不同性别阻塞性睡眠呼吸暂停低通气综合征患者与上气道影像学相关性的研究

doi:10.6040/j.issn.1673-3770.0.2017.100

摘要/Abstract

摘要： 目的探讨上气道影像学在不同性别阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者病情严重程度中的预测作用。方法对163例经多导睡眠监测(PSG)确诊为OSAHS患者(男98例,女65例),行平静呼吸时上气道CT扫描,测量舌骨下缘距下颌骨下缘(颏下点)的垂直距离(D-HM)、舌骨最前点距下颌骨下缘(颏下点)的距离等CT参数,并进行各测量值与睡眠呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(LSaO₂)的相关性分析。结果 (1)AHI。男性患者14.2~52.3次/h,平均(36.22±5.64)次/h;女性患者9.6~46.4次/h,平均(29.38±3.90)次/h;(2)LSaO₂。男性患者48%~79%,平均(63.93%±10.51%);女性患者59%~87%,平均(70.92%±9.17%);(3)各研究平面的最小前后径、左右径及面积与AHI的大小均呈负相关,与LSaO₂呈正相关,且男性OSAHS患者AHI、LSaO₂与腭后区最小截面积相关性更明显(r=-0.441,P<0.01),而女性OSAHS患者AHI、LSaO₂与舌后区最小截面积相关性更明显(r=-0.403,P<0.01);(4)不同性别之间舌骨下缘距下颌骨下缘(颏下点)的垂直距离(D-HM)、舌骨最前点距下颌骨下缘(颏下点)的距离差异具有统计学意义(P<0.01);(5)对部分OSAHS患者行改良UPPP手术,术后3个月,男性OSAHS患者总有效率为84.31%,女性OSAHS患者总有效率为58.06%,CT测量值男性OSAHS患者有4个数值与术前相比有统计学意义,而女性患者有1个数值与术前相比有统计学意义。结论 OSAHS患者上气道CT的测量指标可对OSAHS病情的严重程度有一定预测作用,且不同性别之间的测量数值差异有统计学意义,需根据性别的不同来制定个体化诊疗意见。

关键词: 睡眠呼吸暂停, X线计算机, 改良悬雍垂腭咽成形术, 舌骨, 性别, 体层摄影术, 阻塞性, 多导睡眠监测

Abstract: Objective To investigate the ability of upper airway measurement to predict the severity of obstructive sleep apnea hypopnea syndrome(OSAHS)in different genders. Methods This study included 163 OSAHS patients(98 men and 65 women)diagnosed by polysomnography. Computed tomography(CT)scans of the upper airway during quiet breathing were performed. Parameters including the vertical distance from the inferior margin of the hyoid to the inferior mandibular margin(submental point)(D-HM)and from the forefront points of the hyoid to the inferior mandibular margin(submental point)were measured. Results The AHI was 14.2-52.3/h(mean, 36.22±5.64/h)in men and 9.6-46.4/h(mean, 29.38 ± 3.90/h)in women. The LSaO₂ was 48%-79%(mean, 63.93%±10.51%)in men and 59%-87%(mean, 70.92%±9.17%)in women. The minimal anteroposterior diameter, left and right diameters, and area of each plane were negatively correlated with the AHI and positively correlated with LSaO₂. In men, the AHI and LSaO₂ were strongly correlated with the minimal cross-sectional area of the retropalatal area(r=-0.441; P < 0.01); the AHI and LSaO₂ of women were strongly correlated with the minimal cross-sectional area of the lingual region(r=-0.403; P<0.01). There was a significant difference in the vertical distance from the inferior margin of 山东大学耳鼻喉眼学报31卷4期 -刘文君,等.不同性别阻塞性睡眠呼吸暂停低通气综合征患者与上气道影像学相关性的研究 \=-the hyoid to the D-HM, and in the distance from the forefront points of the hyoid to the inferior mandibular margin(submental point), between men and women(P<0.01). Some OSAHS patients received modified UPPP surgery. The effective rate in men and women 3 months after surgery was 84.31% and 58.06%, respectively. Significant postoperative differences as measured by CT scan were observed in four male OSAHS patients, but only one female patient. Conclusions CT measurements of the upper airway of OSAHS patients could help predict the severity of OSAHS. This study revealed a significant difference between the upper airway measurements of men and women. Individualized treatments should consider gender as a factor.

