Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects
Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects
复制标题
DOI：
10.1152/jappl.1997.82.4.1319
复制
发表时间：
1997-04-01
影响因子：
3.3
通讯作者：
Nishino, T
中科院分区：
文献类型：
--
作者：
Isono, S;Remmers, JE;Nishino, T
咽的解剖异常被认为在阻塞性睡眠呼吸暂停（OSA）的发病机制中起作用，但其作用从未得到最终证实。本研究通过比较OSA患者和正常人的麻痹性咽部力学来验证这一解剖学假说。根据夜间血氧仪评估睡眠呼吸障碍（SDB）情况，将受试者分为正常组（n = 17）、SDB-1组（n = 18）、SDB-2组（n = 22）。在全麻完全麻痹状态下，对被动咽部静压-面积关系进行量化。三组的年龄和身体质量指数相匹配。49例患者的初次闭合部位为腭咽，8例患者为口咽。初级闭合位置的分布在各组之间没有差异。SDB-1组和SDB-2组的腭咽闭合压力（Pc）分别为0.90 +/- 1.34和2.78 +/- 2.78 cmH(2)O，显著高于正常组(-3.77 +/- 3.44 cmH(2)O；P < 0.01)。正常组的最大腭咽面积（2.10 +/- 0.85 cm(2)）显著大于SDB-1组和SDB-2组（分别为1.15 +/- 0.46和1.06 +/- 0.75 cm(2)）。正常受试者和SDB患者的腭咽压力-面积曲线形状不同，SDB患者在Pc附近的斜率更陡。力学参数和氧去饱和指数（ODI）的多变量分析显示，腭咽Pc是唯一与ODI高度相关的变量。腭咽Pc与口咽Pc相关，提示这两个节段的机械相互依赖。我们得出结论，睡眠呼吸暂停患者的被动咽部比对照组更狭窄和可折叠，腭咽Pc是夜间去饱和频率的主要相关因素。
Anatomic abnormalities of the pharynx are thought to play a role in the pathogenesis of obstructive sleep apnea (OSA), but their contribution has never been conclusively proven. The present study tested this anatomic hypothesis by comparing the mechanics of the paralyzed pharynx in OSA patients and in normal subjects. According to evaluation of sleep-disordered breathing (SDB) by nocturnal oximetry, subjects were divided into three groups: normal group (n = 17), SDB-1 (n = 18), and SDB-2 (n = 22). The static pressure-area relationship of the passive pharynx was quantified under general anesthesia with complete paralysis. Age and body mass index were matched among the three groups. The site of the primary closure was the velopharynx in 49 subjects and the oropharynx in only 8 subjects. Distribution of the location of the primary closure did not differ among the groups. Closing pressure (Pc) of the velopharynx for SDB-1 and SDB-2 groups (0.90 +/- 1.34 and 2.78 +/- 2.78 cmH(2)O, respectively) was significantly higher than that for the normal group (-3.77 +/- 3.44 cmH(2)O; P < 0.01). Maximal velopharyngeal area for the normal group (2.10 +/- 0.85 cm(2)) was significantly greater than for SDB-1 and SDB-2 groups (1.15 +/- 0.46 and 1.06 +/- 0.75 cm(2), respectively). The shape of the pressure-area curve for the velopharynx differed between normal subjects and patients with SDB, being steeper in slope near Pc in patients with SDB. Multivariate analysis of mechanical parameters and oxygen desaturation index (ODI) revealed that velopharyngeal Pc was the only variable highly correlated with ODI. Velopharyngeal Pc was associated with oropharyngeal Pc, suggesting mechanical interdependence of these segments. We conclude that the passive pharynx is more narrow and collapsible in sleep-apneic patients than in matched controls and that velopharyngeal Pc is the principal correlate of the frequency of nocturnal desaturations.