Pae E K, Lowe A A, Sasaki K, Price C, Tsuchiya M, Fleetham J A
University of British Columbia, Department of Clinical Dental Sciences, Vancouver, Canada.
Am J Orthod Dentofacial Orthop. 1994 Jul;106(1):52-9. doi: 10.1016/S0889-5406(94)70021-4.
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction during sleep, usually in the supine position. To investigate the relationship between upper airway size and genioglossus (GG) muscle activity, upright and supine cephalograms were obtained in 20 OSA patients and 10 symptom-free control subjects. Tongue electromyographic (EMG) recordings were obtained with surface electrodes, and pressure transducers were placed in the 10 symptom-free controls. The tongue cross-sectional area increased 4.3% (p < 0.05), and the oropharyngeal area decreased 36.5% (p < 0.01) when the OSA patients changed their body position from upright to supine. No changes were observed in the tongue area, but soft palate thickness increased (p < 0.01) when the control subjects changed from the upright to the supine position. Furthermore, the oropharyngeal cross-sectional area decreased 28.8% (p < 0.01) despite a 34% increase (p < 0.05) in resting GG EMG activity. Posterior tongue pressure increased 17% (p < 0.05) with the change from upright to supine. On the basis of these findings, we propose that body posture has a substantial effect on upper airway structure and muscle activity. This postural effect should be taken into account when assessing upper airway size in the erect posture (conventional cephalography) and in the supine position (computed tomography). The vertical and anteroposterior position of the tongue and its relationship to airway size may be more important than soft palate size in the pathogenesis of OSA.
阻塞性睡眠呼吸暂停（OSA）的特征是睡眠期间反复出现上气道阻塞，通常发生在仰卧位。为了研究上气道大小与颏舌肌（GG）肌肉活动之间的关系，对20例OSA患者和10名无症状对照者进行了直立位和仰卧位头颅侧位片检查。使用表面电极进行舌肌电图（EMG）记录，并在10名无症状对照者中放置压力传感器。当OSA患者从直立位变为仰卧位时，舌横截面积增加了4.3%（p<0.05），口咽面积减少了36.5%（p<0.01）。对照者从直立位变为仰卧位时，舌面积未观察到变化，但软腭厚度增加（p<0.01）。此外，尽管静息GG肌电活动增加了34%（p<0.05），口咽横截面积仍减少了28.8%（p<0.01）。从直立位变为仰卧位时，舌后压力增加了17%（p<0.05）。基于这些发现，我们认为身体姿势对上气道结构和肌肉活动有显著影响。在评估直立位（传统头颅侧位片）和仰卧位（计算机断层扫描）时的上气道大小时，应考虑这种姿势效应。在OSA的发病机制中，舌的垂直和前后位置及其与气道大小的关系可能比软腭大小更重要。
