The influential factors on the morphological changes of upper airway associated with mouth opening
The influential factors on the morphological changes of upper airway associated with mouth opening
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张口相关上气道形态变化的影响因素
DOI：
10.1002/lary.27212
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发表时间：
2018-12-01
期刊：
影响因子：
2.6
通讯作者：
Zhang, Yuhuan
中科院分区：
文献类型：
--
作者：
Hu, Bin;Ye, Jingying;Zhang, Yuhuan
目的探讨张口时上气道形态学改变的影响因素。方法入选138例阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者。记录人体测量学和人口统计学数据、Friedman舌位置（FTP）和扁桃体评分。在两种条件下（闭口[MC]和MO）采集过夜多导睡眠图和上气道计算机断层扫描。比较MC和MO上气道形态学参数。以MC与MO的上气道参数（Para-VRs）变异率为因变量，以年龄、性别、体重指数、颈围、腰围、下颌四指数、MO净角或净量、FTP、扁桃体评分为自变量，进行多元线性回归分析。结果总体分析和按OSAHS严重程度分组分析显示，MO组口咽腔最小横截面积（OXmin）显著减小（P < 0.05），而口咽腔最小横截面积（VXmin）无显著变化（P > 0.05）。MO的净角度或MO的量结合扁桃体评分被确定为与EXP（OXmin-VR）具有显著的正相关性，[OXmin-VR用指数函数进行数学转换，EXP（n）= e（n）]; FTP似乎与EXP（VXmin-VR）更相关。张口时FTP I级患者组的VXmin显著增加，FTP IV级患者组的VXmin显著降低（P < 0.05）。结论咽口扩大伴扁桃体增大导致口咽气道狭窄。舌与软腭的相对位置是影响咽腔变化的主要因素。证据等级4喉镜，128：2902-2909，2018
Objective This study aimed to evaluate the influential factors on the morphological changes of upper airway caused by mouth opening (MO). Methods One hundred and thirty-eight obstructive sleep apnea-hypopnea syndrome (OSAHS) patients were enrolled. Anthropometric and demographic data, Friedman tongue position (FTP), and tonsil scores were recorded. Overnight polysomnography and upper airway computed tomography scans under two conditions (mouth closed [MC] and MO) were acquired. Morphological parameters of upper airway were compared between MC and MO. Stepwise multiple linear regression analyses were performed with the variation ratio of upper airway parameters (Para-VRs) from MC to MO as the dependent variable, with age, gender, body mass index, neck circumference, waist circumference, four mandibular indexes, net angle or amount of MO, FTP, and tonsil scores as the independent variables. Results Overall analysis and subgroup analyses based on OSAHS severity revealed that the minimal cross-sectional area of oropharyngeal lumen (OXmin) significantly decreased (P < 0.05) with MO, whereas the minimal cross-sectional area of velopharyngeal lumen (VXmin) did not significantly change with MO (P > 0.05). The net angle of MO or amount of MO combined with tonsil scores were identified to have significant positive correlation with EXP (OXmin-VR), [OXmin-VR was logarithmically transformed with an exponential function, EXP(n) = e(n)]; FTP appeared to be more related to EXP (VXmin-VR). Mouth opening induced a significant increase VXmin for patient subgroup with FTP grading I and a significant decrease VXmin for patient subgroup with FTP grading IV (P < 0.05). Conclusion Wider MO combined with larger tonsils lead to narrower oropharyngeal airway. The relative position of tongue to soft palate is the main factor influencing the changes of velopharyngeal lumen with MO. Level of Evidence 4 Laryngoscope, 128:2902-2909, 2018