上气道压力测定在阻塞性睡眠呼吸暂停综合征定位诊断中的价值

Study of determining the site(s) of airway obstruction in obstructive sleep apnea syndrome

目的:研究阻塞性睡眠呼吸暂停综合征(OSAS)患者睡眠状态下气道阻塞模式及压力变化与多导睡眠监测指标之间的关系。方法:20例患者,在睡眠状态下同步进行上气道压力测定和多导睡眠监测,分析波形变化,并行单因素相关分析和多元线性回归分析。结果:20例患者中,单纯软腭平面阻塞占15％(3／20),软腭与舌根联合阻塞占85％(17／20)。呼吸暂停末最大负压值与呼吸通畅时最大负压值之间的差值(Ap)与呼吸暂停及低通气指数(AHI)、最长呼吸暂停时间(LT)、平均呼吸暂停时间(MT)、最低血氧饱和度相关,并获得了回归方程:△p=-48.740+0.591AHI+0.397LT。结论:上气道压力测定是一种较为准确的定位诊断方法,对于进一步理解OSAS的病理生理改变很有裨益。

PURPOSE: To determine the site(s) of upper airway obstruction in obstructive sleep apnea syndrome with airway pressure monitoring. METHODS:Twenty patients with obstructive sleep apnea syndrome underwent complete polysomnography and simultaneous upper airway pressure monitoring with a custom-made, soft silicone-covered catheter measuring 1.9mm in diameter. The catheter had three solid-state ultraminiature sensors located at the tip of the uvula, base of the tongue and midesophagus. The site(s) of airway obstruction was determined by changes in pressure patterns between transducers. Obstruction occurred associated with disappearing inspiratory pressure above the site of obstruction. RESULTS: Two patterns of obstruction were observed. In 3 of the 20 patients, airway obstruction was located at velopha ryngeal region. 17 patients had obstruction in velopharyngeal and hypopharyngeal region. It showed that there was correlation among the △p, AHI, LT and MT. The equation was △p=-48.740+0.591AHI+0.397LT. CONCLUSIONS: Airway pressure monitoring can objectively identify the level of airway obstruction during sleep. It is beneficial for diagnosis and treatment of obstructive sleep apnea syndrome.