Ono T, Lowe A A, Ferguson K A, Fleetham J A
Department of Clinical Dental Sciences, University of British Columbia, Vancouver, Canada.
Am J Orthod Dentofacial Orthop. 1996 Jun;109(6):625-34. doi: 10.1016/s0889-5406(96)70074-4.
Interactions between upper airway structure and posture in relation to obesity were studied in a sample of 61 adult Class I skeletal type male patients with obstructive sleep apnea (OSA) and 10 homologous control subjects. A pair of upright and supine lateral cephalometric films were taken for each subject. A Pearson correlation analysis identified significant r values for several demographic variables in patients with OSA such as apnea and hypopnea index, percentage of predicted neck circumference, minimum arterial oxygen saturation, and body mass index (BMI). The difference between cephalometric variables identified in upright and supine subjects was calculated. When patients with OSA changed their posture from upright to supine, significant correlations were observed between the cranial base to upper cervical column angle and the hypopharynx cross-sectional area and BMI. Moreover, the mandibular plane angle and the sella-nasion plane was significantly correlated with BMI. This occurred along with a significant positive correlation between the sella-nasion plane angle and BMI and a significant inverse correlation between the mandibular plane angle in reference to the absolute vertical and horizontal planes, with BMI after the positional change. Such correlations were not observed in control subjects. No correlations were observed between the variables related to the position of the hyoid bone with BMI in either patients with OSA or control subjects after the change in posture. On the basis of these findings, we propose that when patients with OSA change their body position from upright to supine (1) the patient's neck is more extended, and (2) the hyoid bone moves more anterosuperiorly in conjunction with an upward and forward rotation of the mandible. This change in craniofacial structure may be a compensatory geometrical change in the upper airway to secure its patency.
在61名患有阻塞性睡眠呼吸暂停（OSA）的成年I类骨骼型男性患者和10名同源对照受试者的样本中，研究了上气道结构与姿势之间与肥胖相关的相互作用。为每个受试者拍摄了一对直立位和仰卧位的头颅侧位片。Pearson相关分析确定了OSA患者的几个人口统计学变量的显著r值，如呼吸暂停低通气指数、预测颈围百分比、最低动脉血氧饱和度和体重指数（BMI）。计算了直立位和仰卧位受试者头颅测量变量之间的差异。当OSA患者从直立位变为仰卧位时，观察到颅底至上颈椎柱角度与下咽横截面积和BMI之间存在显著相关性。此外，下颌平面角和蝶鞍鼻根平面与BMI显著相关。这伴随着蝶鞍鼻根平面角与BMI之间的显著正相关以及下颌平面角相对于绝对垂直和水平平面与体位改变后的BMI之间的显著负相关。在对照受试者中未观察到此类相关性。在体位改变后，OSA患者或对照受试者中，与舌骨位置相关的变量与BMI之间均未观察到相关性。基于这些发现，我们提出，当OSA患者从直立位变为仰卧位时，（1）患者的颈部更加伸展，（2）舌骨随着下颌骨向上和向前旋转而更向前上方移动。颅面结构的这种变化可能是上气道的一种补偿性几何变化，以确保其通畅。