Key words: Obstructive sleep apnea hypopnea syndrome, Hyoid, Polysomnography, X-ray computed tomography, Gender, H-uvulopalatopharyngoplasty

中图分类号:

R766.7

刘文君,于雪莹,吕丹,陈正岗,张艳青,梅栩彬,杨珂. 不同性别阻塞性睡眠呼吸暂停低通气综合征患者与上气道影像学相关性的研究[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 54-59.

LIU Wenjun, YU Xueying, LÜ Dan, CHEN Zhenggang, ZHANG Yanqing, MEI Xubin, YANG Ke. Correlation between obstructive sleep apnea hypopnea syndrome and upper airway measurements of different genders.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(4): 54-59.

参考文献

[1] 中华医学会耳鼻咽喉头颈外科学分会咽喉学组, 中华耳鼻咽喉头颈外科杂志编辑委员会. 阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(2):95-96. Chinese magazine editor committee of otolaryngology head and neck surgery, Chinese medical association otolaryngology head and neck surgery branch of the throat group.Patients with obstructive sleep apnea hypopnea syndrome diagnosis and surgical treatment guidelines[J]. Chin J Otolaryngology Head Neck Surgery, 2009, 44(2): 95-96.
[2] 曹鑫, 叶京英, 张俊波,等. 舌骨位置对预测阻塞性睡眠呼吸暂停低通气综合征腭部手术疗效的作用[J]. 中华耳鼻咽喉头颈外科杂志, 2015, 50(4):281-285. CAO Xin, YE Jingying, ZHANG Junbo, et al. Effects of hyoid position on surgical treatment outcome for patients with obstructive sleep apnea hypopnea syndrome[J]. Chin J Otorhinolarynol Head Neck Surg, 2015, 50(4):281-285.
[3] 顼晋昆, 叶京英, 常青林, 等. 上气道CT软组织测量值与阻塞性睡眠呼吸暂停低通气综合征病情程度的关系[J].中华耳鼻咽喉头颈外科杂志, 2010, 45(5): 387-392. XU Jinkun, YE Jingying, CHANG Qinglin, et al.Correlation between upper airway soft tissue 3-D measurement and the severity of obstructive sleep apnea hypopnea syndrome[J]. Chin J Otorhinolarynol Head Neck Surg, 2010, 45(5):387-392.
[4] 尹国平, 叶京英, 常青林. 阻塞性睡眠呼吸暂停低通气综合征患者咽腔容积测量[J]. 中国耳鼻咽喉头颈外科, 2008, 15(2): 103-106. YIN Guoping, YE Jingying, CHANG Qinglin, et al. Pharyngeal volume measurement using CT three-dimensional reconstruction technique in patients with OSAHS[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2008, 15(2): 103-106.
[5] Deegan PC, McNichols WT. Pathophysiology of obstructive sleep apnea[J]. EurRespir J, 1995, 8(7):1161-1178.
[6] Huang TW, Cheng PW. Microdebrider-assisted Extended Uvulopalatoplasty: an Effective and Safe Technique for Selected Patients with Obstructive Sleep Apnea Syndrome[J]. Arch Otolaryngol Head Neck Sury, 2008, 134(2): 141-145.
[7] 胡芸, 张树桐, 金朝林, 等. 64层螺旋CT诊断阻塞性睡眠呼吸暂停综合征[J]. 放射学实践, 2009, 24(6): 622-624. HU Yun, ZHANG Shutong, JIN Chaolin,et al. Clinical Application of 64-slice Spiral CT in Diagnosis of Obstructive Sleep Apnea Hypopnea Syndrome[J]. Radiologic Practice, 2009, 24(6): 622-624.
[8] 乔晓丞, 李树华, 石洪金. 阻塞性睡眠呼吸暂停低通气综合征患者及正常成人呼吸运动周期中上气道形态变化的研究[J]. 临床耳鼻咽喉头颈外科杂志, 2009, 23(24): 1123-1127. QIAO Xiaocheng, LI Shuhua, SHI Hongjin. Difference of upper airway variety with respiration in the sufferer of OSAHS and normal adult[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2009, 23(24): 1123-1127.
[9] Mohsenin V. Effects of gender on upper airway collapsibility and severity of obstructive sleep apnea[J]. Sleep Med, 2003, 4(6): 523-529.
[10] 尹国平, 叶京英, 常青林,等. 中老年女性阻塞性睡眠呼吸暂停低通气综合征患者上气道形态功能研究[J]. 中国耳鼻咽喉头颈外科, 2008, 15(6): 357-360. YIN Guoping, YE Jingying, CHANG Qinglin, et al.Upper airway morphology and function study of middle-age and old women with OSAHS[J]. Chin J Otorhinolarynol Head Neck Surg, 2008, 15(6): 357-360.
[11] 易红良, 殷善开, 关建,等. 颏舌肌前移术的应用解剖学研究[J]. 临床耳鼻咽喉科杂志, 2004, 18(12): 719-722. YI Hongliang, YIN Shankai, GUAN Jian, et al. Applied anatomic study for genioglossusadvancement[J]. Clin J Otorhinolarynol Head Neck Surg, 2004, 18(12): 719-722.
[12] 马国伟, 张庆泉, 周文亮. 舌骨位置与舌后气道最小截面积及阻塞性睡眠呼吸暂停低通气综合征严重程度的相关性分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(6): 66-68. MA Guowei, ZHANG Qingquan, ZHOU Wenliang. Correlation of hyoid position, minimal retroglossal cross-section area and severity of obstructive sleep apnea hypopnea syndrome[J]. J Otolaryngol Ophthalmol Shandong Univ, 2013, 27(6): 66-68.
[13] Leiter JC. Upper airway shape: Is it important in the pathogenesis of obstructive sleep apnea? [J]. Am J RespirCrit Care Med, 1996, 153(3): 894-898.
[14] Millman RP, Carlisle CC, Rosenberg C, et al. Simple predictors of uvulopalatopharyngoplasty outcome in the treatment of obstructive sleep apnea[J]. Chest, 2000, 118(4):1025-1030.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed

