阻塞性睡眠呼吸暂停患者咽腔阻塞的整夜定位及影响因素分析

Sites of obstruction in obstructive sleep apnea patients and their influencing factors: an overnight study

目的定位阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)患者整夜睡眠中的咽腔阻塞部位,分析睡眠分期和体位对阻塞部位的影响。方法对54例OSAHS患者行整夜多道睡眠监测与同步上气道-食管压力持续测定,判定每次阻塞性、混合性呼吸暂停和低通气的塌陷阻塞部位,结合睡眠分期、体位进行分析。结果54例患者共分析气道塌陷事件23172次,均存在源自腭咽平面(14837次)和舌咽平面(5605次)阻塞,29例观察到喉咽阻塞共105次。81·4%的患者腭咽平面的气道塌陷次数占气道塌陷总数的构成比在50%以上。快速动眼睡眠期源自舌咽平面的气道塌陷、阻塞频率和占同期阻塞来源构成比较非快速动眼睡眠期增加,差异有统计学意义(t值分别为6·189和8·790,P值均<0·01),腭咽平面阻塞构成比相对下降(t=-6·846,P<0·01)。仰卧位时呼吸暂停低通气指数增高(t=4·000,P<0·01),腭咽、舌咽平面气道塌陷、阻塞频率平均较侧卧位高,但差异无统计学意义(腭咽平面t=1·890,舌咽平面t=1·393,P值均>0·05)。不同体位各平面阻塞构成比差异无统计学意义。结论腭咽是OSAHS患者最主要的咽腔阻塞部位,其次为舌咽。阻塞部位和程度受睡眠分期、体位影响,快速动眼睡眠期舌咽后气道阻塞明显增加。仰卧位阻塞增加来源于各平面阻塞程度增加的共同作用。

Objective To understand how sleep stage and position influence the mechanisms for pharyngeal collapse in different levels of upper airway （ UA）, overnight state-related changes and postural variation in obstructive sites in obstructive sleep apnea hypopnea syndrome （OSAHS） patients were studied. Methods Fifty four OSAHS patients underwent overnight upper airway pressure monitoring during polysomnography. The lower limits of the UA obstruction were determined and their relationship with sleep stage, position, age, body mass index and apnea hypopnea index （AHI） were investigated. Results All 54 patients had oropharynx （14 837 of the 23 172 analyzed events ） and tongue base obstruction （5605/23 172）, 2532 events were located at the orupharynx with extension to tongue base. Twenty nine patients has hypopharynx obstruction （ 105/23 172）. Of the total amount of apnea hypopnea, the portions of obstruction located at tongue base level increased （ t = 8. 790, P = 0. 000） in rapid eye movement （REM） sleep while those located at oropharynx decreased（ t = -6. 846 ,P = 0. 000）. Indexes of the apnea hypopnea caused by tongue base obstruction raised （t = 6. 189, P = 0. 000）. Although the overall AHI in supine position was higher than in lateral position （ t = 4. 000, P = 0. 000）, increases in indexes of both the apnea hypopnea caused by tongue base （supine, 17. 1 ± 13.8 vs. lateral, 13.9 ± 14. 6） and oropharynx obstruction （44. 3 ± 20. 3 vs. 37.2 ± 25.9） were without significance （ P 〉 0. 05 ）. Distribution of obstructive site varied little with different position （P 〉 0. 05）. Condusious Upper airway obstruction involves more than one specific site of the upper airway and the oropharynx is the most common collapse site. Obstructive sites are likely to extend to lower levels during REM sleep. Sleep position has little effect on the distribution of obstructive site.