纤维鼻咽喉镜下观察经药物诱导睡眠的鼾症患者鼾声来源

doi:10.6040/j.issn.1673-3770.0.2015.054

摘要/Abstract

摘要： 目的对睡眠呼吸障碍程度不同的鼾症患者进行药物诱导下睡眠, 通过纤维鼻咽喉镜下观察患者睡眠中鼾声来源, 为治疗鼾症提供依据。方法经多导睡眠监测(PSG)诊断为单纯打鼾(SS)及轻、中、重度(AHI≤40次/h)阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的患者共52例, 用异丙酚复合右美托米啶进行诱导睡眠后, 通过纤维鼻咽喉镜观察不同组鼾症患者仰卧位打鼾时咽部组织的振动及塌陷情况。结果鼾声可来源于软腭、咽侧壁、会厌及舌根的振动, 其中咽侧壁振动的发生率在各组中的差异有统计学意义。不同患者的鼾声来源表现为单纯软腭振动型(Ⅰ型)和混合振动型(Ⅱ型)两大类型, Ⅱ型又可分为软腭加会厌振动(或加会厌舌根振动, Ⅱa型)、软腭加咽侧壁振动(Ⅱb型)和软腭加咽侧壁及会厌舌根振动(Ⅱc型)3种亚型。Ⅰ型鼾声来源在SS和轻、中、重度OSAHS患者中的比例有逐渐降低的趋势, Ⅱb型来源多见于中、重度患者, Ⅱc型来源在重度患者中最多见。结论鼾声来源具有多样性, 睡眠呼吸障碍程度不同的鼾症患者鼾声来源有不同的特点, 选择治疗措施时应对主要鼾声来源进行辨别。

关键词: 阻塞性, 睡眠呼吸暂停, 单纯打鼾, 鼾声, 药物诱导睡眠, 纤维鼻咽喉镜

Abstract: Objective To investigate the sources of snoring sound in simple snores and in patients with different degrees of obstructive sleep apnea/hypopnea syndrome (OSAHS). Methods A total of 15 subjects with simple snores and 37 patients with mild to severe OSAHS were involved. Sites of vibration from nasopharynx to laryngeal pharynx while snoring in each patient were observed with fiberoptic laryngoscope during drug-induced sleep. Results Vibration of soft palate, lateral wall, epiglottis and tongue base could be observed during snoring, and the distribution of lateral wall vibration had statistical significance among different groups.52 snores showed two types of source of snoring in general: palatal fluttering only(type Ⅰ) and multisite vibration (type Ⅱ). The latter could be divided into 3 subtypes further: palatal fluttering with vibration of epiglottis (type Ⅱa), palatal fluttering with vibration of Lateral wall(type Ⅱb), and palatal fluttering with vibration of lateral wall, epiglottis and tongue base together(type Ⅱc). Percentage of type Ⅰ decreased as the severity of OSAHS increased. Type IIb was more common in patients with media and heavy OSAHS, and type IIc were most common in patients with heavy OSAHS. Conclusion Source of snoring is of diversity, snorers with different severity of sleep breath disorder shows different patterns of that. The main source of snoring should be identified when we choose treatment method for snorers.

Key words: Drug-induced sleep, Fiberoptic laryngoscope, Sleep apnea hypopnea, obstructive, Snoring sound, Simple snoring

中图分类号:

R766.7

许辉杰, 贾瑞芳, 于晖, 高瞻, 彭好, 杨弋, 张雷, 黄魏宁. 纤维鼻咽喉镜下观察经药物诱导睡眠的鼾症患者鼾声来源[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 1-5.

XU Huijie, JIA Ruifang, YU Hui, GAO Zhan, PENG Hao, YANG Yi, ZHANG Lei, HUANG Weining. Sources of snoring sound during drug-induced sleep observed with fiberoptic laryngoscope[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2015, 29(3): 1-5.

