Riley R W, Powell N B, Guilleminault C
Stanford Sleep Disorders Clinic and Research Center, Stanford University School of Medicine, Palo Alto, CA.
Otolaryngol Head Neck Surg. 1994 Dec;111(6):717-21. doi: 10.1177/019459989411100604.
Obstructive sleep apnea syndrome results from a loss of muscular activity of pharyngeal dilators and airway collapse at the hypopharynx-base of tongue or the oropharynx-soft palate. The hyoid arch and its muscle attachments strongly affect hypopharyngeal airway patency and resistance. On the basis of these concepts and previous experience, a modified hyoid suspension procedure is presented. Fifteen consecutively treated surgical patients underwent an isolated modified hyoid suspension procedure to correct hypopharyngeal obstruction. Oropharyngeal-palatal obstruction had previously been corrected or was thought not to be a component of the obstruction. Treatment outcomes were based on objective polysomnographic data and subjective clinical correction of excessive daytime sleepiness. The polysomnographic data included analysis of the respiratory disturbance index and lowest oxyhemoglobin desaturation. On the basis of these criteria, 12 of 15 patients (75%) had correction of their excessive daytime sleepiness and marked improvement in their sleep disorder breathing. The mean preoperative respiratory disturbance index was 44.7 +/- 22.6, and the lowest oxyhemoglobin desaturation was 82% +/- 6%. The postoperative respiratory disturbance index and lowest oxyhemoglobin desaturation were 12.8 +/- 6.9 and 86% +/- 5%, respectively. The modified hyoid suspension procedure appears to offer significant adjunctive treatment for hypopharyngeal obstruction in obstructive sleep apnea syndrome.
阻塞性睡眠呼吸暂停综合征是由于咽部扩张肌肌肉活动丧失以及下咽-舌根或口咽-软腭处气道塌陷所致。舌骨弓及其肌肉附着点对下咽气道通畅性和阻力有强烈影响。基于这些概念和以往经验，本文介绍了一种改良的舌骨悬吊手术。15例接受连续治疗的手术患者接受了单独的改良舌骨悬吊手术以纠正下咽梗阻。口咽-腭部梗阻此前已得到纠正或被认为不是梗阻的组成部分。治疗结果基于客观的多导睡眠图数据以及对日间过度嗜睡的主观临床纠正。多导睡眠图数据包括呼吸紊乱指数分析和最低氧合血红蛋白饱和度下降情况。基于这些标准，15例患者中有12例（75%）的日间过度嗜睡得到纠正，睡眠呼吸障碍有显著改善。术前平均呼吸紊乱指数为44.7±22.6，最低氧合血红蛋白饱和度下降为82%±6%。术后呼吸紊乱指数和最低氧合血红蛋白饱和度下降分别为12.8±6.9和86%±5%。改良舌骨悬吊手术似乎为阻塞性睡眠呼吸暂停综合征的下咽梗阻提供了重要的辅助治疗方法。
