Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea
Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea
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DOI：
10.1164/ajrccm.161.2.9810091
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发表时间：
2000-02-01
影响因子：
24.7
通讯作者：
Krieger, J
中科院分区：
文献类型：
--
作者：
Sforza, E;Bacon, W;Krieger, J
增加的咽萎陷性和异常的解剖结构被认为有助于阻塞性睡眠呼吸暂停（OSA）综合征的病理生理。颅面和软组织的异常特征是否会影响咽陷性并导致呼吸暂停密度，目前尚不清楚。在本研究中，我们检查了57名男性OSA患者咽萎性与头测量变量之间的关系。通过分析压流关系，测定鼻腔持续气道正压（nCPAP）滴定夜间咽溃性。咽部临界压力（Pcrit）计算为零流量时的外推压力。患者年龄52.0 +/- 9.0岁，平均呼吸暂停低通气指数（AHI）为72.6 +/- 31.8，平均Pcrit为2.4 +/- 1.0 cm H2O。Pcrit与软腭长度（SPI） （r = 0.27, p = 0.04）、舌骨到咽后壁的距离（H-Ph） （r = 0.29, p = 0.03）、舌骨到鼻后间隙的距离（H-Pns） （r = 0.32, p = 0.02）有显著相关性。肥胖患者的Pcrit与SPI和颈围有关，非肥胖患者的Pcrit受舌骨到下颌平面的距离（H-MP）的影响。我们的研究结果表明，咽部软组织异常和舌骨下部位置均影响OSA患者的Pcrit，提示解剖性变窄有助于上呼吸道塌陷。
Increased pharyngeal collapsibility and abnormal anatomic structures have been postulated to contribute to the pathophysiology of obstructive sleep apnea (OSA) syndrome. It is unclear whether the abnormal craniofacial and soft tissue features may affect the pharyngeal collapsibility and contribute to the apnea density. In the present study we examine the relationship between pharyngeal collapsibility and cephalometric variables in a group of 57 male OSA patients. Pharyngeal collapsibility was measured during the night of nasal continuous positive airway pressure (nCPAP) titration by analyzing the pressure-flow relationship. Pharyngeal critical pressure (Pcrit) was calculated as the extrapolated pressure at zero flow. The patients, age 52.0 +/- 9.0 yr, had an average apnea-hypopnea index (AHI) of 72.6 +/- 31.8 and a mean Pcrit of 2.4 +/- 1.0 cm H2O. A significant correlation was found between Pcrit and the soft palate length (SPI) (r = 0.27, p = 0.04), the distance from the hyoid bone to the posterior pharyngeal wall (H-Ph) (r = 0.29, p = 0.03), and the distance from the hyoid bone to posterior nasal space (H-Pns) (r = 0.32 p = 0.02). While in obese patients Pcrit was related to SPI and neck circumference, the distance of the hyoid bone to the mandibular plane (H-MP) affected Pcrit in nonobese patients. Our results show that both pharyngeal soft tissue abnormalities and the lower position of the hyoid bone affect Pcrit in OSA patients, suggesting that an anatomic narrowing contributes to the upper airway collapsibility.