Videoendoscopic Assessment of Uncommon Sites of Upper Airway Obstruction during Sleep
Videoendoscopic Assessment of Uncommon Sites of Upper Airway Obstruction during Sleep
复制标题
睡眠期间上呼吸道阻塞的罕见部位的视频内窥镜评估
DOI：
10.1007/s11325-000-0131-9
复制
发表时间：
2000
影响因子：
2.5
通讯作者：
K. Hörmann
中科院分区：
文献类型：
--
作者：
J. Maurer;B. Stuck;G. Hein;K. Hörmann
睡眠呼吸障碍(SDB)患者反复上呼吸道阻塞。已经描述了各种技术来评估上呼吸道塌陷的位置。在大多数情况下，软腭部或舌根部或两者都是主要的梗阻部位；很少会累及喉部，包括会厌。我们提出五个案例，在这些案例中，睡眠视频内窥镜最终揭示了吸气行为的真实机制。两名患者因鼻腔机械通气治疗无效而被送往我们的服务中心。其中一例会厌松弛，被吸入声门。另一名患者在电视内窥镜检查中喉部正常。相反，可以检测到常见的咽部塌陷。增加压力使睡眠、呼吸和电视内窥镜检查正常化。第三例患者因会厌会厌外收部内收而出现呼吸暂停。在另一个案例中，吸气性声带颤动引起鼾声和觉醒。最后一例患者为双侧声带麻痹，夜间出现严重的低饱和度，提示呼吸道关闭。然而，咽喉整夜都是开放的。睡眠电视内窥镜是确定梗阻性SDB闭塞程度和机制的一种方便的方法，尤其是在累及喉部的情况下。在反复出现夜间低氧血症的情况下，排除呼吸道损害是有用的。因此，睡眠电视内窥镜检查的结果对治疗有很强的影响。
Patients with sleep-disordered breathing (SDB) suffer from repetitive upper airway occlusion. Various techniques have been described to assess the site of upper airway collapse. In most cases the soft palate or the base of tongue, or both, are the major levels of obstruction; rarely, the larynx, including the epiglottis, are found to be involved. We present five cases in which sleep videoendoscopy finally revealed the true mechanism of the inspiratory airway behavior. Two patients were sent to our service because of inefficacy of nasal ventilation therapy. One had a floppy epiglottis that was being sucked into the glottis. The other had a normal larynx during videoendoscopy. Instead, common pharyngeal collapse could be detected. Increasing the pressure normalized sleep, breathing, and videoendoscopy. The third patient showed apneas due to the adduction of the lateral parts of his omega-shaped epiglottis. In another case, inspiratory fluttering of the vocal cords caused snoring and arousals. The last case came in for bilateral vocal cord palsy with heavy nocturnal desaturations suggesting airway closure. Yet, the pharynx and larynx remained open throughout the night. Sleep videoendoscopy is a convenient method to define the level and mechanism of occlusion in obstructive SDB, particularly if the larynx is involved. It is useful to rule out airway compromise in case of recurrent nocturnal hypoxemias. Thus the results of sleep videoendoscopy have a strong therapeutical impact.