Sadaoka T
Department of Otolaryngology, Osaka Medical College.
Nihon Jibiinkoka Gakkai Kaiho. 1994 Feb;97(2):284-95. doi: 10.3950/jibiinkoka.97.284.
Twenty two patients with obstructive sleep apnea syndrome were examined by nocturnal polysomnography (n-PSG), and the obstructive sites in the upper airway were observed by nasendoscopic diurnal polysomnography using diazepam (n-d-PSGD). The types of apnea were divided into three groups according to the obstructive sites in the upper airway: soft palate apnea, tongue base apnea, and combined type apnea. Among the 22 patients, there were 17 soft palate apneas, 3 tongue base apneas and 2 combined type apneas. All patients underwent uvulopalatopharyngoplasty (UPPP). Preoperative values of AI, AR, DI and mean sleep SaO2 were 37.2, 24.5%, 31.4 and 92.5%, and the postoperative values were 10.4, 7.3%, 6.8 and 94.8%, respectively. Criteria were established to define UPPP responders, as follows: 50% or more reduction in AI and postoperative AI less than 20. The overall improvement rate was 81.0%. The improvement rates for soft palate apnea, combined type apnea and tongue base apnea were 93.8%, 50.0%, and 0%, respectively. In 15 of the 22 patients, measurements of mesopharyngeal and esophageal pressures were performed simultaneously with n-d-PSGD. In these 15 patients, 12 soft palate apneas, 2 combined type apneas and 3 tongue base apneas were observed with n-d-PSGD, while 7 soft palate apneas, 3 combined type apneas and 5 tongue base apneas were detected by measuring the pressures. The results of these two methods concurred in only nine of fifteen patients. It was suspected that the obstructive sites in the upper airway were identified by tissues with n-d-PSGD, but by region with the pressure measuring method. It was suggested that UPPP is the most suitable treatment for patients with soft palate type apnea, without pathologic obesity.
n-d-PSGD is a useful method of evaluating respiratory status during sleep, can be performed in a few hours, and can simultaneously identify the obstructive site in the upper airway, so as to allow treatment planning.
对22例阻塞性睡眠呼吸暂停综合征患者进行了夜间多导睡眠图（n-PSG）检查，并采用地西泮日间多导睡眠图（n-d-PSGD）通过鼻内镜观察上气道阻塞部位。根据上气道阻塞部位将呼吸暂停类型分为三组：软腭性呼吸暂停、舌根性呼吸暂停和混合型呼吸暂停。22例患者中，有17例软腭性呼吸暂停、3例舌根性呼吸暂停和2例混合型呼吸暂停。所有患者均接受了悬雍垂腭咽成形术（UPPP）。术前AI、AR、DI和平均睡眠SaO2值分别为37.2、24.5%、31.4和92.5%，术后值分别为10.4、7.3%、6.8和94.8%。制定了定义UPPP有效反应者的标准如下：AI降低50%或更多且术后AI小于20。总体改善率为81.0%。软腭性呼吸暂停、混合型呼吸暂停和舌根性呼吸暂停的改善率分别为93.8%、50.0%和0%。22例患者中有15例在进行n-d-PSGD时同时测量了鼻咽和食管压力。在这15例患者中，n-d-PSGD观察到12例软腭性呼吸暂停、2例混合型呼吸暂停和3例舌根性呼吸暂停，而通过测量压力检测到7例软腭性呼吸暂停、3例混合型呼吸暂停和5例舌根性呼吸暂停。这两种方法的结果仅在15例患者中的9例中一致。怀疑n-d-PSGD通过组织识别上气道阻塞部位，而压力测量方法通过区域识别。提示UPPP是治疗无病理性肥胖的软腭型呼吸暂停患者的最合适方法。
n-d-PSGD是一种评估睡眠期间呼吸状态的有用方法，可在数小时内完成，且可同时识别上气道阻塞部位，从而便于制定治疗方案。
