摘要
目的分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者药物诱导模拟上气道睡眠状态下上气道阻塞平面特点、阻塞程度及动态形态学变化,并与模拟打鼾和Muller’s检查进行比较,寻找一种更为准确、真实、客观反映上气道形态的诊断方法。方法选取经多道睡眠图监测符合OSAHS男性患者10例,分别进行模拟打鼾、Muller’s检查以及药物诱导睡眠内镜(drug-induced sleep endoscopy,DISE)检查,评估患者上气道阻塞平面及形态学特点,并采用SPSS统计软件及VOTE评分系统对数据进行比较研究。结果3种状态下上气道阻塞平面及形态改变具有差异性及多样性特点。清醒模拟睡眠状态下OSAHS患者主要表现为双平面狭窄,在诱导睡眠状态下则主要表现为多平面狭窄。在形态学观察中,在清醒模拟睡眠状态下腭咽平面主要表现为前后狭窄,口咽侧壁平面表现为左右狭窄,而在DISE下阻塞平面可表现左右狭窄、前后狭窄或者环形狭窄;同一患者气道阻塞形态随着不同睡眠时相亦可发生动态变化。统计学资料分析显示:①3种检查方法在会厌、舌根平面有统计学差异(P<0.05),DISE检查在会厌、舌根平面阻塞程度VOTE评分均高于其他2种检查方法;②3种检查方法阻塞平面引出率在腭咽平面及口咽侧壁平面无显著性差异(P<0.05),会厌平面和舌根平面有显著性差异(P<0.01)。结论与清醒状态相比,DISE下OSAHS患者上气道狭窄平面形态呈现为左右狭窄、前后狭窄和环形狭窄,或者3种形态互相动态转变,具有与睡眠周期咽腔肌肉活动张力相似的时相性变化特点。
OBJECTIVE To analyze the characteristics of upper airway obstruction plane,obstruction degree and dynamic morphological changes in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)under drug-induced sleep state.Compare with Muller’s examination of simulated negative pressure to find a more accurate,realistic and objective diagnosis of upper airway morphology.METHODS Ten male patients who were eligible for OSAHS after polysomnography were selected,and simulated snoring,Muller’s test,and drug-induced sleep endoscopy(DISE)were performed to evaluate the plane and morphological characteristics of upper airway obstruction.SPSS statistical software and VOTE scoring system were used to compare the data.RESULTS The plane and morphological changes of upper airway obstruction in the three states were different and diverse.OSAHS patients in awake simulated sleep state mainly showed biplanar stenosis,while in induced sleep state they mainly showed multiplanar stenosis.In morphological observations,the velopharyngeal plane mainly manifested as anterior-posterior stenosis,and the oropharyngeal plane exhibited left-right stenosis under awake simulated sleep state,and the obstruction plane under DISE could exhibit left-right,anteroposterior,or annular stenosis;In the same patient,the airway obstruction pattern can also change dynamically with different sleep phases.The analysis of statistical data shows:1.There were statistical differences in epiglottis and tongue root planes among the three methods(P<0.05).The DISE test had higher VOTE scores in the epiglottis and tongue root plane obstruction than the other two inspection methods;2.There were no significant differences in the obstruction plane rates between the opharyngeal plane and the oropharyngeal lateral plane(P>0.05),and there were significant differences between the epiglottic plane and the tongue root plane(P<0.01).CONCLUSION Compared with the awake state,the upper airway stenosis plane morphology of patients with OSAHS under DISE showed left and right stenosis,anterior and posterior stenosis and annular stenosis,or three forms of dynamic transitions,which have similar temporal changes with pharyngeal muscle activity during sleep cycle.
作者
吴振恭
曾进
熊俊
李丽娟
王丽
刘云亮
WU Zhengong;ZENG jin;XIONG Jun;LI Lijuan;WANG Li;LIU Yunliang(Department of Otolaryngology Head and Neck Surgery,the Third Hospital of Peking University,Beijing,100191,China;Department of Otolaryngology Head and Neck Surgery,Anxi County Hospital,Quanzhou,Fujian,362400,China;Department of Otolaryngology,Fujian Maternal and Child Health Hospital,Fuzhou,Fujian,350001,China)
出处
《中国耳鼻咽喉头颈外科》
CSCD
2020年第11期651-655,共5页
Chinese Archives of Otolaryngology-Head and Neck Surgery