[1]	刘大炜,张宇,李成林,陈秀梅,宋西成. 加速康复外科在儿童OSAS围手术期中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 19-22.
[2]	吕旭琴,万文锦. 阻塞性睡眠呼吸暂停低通气综合征合并高血糖患者的围手术期血糖管理[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 100-104.
[3]	陈涛,刘善平,卢永田. 中耳炎鼓室窦CT分型与手术方式初探[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 14-16.
[4]	于倩倩,关鸽,张念凯,李娜,温君凤,刘婷婷,连媛媛. 鼻腔嗅裂区呼吸道上皮腺瘤样错构瘤的CT影像表现[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 76-81.
[5]	张会芳,杨红珍. 经鼻持续气道正压通气对阻塞性睡眠呼吸暂停低通气[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 48-51.
[6]	许志飞,倪鑫. 重视阻塞性睡眠呼吸暂停低通气综合征儿童腺样体[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 9-13.
[7]	王岩,师晓丽. 变态反应与儿童OSAHS的关系[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 14-18.
[8]	杨微,郑莉,许志飞. 中重度阻塞性睡眠呼吸暂停低通气综合征儿童无创正压[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 19-24.
[9]	仇书要,刘大波,钟建文,杨李强. 儿童阻塞性睡眠呼吸暂停低通气综合征等离子[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 34-37.
[10]	钟建文,刘大波,罗向前,黄振云,仇书要,程超,杨李强,易新华,曾锦鸿. 可穿戴设备在儿童阻塞性睡眠呼吸暂停诊断中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 30-33.
[11]	李浩,李延忠,王岩. HIF-1α、VEGF在阻塞性睡眠呼吸暂停低通气综合征患者[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 43-47.
[12]	龚齐,张劼,赵屏屏. 鼻腔扩容术对慢性鼻-鼻窦炎伴睡眠呼吸暂停[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 52-55.
[13]	王红梅,李连贺. 神经心理量表联合事件相关电位对中、重度阻塞性睡眠呼吸[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 56-61.
[14]	刘大波. 重视儿童阻塞性睡眠呼吸暂停低通气综合征睡眠结构紊乱[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 6-8.
[15]	沈翎,林宗通,林兴,杨中婕. 儿童阻塞性睡眠呼吸暂停低通气综合征危险因素的[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 25-29.