Rivlin J, Hoffstein V, Kalbfleisch J, McNicholas W, Zamel N, Bryan A C
Am Rev Respir Dis. 1984 Mar;129(3):355-60. doi: 10.1164/arrd.1984.129.3.355.
Fundamental to the pathogenesis of obstructive sleep apnea (OSA) is the interaction of physiologic and anatomic alterations of the upper airway. However, many patients with OSA have no identifiable abnormality of the upper airway, and they have been termed idiopathic. In an attempt to find a structural deviation in upper airway anatomy, we performed acoustic echography and cephalometric roentgenograms in 9 male patients with OSA and no clinical evidence of upper airway abnormality. Mean cross-sectional area of the pharynx by acoustic reflection was less in these patients (3.7 +/- 0.8 cm2) than in subjects in a control group (5.3 +/- 0.6 cm2) (p less than 0.001). Mean glottic cross-sectional area was less in the patient group (1.5 +/- 0.5 cm2) than in the control group (2.7 +/- 0.5) (p less than 0.001). There was a significant correlation between the number of apneas per sleep hour and pharyngeal cross-sectional area (r = 0.87, p less than 0.01). Cephalometric analysis indicated that the patients had smaller mandibles by a mean of 5.4 +/- 6.6 mm (p less than 0.05). The overall posterior displacement of the mandibular symphysis, which is representative of the skeletal support of the anterior pharyngeal wall and is dependent on both mandibular size and position, was highly significant (6.4 +/- 4.7 mm) (p less than 0.01). Furthermore, there was a significant correlation between the number of apnea episodes per sleep hour and the total posterior displacement (r = 0.67, p less than 0.05). This study indicates that patients with so-called idiopathic OSA may have an anatomic predisposition to the development of upper airway occlusion that may not be detectable on clinical examination.
上气道的生理和解剖改变之间的相互作用是阻塞性睡眠呼吸暂停（OSA）发病机制的基础。然而，许多OSA患者没有可识别的上气道异常，他们被称为特发性患者。为了寻找上气道解剖结构的结构偏差，我们对9名男性OSA患者进行了声学超声检查和头影测量X线片检查，这些患者没有上气道异常的临床证据。通过声学反射测得的这些患者咽部平均横截面积（3.7±0.8cm²）小于对照组受试者（5.3±0.6cm²）（p<0.001）。患者组的平均声门横截面积（1.5±0.5cm²）小于对照组（2.7±0.5）（p<0.001）。每睡眠小时呼吸暂停次数与咽部横截面积之间存在显著相关性（r = 0.87，p<0.01）。头影测量分析表明，患者的下颌骨平均小5.4±6.6mm（p<0.05）。下颌联合的整体向后移位，它代表咽前壁的骨骼支撑，并且取决于下颌骨的大小和位置，差异非常显著（6.4±4.7mm）（p<0.01）。此外，每睡眠小时呼吸暂停发作次数与总向后移位之间存在显著相关性（r = 0.67，p<0.05）。这项研究表明，所谓的特发性OSA患者可能对上气道阻塞的发生具有解剖学易感性，而这种易感性在临床检查中可能无法检测到。
