阻塞性睡眠呼吸暂停综合征患者不同体位下上气道变化的临床观察

A COMPARATIVE STUDY ON UPPER AIRWAY SPACE OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME IN DIFFERENT POSTURE

目的 :对阻塞性睡眠呼吸暂停综合征 (obstructivesleepapneasyndrome,OSAS)患者不同体位下上气道的变化做了观察比较 ,初步探讨了仰卧位时上气道软组织及骨组织位置及结构的变化 ,为OSAS的诊治提供有关依据。方法 :对 10例经PSG确诊的OSAS患者分别拍摄常规坐位头影测量侧位片及仰卧位头颅侧位片。测量两种体位下腭后气道前后径、软腭下垂角度、最小矢状咽径、下颌平面角及舌骨至咽后壁水平距离等。结果 :两种体位比较 ,仰卧位时最小矢状咽径、悬雍垂顶点至咽后壁的水平距离及软腭中点至咽后壁的水平距离均小于坐位时 ;软腭下垂角度及下颌平面角大于坐位时 ;∠SNB小于坐位时 ;舌骨无明显前移或后退。结论 :OSAS患者仰卧位时腭后气道的前后径及最小矢状咽径更趋狭小 ,软腭向咽后壁方向移位 ,下颌骨以颞下颌关节为中心呈向下向后方旋转运动 ,从而使上气道在腭咽气道、舌咽气道及下咽气道多个水平趋于狭小。OSAS患者多在卧位时发病 ,在OSAS患者术前评估时 ,仰卧位X线头颅侧位片可以更客观的反映患者上气道解剖情况 ,为OSAS患者的治疗提供更为可靠的依据。

Objective: To compare the upper airway dimensions of patients with obstructive sleep apnea syndrome(OSAS) in different posture and to study the changes of soft tissue and skeletal in supine position. Methods: A detailed cephalometric analysis was performed using lateral X-ray films in sitting position and supine position from 10 male patients with OSAS.M-PW,PAS,H-S,∠ANS·PNS·U,∠SNA,∠SNB and the mandibular plane angle were recorded in different posture. Results: The results showed that the paremeters examined in OSAS patients varied with posture.The horizontal distance between the soft palate and postpharyngeal wall was shorter in supine position than in sitting position.The posterior airway space(base of tongue plane) was narrower,the angle between the hard and soft palate larger,the mandibular plane angle was more abrupt and SNB was smaller in supine position than in sitting position. Conclusion: Multiple changes occur in upper airway space of patients with OSAS in different posture.Lateral X-ray film in supine position is highly recommended as a valuable tool in the evaluation of OSAS.