Cephalometric analysis in obese and nonobese patients with obstructive sleep apnea syndrome
Cephalometric analysis in obese and nonobese patients with obstructive sleep apnea syndrome
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DOI：
10.1378/chest.124.1.212
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发表时间：
2003-07-01
期刊：
影响因子：
9.6
通讯作者：
Kubo, K
中科院分区：
文献类型：
--
作者：
Yu, XJ;Fujimoto, K;Kubo, K
研究目的：本研究的目的是全面评价颅颌面畸形患者的头影测量特征。阻塞性睡眠呼吸暂停综合征（OSAS），并阐明头影测量变量与呼吸暂停低通气指数（AHI）严重程度之间的关系。患者：研究人群包括62名男性OSAS患者，其中33名为肥胖患者（体重指数[BMI]大于或等于27）和29例非肥胖患者（BMI < 27），男性单纯打鼾者13例（AHI < 5次事件/小时）。对所有患者和单纯打鼾者进行诊断性多导睡眠图和22个头影测量变量的测量。与单纯打鼾者相比，两个亚组中的OSAS患者显示出几个显著的头影测量特征：（1）舌骨位置前移，（2）软腭扩大，（3）软腭处上气道宽度减小。在肥胖患者中发现了更广泛和严重的软组织增大，包括前向定位的舌骨和较长的舌头。非肥胖组骨性鼻咽部和口咽部的前后距离明显小于单纯打鼾组和肥胖组。逐步回归分析显示，舌骨前移和下颌骨后移是OSAS患者AHI的主要总体决定因素，而骨性口咽部狭窄和舌骨下移位是非肥胖患者AHI的主要决定因素。一个显着的回归模型AHI使用头影测量变量不能获得肥胖患者，但BMI被证明是最显着的determiner.Conclusion：颅面骨结构的特点，如鼻咽和口咽部的狭窄和扩大的软组织在上气道可能是重要的危险因素，在非肥胖患者OSAS的发展。肥胖患者上气道脂肪组织的沉积可能加重OSAS的严重程度。
Study objectives: The aims of this study were to comprehensively evaluate the cephalometric features of patients with. obstructive sleep apnea syndrome (OSAS), and to elucidate the relationship between cephalometric variables and severity of the apnea-hypopnea index (AHI).Patients: The study population consisted of 62 male patients with OSAS, classified into 33 obese patients (body mass index [BMI] greater than or equal to 27) and 29 nonobese patients (BMI < 27), and 13 male simple snorers (AHI < 5 events per hour).Method and measurements: Diagnostic polysomnography and measurements of 22 cephalometrie variables were carried out for all patients and simple snorers.Results: Patients with OSAS in both subgroups showed several significant cephalometric features compared with simple snorers: (1) inferiorly positioned hyoid bone, (2) enlarged soft palate, and (3) reduced upper airway width at soft palate. More extensive and severe soft-tissue enlargements including anteriorly positioned hyoid bone and a longer tongue were found in the obese patients. In the nonobese patients, the anteroposterior distances of the bony nasopharynx and oropharynx were significantly smaller than those of simple snorers and obese patients. Stepwise regression analysis showed that anterior displacement of the hyoid bone and retroposition of the mandible were the dominant overall determinants for AHI in patients with OSAS, and that narrowing of the bony oropharynx and inferior displacement of the hyoid bone were dominant determinants for AHI in nonobese patients. A significant regression model for AHI using cephalometric variables could not be obtained for the obese patients, but the BMI proved to be the most significant determinant.Conclusion: Characteristics of the craniofacial bony structure such as narrowing of the nasopharynx and oropharynx and enlargement of the soft tissue in the upper airway may be important risk factors for the development of OSAS in nonobese patients. In obese patients, the deposition of adipose tissue in the upper airway may aggravate the severity of OSAS.