Park Jae-Seon, Kwon Bin, Kang Hyun-Seok, Yun Seong-Jin, Han Sung-Jun, Choi Yeso, Kang Sung-Hun, Lee Mi-Yeon, Lee Kyung-Chul, Hong Seok-Jin
Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea.
J Pers Med. 2023 Jul 27;13(8):1196. doi: 10.3390/jpm13081196.
Positive airway pressure (PAP) is an important treatment tool for patients with moderate and severe obstructive sleep apnea (OSA), and adherence to PAP significantly affects treatment outcomes. Disease severity, adverse effects, and psychosocial factors are known to predict medication adherence. Cephalometric parameters have been reported to positively correlate with upper airway collapse. However, research on the correlation between these cephalometric parameters and PAP adherence remains insufficient. This study aimed to identify this relationship. This study included 185 patients with OSA who were prescribed PAP. Polysomnography (PSG) was performed to diagnose OSA, and paranasal sinus computed tomography (PNS CT) was performed to check for comorbidities of the upper airway. In addition, cephalometric parameters such as the hyoid-posterior nasal spine (H-PNS), posterior nasal spine-mandibular plane (PNS-MP), and hyoid-mandibular plane (H-MP) were measured in the midsagittal and axial CT views. Adherence was evaluated 3-12 months after the PAP prescription. A total of 136 patients were PAP-adherent, and 49 were nonadherent. There were more males in the adherent group and a higher average height in the adherent group. The PSG results showed that the apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), arousal index (AI), rapid eye movement (REM) AHI, and supine AHI were significantly higher, and the lowest oxygen saturation was lower in the adherent group. In the analysis of covariance (ANCOVA) model adjusted for sex and height, among the cephalometric parameters, H-MP was significantly longer in the adherent group ( = 0.027), and H-PNS showed a longer tendency ( = 0.074). In the logistic regression analysis model, the odds ratio (OR) and 95% confidence intervals (95% CI) of adherence and severe OSA in the third tertile compared to the first tertile of H-MP were 2.93 (1.25-6.86) and 4.00 (1.87-8.56). In the case of H-PNS, they were 2.58 (1.14-5.81) and 4.86 (2.24-10.54), respectively. This study concluded that an inferiorly placed hyoid bone in adult patients is associated with PAP adherence and disease severity.
气道正压通气（PAP）是中重度阻塞性睡眠呼吸暂停（OSA）患者的重要治疗工具，而坚持使用PAP对治疗效果有显著影响。已知疾病严重程度、不良反应和社会心理因素可预测药物依从性。据报道，头影测量参数与上气道塌陷呈正相关。然而，关于这些头影测量参数与PAP依从性之间相关性的研究仍然不足。本研究旨在确定这种关系。本研究纳入了185例被处方PAP的OSA患者。进行多导睡眠图（PSG）以诊断OSA，并进行鼻窦计算机断层扫描（PNS CT）以检查上气道的合并症。此外，在矢状面和轴向CT视图中测量舌骨-后鼻棘（H-PNS）、后鼻棘-下颌平面（PNS-MP）和舌骨-下颌平面（H-MP）等头影测量参数。在PAP处方后3至12个月评估依从性。共有136例患者坚持使用PAP，49例不依从。依从组男性更多，且平均身高更高。PSG结果显示，依从组的呼吸暂停低通气指数（AHI）、呼吸紊乱指数（RDI）、氧饱和度下降指数（ODI）、觉醒指数（AI）、快速眼动（REM）AHI和仰卧位AHI显著更高，最低氧饱和度更低。在对性别和身高进行调整的协方差分析（ANCOVA）模型中，在头影测量参数中，依从组H-MP显著更长（P = 0.027），H-PNS有更长的趋势（P = 0.074）。在逻辑回归分析模型中，与H-MP第一三分位数相比，第三三分位数中依从性和重度OSA 的比值比（OR）及95%置信区间（95%CI）分别为2.93（1.25 - 6.86）和4.00（1.87 - 8.56）。对于H-PNS而言，它们分别为2.58（1.14 - 5.81）和4.86（2.24 - 10.54）。本研究得出结论，成年患者舌骨位置较低与PAP依从性和疾病严重程度相关。
