Upper airway and soft tissue structural changes induced by CPAP in normal subjects
Upper airway and soft tissue structural changes induced by CPAP in normal subjects
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DOI：
10.1164/ajrccm.154.4.8887615
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发表时间：
1996-10-01
影响因子：
24.7
通讯作者：
Gefter, WB
中科院分区：
文献类型：
--
作者：
Schwab, RJ;Pack, AI;Gefter, WB
经鼻持续气道正压通气（CPAP）是成人阻塞性睡眠呼吸暂停的首选治疗方法。已知CPAP可增加上气道大小;然而，CPAP对上气道周围软组织结构的直接影响尚不清楚。磁共振成像被用来研究增量水平的影响结果显示：CPAP持续时间为0、5、10、15 cm H2O时，对10例正常人的上气道及周围软组织结构的影响为：（1）气道容积和气道面积腭后和舌后区（在几个不同位置[中部、最小、最大]测量）增加;（2）侧气道尺寸变化大于前后变化;（3）侧上气道软组织结构变化明显大于前后变化;（4）侧咽壁厚度减小，侧咽旁脂肪垫间距增大。CPAP水平与咽壁厚度呈负相关;（5）软腭和舌变化最小。这些数据表明，咽侧壁比软腭和舌更“顺从”。本研究进一步证明了咽侧壁在调节上气道口径方面起着重要作用。
Nasal continuous positive airway pressure (CPAP) is the treatment of choice for adults with obstructive sleep apnea. CPAP is known to increase upper airway size; however, the direct effects of CPAP on soft tissue structures surrounding the upper airway are less well understood. Magnetic resonance imaging was used to study the effect of incremental levels (0, 5, 10, and 15 cm H2O) of CPAP on the upper airway and surrounding soft tissue structures in 10 normal subjects, Progressive increases in CPAP resulted in the following major findings: (1) airway volume and airway area (measured at several different locations [midregion, minimal, maximal]) within the retropalatal and retroglossal regions increased; (2) lateral airway dimensional changes were greater than anterior-posterior changes; (3) lateral upper airway soft tissue structural changes were significantly greater than anterior-posterior changes; (4) lateral pharyngeal wall thickness decreased and the distance between the lateral parapharyngeal fat pads increased. An inverse relationship was demonstrated between CPAP level acid pharyngeal wall thickness; (5) minimal changes were noted in the soft palate and tongue. These data suggest that the lateral pharyngeal walls are more ''compliant'' than the soft palate and tongue. This investigation provides further evidence that the lateral pharyngeal walls play an important role in mediating upper airway caliber.