Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging
Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging
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DOI：
10.1164/rccm.200208-866oc
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发表时间：
2003-09-01
影响因子：
24.7
通讯作者：
Pack, AI
中科院分区：
文献类型：
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作者：
Schwab, RJ;Pasirstein, M;Pack, AI
我们在病例对照设计中使用了具有磁共振成像的复杂体积分析技术，以研究48位控制受试者的上空气道软组织结构（呼吸暂停指数，2.0 +/- 1.6事件/小时）和48例睡眠呼吸暂停患者（呼吸暂停指数，43.8 +/- 25.4事件/小时）。我们的设计使用了性别和种族，年龄匹配的频率匹配以及颅面大小和内脏颈部脂肪的统计控制。该数据支持我们先验假设，即睡眠呼吸暂停患者的上呼吸道周围软组织结构的体积已扩大，并且这种增大是睡眠呼吸暂停的重要危险因素。协变量调整后，睡眠呼吸暂停受试者的侧面咽壁的体积（p <0.0001），舌头（p <0.0001）和总软组织（P <0.0001）明显大于正常受试者中。这些数据还表明，在协变量调整后，舌头的体积越大，咽壁和总软组织大大增加了睡眠呼吸暂停的风险：（1）总咽壁壁（ORD]，6.01，6.01; 95％; 95％; 95％;置信区间[CI]，2.62-17.14）; （2）总舌头（OR，4.66; 95％CI，2.31-10.95）; （3）总软组织（OR，6.95; 95％CI，3.08-19.11）。在多变量的逻辑回归分析中，舌头和侧壁的体积被证明可独立增加睡眠呼吸暂停的风险。
We used sophisticated volumetric analysis techniques with magnetic resonance imaging in a case-control design to study the upper airway soft tissue structures in 48 control subjects (apnea-hypopnea index, 2.0 +/- 1.6 events/hour) and 48 patients with sleep apnea (apnea-hypopnea index, 43.8 +/- 25.4 events/hour). Our design used exact matching on sex and ethnicity, frequency matching on age, and statistical control for craniofacial size and visceral neck fat. The data support our a priori hypotheses that the volume of the soft tissue structures surrounding the upper airway is enlarged in patients with sleep apnea and that this enlargement is a significant risk factor for sleep apnea. After covariate adjustments the volume of the lateral pharyngeal walls (p < 0.0001), tongue (p < 0.0001), and total soft tissue (p < 0.0001) was significantly larger in subjects with sleep apnea than in normal subjects. These data also demonstrated, after covariate adjustments, significantly increased risk of sleep apnea the larger the volume of the tongue, lateral pharyngeal walls, and total soft tissue: (1) total lateral pharyngeal wall (odds ratio [OR], 6.01; 95% confidence interval [CI], 2.62-17.14); (2) total tongue (OR, 4.66; 95% CI, 2.31-10.95); and (3) total soft tissue (OR, 6.95; 95% CI, 3.08-19.11). In a multivariable logistic regression analysis the volume of the tongue and lateral walls was shown to independently increase the risk of sleep apnea.