PHARYNGEAL NARROWING AND CLOSING PRESSURES IN PATIENTS WITH OBSTRUCTIVE SLEEP-APNEA
PHARYNGEAL NARROWING AND CLOSING PRESSURES IN PATIENTS WITH OBSTRUCTIVE SLEEP-APNEA
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DOI：
10.1164/ajrccm/148.3.606
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发表时间：
1993-09-01
期刊：
影响因子：
--
通讯作者：
REMMERS, JE
中科院分区：
文献类型：
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作者：
MORRISON, DL;LAUNOIS, SH;REMMERS, JE
基于以往的研究，我们假设大多数阻塞性睡眠呼吸暂停（OSA）患者的咽部在多个部位塌陷。本研究的目的是记录在一群呼吸暂停的受试者中，低张力咽部狭窄和闭合压力的部位。我们对45例睡眠性呼吸暂停（OSA）患者在接受鼻腔持续气道正压通气（CPAP）时的咽部进行了内窥镜检查。在呼气结束时进行单呼吸试验（SBT）获得咽内图像和压力。每个咽段（鼻咽部、口咽部和下咽）的分数变窄（FN）计算为鼻气道压力从保持咽部完全扩张的压力降低到气道关闭的压力时面积的相对变化。鼻咽部FN的频率分布偏大，口咽部和下咽的频率分布相对均匀。FN大于0.75的位点被定义为原发性狭窄，FN 0.25 ~ 0.75的位点被定义为继发性狭窄。鼻咽部是80%患者的原发性狭窄部位，通常观察到两个或两个以上的狭窄部位（82%）。合并狭窄分为四类：(1)仅在鼻咽部发生原发性狭窄（18%）；(2)鼻咽部原发性狭窄加上其他部位继发性狭窄（40%）；(3)鼻咽部原发性狭窄加上其他部位原发性狭窄（22%）；(4)其他模式（20%）。关闭压力范围从-2到8 cm H2O， 85%的值等于或大于0 cm H2O。我们的研究结果表明，睡眠呼吸暂停患者的低张力咽部通常在多个部位塌陷，绝大多数患者的鼻咽部是原发性狭窄的部位，在大多数情况下，闭合压力等于或大于大气压。
Based on previous studies, we hypothesized that the pharynx collapses at multiple sites in most patients with obstructive sleep apnea (OSA). The purpose of this study was to document, in a population of apneic subjects, the site(s) of narrowing and closing pressure of the hypotonic pharynx. We endoscopically examined the pharynx in 45 OSA patients during sleep while they received nasal continuous positive airway pressure (CPAP), which produces hypotonia of pharyngeal muscles. Intrapharyngeal images and pressures were obtained at the end of expiration during single-breath tests (SBT). The fractional narrowing (FN) of each pharyngeal segment (nasopharynx, oropharynx, and hypopharynx) was calculated as the relative change in area when nasal airway pressure was reduced from a pressure that held the pharynx fully distended to the pressure at which the airway closed. The frequency distribution of FN for the nasopharynx was skewed toward larger values, and the frequency was relatively evenly distributed for the oropharynx and hypopharynx. A site having FN greater than 0.75 was defined as a site of primary narrowing, and a site showing FN 0.25 to 0.75 was defined as a site of secondary narrowing. The nasopharynx was a site of primary narrowing in 80% of patients, and two or more sites of narrowing were commonly observed (82%). Four categories of combined narrowing were identified: (1) primary narrowing only at the nasopharynx (18%); (2) primary narrowing at the nasopharynx plus other sites of secondary narrowing (40%); (3) primary narrowing at the nasopharynx plus other sites of primary narrowing (22%); and (4) other patterns (20%). Closing pressures ranged from -2 to 8 cm H2O, and 85% of values were equal to or greater than 0 cm H2O. Our results demonstrate that the hypotonic pharynx of sleeping apneic subjects commonly collapses at multiple sites, that the nasopharynx is a site of primary narrowing in the vast majority of patients, and that closing pressure is equal to or greater than atmospheric pressure in most cases.