Sinha Sanjeev, Mohan Lal Bhavesh, Nithya Maskani, Titiyal Renuka, Datta Soumyadeep, Vyas Surabhi, Aggarwal Sandeep, Nokes Brandon, Malhotra Atul
Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
Diabetes Metab Syndr. 2024 Nov-Dec;18(11-12):103169. doi: 10.1016/j.dsx.2024.103169. Epub 2024 Dec 3.
Obstructive sleep apnea (OSA) is very common in obese patients. However, why some obese patients have severe OSA while others do not is unclear. Research is limited regarding which structures contribute to upper airway narrowing, especially in Asian patients where bony restrictions is thought to be important.
Nineteen consecutive patients with BMI ≥35 kg/m, and newly diagnosed with OSA based on overnight polysomnography were studied using non-contrast magnetic resonance imaging (MRI) of the upper airway during wakefulness.
Patients were divided into two groups, one with severe OSA comprising 11 patients and one without severe OSA having 8 patients. The retro-palatal airway was narrowest in both groups. Patients with severe OSA had a significantly narrower retroglossal airway (0.99 ± 0.48 cm vs 2.61 ± 2.02 cm, p = 0.02), primarily due to a narrower anteroposterior diameter at this level (p = 0.03). The tongue volume (p = 0.91), lateral pharyngeal wall volume (p = 0.26), tongue length (p = 0.93), soft palate length (p = 0.13), and dynamic change of upper airway with inspiration (p = 0.31) were not significantly different between the two groups.
While the retro-palatal airway is equally narrow in both groups of patients, patients with severe OSA also have a significantly narrower retro-glossal airway. This finding could represent either a generalized reduction in airway area in whole of the oropharynx or multiple-level obstruction; probably aggravating upper airway collapse during sleep, predisposing some Asian obese patients to develop severe OSA.
阻塞性睡眠呼吸暂停（OSA）在肥胖患者中非常常见。然而，为何一些肥胖患者患有严重OSA而另一些却没有尚不清楚。关于哪些结构导致上气道狭窄的研究有限，尤其是在认为骨骼限制很重要的亚洲患者中。
对19例BMI≥35kg/m²且基于夜间多导睡眠图新诊断为OSA的连续患者，在清醒状态下使用上气道非增强磁共振成像（MRI）进行研究。
患者分为两组，一组为11例严重OSA患者，另一组为8例无严重OSA患者。两组患者的腭后气道均最狭窄。严重OSA患者的舌后气道明显更窄（0.99±0.48cm对2.61±2.02cm，p = 0.02），主要是由于该水平的前后径更窄（p = 0.03）。两组患者的舌体积（p = 0.91）、咽侧壁体积（p = 0.26）、舌长度（p = 0.93）、软腭长度（p = 0.13）以及上气道吸气时的动态变化（p = 0.31）无显著差异。
虽然两组患者的腭后气道同样狭窄，但严重OSA患者的舌后气道也明显更窄。这一发现可能代表整个口咽气道面积的普遍减小或多平面阻塞；可能会加重睡眠期间上气道塌陷，使一些亚洲肥胖患者易患严重OSA。
