之间无明显的咽腔扩张相关性。