Three-dimensional Morphological Analyses of Positional Dependence in Patients with Obstructive Sleep Apnea Syndrome
Three-dimensional Morphological Analyses of Positional Dependence in Patients with Obstructive Sleep Apnea Syndrome
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DOI：
10.1097/aln.0b013e31819b5d57
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发表时间：
2009-04-01
期刊：
影响因子：
8.8
通讯作者：
Kodera, Kazuoki
中科院分区：
文献类型：
--
作者：
Saigusa, Hanako;Suzuki, Masaaki;Kodera, Kazuoki
背景资料：一般认为，阻塞性睡眠呼吸暂停综合征（OSAS）患者在围手术期的风险增加，应在整个恢复过程中放置在非仰卧位，然而，并不是所有的OSAS患者显示位置依赖。作者假设体位性和非体位性阻塞性睡眠呼吸暂停综合征患者咽部气道的三维软组织和颅面结构存在形态学差异。研究对象是体重指数匹配的，年龄匹配的，和呼吸暂停低通气指数匹配的体位性（n = 10）和非体位性（n = 10）日本OSAS患者和体重指数匹配的日本对照组（n = 10）。结果：体位性OSAS患者咽部外侧壁软组织体积较非体位性OSAS患者和对照组小，上下颌角较大，下面部高度较小。位置性OSAS患者的鞍-鼻根-下颌角较对照组明显变陡，颅面体积较对照组明显减小。体位性和非体位性OSAS患者的舌体积和咽部三维解剖平衡无显著差异。多元逐步回归分析显示，咽侧壁的体积是影响下颌骨位置的主要因素，其次是较低的面高和上下颌角。位置性阻塞性睡眠呼吸暂停综合征患者侧位气道较宽，面高较低，下颌位置较后，这可以解释在侧睡位置中保持咽气道开放性的差异。
Background: It is generally considered that patients with obstructive sleep apnea syndrome (OSAS) at increased perioperative risk should be placed in nonsupine positions throughout the recovery process; however, not all patients with OSAS show positional dependence. The authors hypothesized that morphological differences exist In three-dimensional (3D) soft tissue and craniofacial structures of the pharyngeal airway between positional and nonpositional OSAS.Methods: The subjects of the study were body mass index-matched, age-matched, and apnea hypopnea index-matched positional (n = 10) and nonpositional (n = 10) Japanese OSAS patients and body mass index-matched Japanese control subjects (n = 10). Pharyngeal magnetic resonance imaging and cephalometric radiography were performed during wakefulness.Results: The patients with positional OSAS had a smaller volume of die pharyngeal lateral wall soft tissues, larger maxilla-nasion-mandible angle, and smaller lower facial height than the nonpositional OSAS and the control subjects. The patients with positional OSAS showed a significantly steeper sella-nasion-mandible angle and smaller craniofacial volume than the control subjects. There were no significant differences In tongue volume and 3D pharyngeal anatomical balance between positional and nonpositional OSAS. Multivariate stepwise regression for positional dependence showed that the dominant determinant was the volume of the lateral pharyngeal wall, followed by lower facial height and maxilla-nasion-mandible angle.Conclusions: Patients with positional OSAS have wider airways In the lateral parts, lower facial height, and more backward position of the lower jaw, which may explain differences in the maintenance of pharyngeal airway patency in the lateral sleep position.