Lai Yi-Ju, Li Chung-Yi, Hung Ching-Hsia, Lin Cheng-Yu
Institute of Physical Education, Health and Leisure Studies, College of Management, National Cheng Kung University, Tainan, Taiwan; Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
J Formos Med Assoc. 2024 Nov;123(11):1175-1181. doi: 10.1016/j.jfma.2024.01.033. Epub 2024 Feb 28.
Drug-induced sleep endoscopy (DISE) is used for evaluating upper airway anatomy and determining airway obstruction patterns. It is typically performed with the patient in the supine position. Airway collapse severity is influenced by body position and level of consciousness; the resultant dynamic changes may vary across patients. In this study, we evaluated the severity of upper airway collapse through awake endoscopy and DISE and identified factors affecting the pattern of airway collapse severity.
This study included 66 patients with obstructive sleep apnea. The patients underwent type 1 polysomnography, tongue strength assessment, awake endoscopy in the sitting and supine positions, and DISE. Group-based trajectory modeling was performed to identify patients with different collapse severity patterns in different body positions and at different levels of consciousness.
Patient with similar severity trajectory were assigned to the same group. Two different severity trajectories (group 1 and group 2) were identified at the tongue base level. Tongue depression strength varied significantly between groups 1 and 2 (47.00 vs. 35.00 kPa; P = .047). During awake endoscopy, collapse severity was significantly higher in group 2 than in group 1. Group 1 had lower rapid eye movement/nonrapid eye movement apnea-hypopnea index ratios and higher tongue depression strength than did group 2.
In patients with obstructive sleep apnea, tongue strength may vary depending on body position. Our results should be interpreted with caution because of the limited sample size. Future studies should investigate the effect of oropharyngeal rehabilitation on tongue strength and collapse severity.
药物诱导睡眠内镜检查（DISE）用于评估上气道解剖结构并确定气道阻塞模式。通常在患者仰卧位时进行。气道塌陷严重程度受身体姿势和意识水平影响；由此产生的动态变化在不同患者之间可能有所不同。在本研究中，我们通过清醒内镜检查和DISE评估了上气道塌陷的严重程度，并确定了影响气道塌陷严重程度模式的因素。
本研究纳入了66例阻塞性睡眠呼吸暂停患者。这些患者接受了1型多导睡眠图检查、舌肌力量评估、坐位和仰卧位清醒内镜检查以及DISE。进行基于组的轨迹建模，以识别在不同身体姿势和不同意识水平下具有不同塌陷严重程度模式的患者。
具有相似严重程度轨迹的患者被分配到同一组。在舌根水平识别出两种不同的严重程度轨迹（第1组和第2组）。第1组和第2组之间的舌压低力量差异显著（47.00对35.00 kPa；P = 0.047）。在清醒内镜检查期间，第2组的塌陷严重程度显著高于第1组。第1组的快速眼动/非快速眼动呼吸暂停低通气指数比值低于第2组，舌压低力量高于第2组。
在阻塞性睡眠呼吸暂停患者中，舌肌力量可能因身体姿势而异。由于样本量有限，我们的结果应谨慎解释。未来的研究应调查口咽康复对舌肌力量和塌陷严重程度的影响。
