Assessment of pharyngeal airway stability in normal and micrognathic infants.
Assessment of pharyngeal airway stability in normal and micrognathic infants.
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正常和小颌婴儿咽部气道稳定性的评估。
DOI：
10.1152/jappl.1985.58.1.290
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
Thach,BT
中科院分区：
文献类型：
--
作者：
Roberts,JL;Reed,WR;Mathew,OP;Menon,AA;Thach,BT
目前关于阻塞性睡眠呼吸暂停的假设指出：1）吸气期间气道负压会使咽部气道塌陷，2）咽部气道扩张肌肉的神经控制对于防止这种塌陷非常重要。为了检验这一假设，我们对八名正常婴儿和五名小颌婴儿进行了鼻罩封闭，以增加吸气时的咽部气道负压。两组均出现吸气中段咽部阻塞，但阻塞在小颌婴儿中更为常见，并且在某些睡眠状态的婴儿中阻塞情况有所不同。气道通常会在随后的呼气后重新打开。偶尔无法重新打开可能是由于咽壁粘连所致。如果正常婴儿在多次呼吸鼻罩闭塞期间连续呼吸发生气道阻塞，则与气道关闭相关的气道压力（气道关闭压力）会随着每次呼吸而变化；气道关闭压逐渐变得更负。小颌婴儿改善气道闭合压力的能力较差，但这种能力随着年龄的增长而增强。这些发现表明，鼻罩封闭可以测试维持婴儿咽部气道通畅的神经肌肉机制的能力。小颌婴儿在打鼾时会出现自发性吸气中段咽部气道阻塞。他们的阻塞性呼吸暂停发作始于吸气中期咽部阻塞，类似于打鼾和鼻罩阻塞时所见的情况。这些发现意味着打鼾、自发性气道阻塞和打鼾期间阻塞具有相似的病理生理学。
A current hypothesis for obstructive sleep apnea states that 1) negative airway pressure during inspiration can collapse the pharyngeal airway, and 2) neural control of pharyngeal airway-dilating muscles is important in preventing this collapse. To test this hypothesis we performed nasal mask occlusions to increase negative pharyngeal airway pressures during inspiration in eight normal and five micrognathic infants. Both groups developed midinspiratory pharyngeal obstruction, but obstruction was more frequent in micrognathic infants and varied in some infants with sleep state. The airway usually reopened with the subsequent expiration. The occasional failure to reopen was presumably due to pharyngeal wall adhesion. If airway obstruction occurred in sequential breaths during multiple-breath nasal mask occlusions in normal infants, there was a breath-by-breath change in the airway pressure associated with airway closure (airway closing pressure); the airway closing pressure became progressively more negative. Micrognathic infants showed less ability to improve the airway closing pressure, but this ability increased with age. These findings suggest that nasal mask occlusion can test the competence of the neuromuscular mechanisms that maintain pharyngeal airway patency in infants. Micrognathic infants had spontaneous midinspiratory pharyngeal airway obstructions during snoring. Their episodes of obstructive apnea began with midinspiratory pharyngeal obstruction similar to that seen during snoring and nasal mask occlusions. These findings imply a similar pathophysiology for snoring, spontaneous airway obstruction, and obstruction during snoring.