阻塞性睡眠呼吸暂停中会厌外侧塌陷与咽侧向塌陷有关。
Lateral epiglottic collapse in obstructive sleep apnea is associated with laterally directed pharyngeal collapse.
作者信息
Wang Tsai-Yu, Huyett Phillip, Yang Hyungchae, Sumner Jeffrey, Aishah Atqiya, Gell Laura, Azarbarzin Ali, Messineo Ludovico, Labarca Gonzalo, White David, Sands Scott, Wellman Andrew, Vena Daniel
机构信息
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Thoracic Medicine, Chang Gung Memorial Hospital Linkou Main Branch, and School of Medicine, Chang Gung University, Taoyuan, Taiwan.
出版信息
J Clin Sleep Med. 2025 Apr 1;21(4):649-654. doi: 10.5664/jcsm.11478.
STUDY OBJECTIVES
Epiglottic collapse can obstruct the airway in patients with obstructive sleep apnea in an anteroposterior or lateral direction. The present study investigates the concept that lateral or concentric pharyngeal collapse patterns may remodel the epiglottis and predispose it to lateral collapse. To do so, we hypothesized that the presence of-any form of laterally directed pharyngeal collapse, eg, oropharyngeal lateral wall collapse or complete concentric collapse of the soft palate, is associated with increased odds for having concurrent lateral epiglottic collapse (E-lat).
METHODS
We analyzed 582 patients with obstructive sleep apnea from our drug-induced sleep endoscopy cohort. Site of collapse was scored by a single scorer using the VOTE criteria, with patients with epiglottic collapse reviewed by 2 additional independent scorers. Logistic regression evaluated the association between presence of laterally directed pharyngeal collapse and the presence of E-lat.
RESULTS
The overall prevalence of E-lat was 2.6% (n = 15). The presence of any form of laterally directed pharyngeal collapse was associated with 4-fold increased odds (4.4 [1.5-12.6], = .006) of having concurrent E-lat. Further, the specific presence of either complete oropharyngeal lateral wall collapse or complete concentric collapse of the soft palate was associated with an odds ratio of 3.4 [1.2-9.6] and 8.6 [2.2-33.5], respectively, of having concurrent E-lat.
CONCLUSIONS
Greater prevalence of severe laterally directed pharyngeal collapse, in the form of either complete concentric collapse of the soft palate or oropharyngeal lateral wall collapse in patients with E-lat supports the concept that laterally and concentric pharyngeal collapse patterns may shape the epiglottis and thereby contribute to the pathogenesis of E-lat.
CITATION
Wang T-Y, Huyett P, Yang H, et al. Lateral epiglottic collapse in obstructive sleep apnea is associated with laterally directed pharyngeal collapse. . 2025;21(4):649-654.
研究目的
会厌塌陷可在前后方向或侧方阻塞阻塞性睡眠呼吸暂停患者的气道。本研究探讨侧向或同心性咽部塌陷模式可能重塑会厌并使其易发生侧向塌陷的概念。为此，我们假设存在任何形式的侧向咽部塌陷，例如口咽侧壁塌陷或软腭完全同心塌陷，与同时发生侧向会厌塌陷（E-lat）的几率增加有关。
方法
我们分析了来自药物诱导睡眠内镜队列的582例阻塞性睡眠呼吸暂停患者。由一名评分者使用VOTE标准对塌陷部位进行评分，会厌塌陷患者由另外两名独立评分者进行复查。逻辑回归评估侧向咽部塌陷的存在与E-lat存在之间的关联。
结果
E-lat的总体患病率为2.6%（n = 15）。任何形式的侧向咽部塌陷的存在与同时发生E-lat的几率增加4倍相关（4.4 [1.5 - 12.6]，P = .006）。此外，口咽侧壁完全塌陷或软腭完全同心塌陷的具体存在分别与同时发生E-lat的比值比为3.4 [1.2 - 9.6]和8.6 [2.2 - 33.5]相关。
结论
在E-lat患者中，以软腭完全同心塌陷或口咽侧壁塌陷形式出现的严重侧向咽部塌陷的患病率更高，支持侧向和同心性咽部塌陷模式可能塑造会厌并从而促成E-lat发病机制的概念。
引用文献
Wang T-Y, Huyett P, Yang H, et al. Lateral epiglottic collapse in obstructive sleep apnea is associated with laterally directed pharyngeal collapse.. 2025;21(4):649 - 654.
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