参考文献

[1] 许辉杰, 黄魏宁. 鼾声声学特征研究现状[J]. 国际耳鼻咽喉头颈外科杂志, 2013, 37(5):278-282. XU Huijie, HUANG Weining. Current situation of research on acoustic characters of snoring sound[J]. Int J Otolaryngol Head Neck Surg, 2013, 37(5):278-282.
[2] Xu H, Huang W, Yu L, et al. Sound spectral analysis of snoring sound and site of obstruction in obstructive sleep apnea syndrome[J]. Acta Otolaryngologica, 2010, 130(10):1175-1179.
[3] Pevernagie D, Aarts R M, De Meyer M. The acoustics of snoring[J]. Sleep Med Rev, 2010, 14(2):131-144.
[4] 智铁铮, 张莉, 高国风, 等. 药物诱导睡眠下纤维鼻咽喉镜和多导睡眠仪的同步检查[J]. 中华耳鼻咽喉科杂志, 2003, 38(5):383-386. ZHI Tiezheng, ZHANG Li, GAO Guofeng, et al. Clinical study of synchronized examinations of nasopharyngoscope and polysomnography during drug-induced sleep[J]. Chin J Otorhinolarynol Head Neck Surg, 2003, 38(5):383-386.
[5] De Vito A, Agnoletti V, Berrettini S, et al. Drug-induced sleep endoscopy: conventional versus target controlled infusion techniques-a randomized controlled study[J]. Eur Arch Otorhinolaryngol, 2011, 268(3):457-462.
[6] Dalmasso F, Prota R. Snoring: analysis, measurement, clinical implications and applications[J]. Eur Respir J, 1996, 9(1):146-159.
[7] Quinn S J, Huang L, Ellis P D, et al. The differentiation of snoring mechanisms using sound analysis[J]. Clin Otolaryngol Allied Sci, 1996, 21(2):119-123.
[8] Quinn S J, Daly N, Ellis P D. Observation of the mechanism of snoring using sleep nasendoscopy[J]. Clin Otolaryngol Allied Sci, 1995, 20(4):360-364.
[9] Vicini C, Marani M, Frasconi P C. Failures in snoring and osas surgery[J]. Facial Plast Surg, 1999, 15(4):327-335.
[10] Levin B C, Becker G D. Uvulopalatopharyngoplasty for snoring: long-term results[J]. Laryngoscope, 1994, 104(9):1150-1152.
[11] Pilaete K, De Medts J, Delsupehe K G. Drug-induced sleep endoscopy changes snoring management plan very significantly compared to standard clinical evaluation[J]. Eur Arch Otorhinolaryngol, 2014, 271(5):1311-1319.
[12] Friedman M, Ibrahim H, Vidyasagar R, et al. Z-palatoplasty(ZPP): a technique for patients without tonsils[J]. Otolaryngology Head Neck Surg, 2004, 131(1):89-100.
[13] Pang K P, Woodson B T. Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea[J]. Otolaryngology Head Neck Surg, 2007, 137(1):110-114.
[14] Agrawal S, Stone P, Mcguinness K, et al. Sound frequency analysis and the site of snoring in natural and induced sleep[J]. Clin Otolaryngol Allied Sci, 2002, 27(3):162-166.
[15] Ravesloot M J, De Vries N. One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation[J]. Laryngoscope, 2011, 121(12):2710-2716.
[16] Jone T M, Ho M S, Earis J E, et al. Acoustic parameters of snoring sound to compare natural snores with snores during "steady-state" propofol[J]. Clin Otolaryngol, 2006, 31(1):46-52.
[17] Steinhart H, Kuhn-Lohmann J, Gewalt K, et al. Upper airway collapsibility in habitual snorers and sleep apneics: evaluation with drug-induced sleep endoscopy[J]. Acta Otolaryngol, 2000, 120(8):990-994.
[18] 李五一, 倪道凤, 姜鸿, 等. 阻塞性睡眠呼吸暂停综合征患者睡眠时咽腔观察[J]. 中华耳鼻咽喉科杂志, 1999, 34(1):38-40. LI Wuyi, NI Daofeng, JIANG Hong, et al. Pharyngoscopic observation during sleep in patients with obstructive sleep apnea syndrome[J]. Chin J Otorhinolarynol Head Neck Surg, 1999, 34(1):38-40.
[19] 周鹏, 神平, 刘稳, 等. 药物诱导睡眠内镜检查对上气道阻塞平面形态的研究[J]. 中华耳鼻咽喉头颈外科杂志, 2014, 49(1):58-61. ZHOU Peng, SHEN Ping, LIU Wen, et al. Research on the patterns of upper airway obstructive levels by drug-induced sleep endoscopy[J]. Chin J Otorhinolarynol Head Neck Surg, 2014, 49(1):58-61.
[20] 中华医学会麻醉学会. 右美托咪定临床应用指导意见(2013)[J]. 中华医学杂志, 2013, 93(35):2775-2777. The Chinese Medical Association of Anesthesia. Instruction for clinical application of dexmedetomidine[J]. Nat Med J Chin, 2013, 93(35):2775-2777.
[21] Kotecha B T, Hannan A, Khalil H, et al. Sleep nasendoscopy: a 10-year retrospective audit study[J]. Eur Arch Otorhinolaryngol, 2007, 264:1361-1367.
[22] Eichler C, Sommer J U, Stuck B A, et al. Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea?[J]. Sleep Breath, 2013, 17(1):63-68.

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