阻塞性睡眠呼吸暂停患者的上气道狭窄与头姿变化

UPPER AIRWAY NARROWING AND CHANGES IN HEAD POSTURE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

探讨阻塞性睡眠呼吸暂停（Ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａ，ＯＳＡ）患者上气道狭窄的程度、头姿改变情况，以及这些形态学指标与病理生理学参数之间的关系。研究对象为８６例男性ＯＳＡ患者及３７名健康男性。经整夜多导睡眠仪检查诊断或排除ＯＳＡ；采用数字化技术摄取受试者头颅侧位片，并用ＮＩＨＩｍａｇｅ软件测定上气道口径、面积及头姿指标共１５项。ＯＳＡ患者各水平上气道前后径均显著小于对照组；经年龄及身高体重指数校正后，上述结果不变。重症ＯＳＡ患者呈显著头颅前倾。头姿变化指标与呼吸暂停指数及多个水平的气道前后径呈显著相关。亚洲人种ＯＳＡ患者存在明显及广泛的上气道狭窄；随ＯＳＡ程度加重及上气道阻塞程度加重。

To investigate the upper airway narrowing and changes in head posture and their relationship with apnea severity in patients with obstructive sleep apnea (OSA). Eighty six male OSA patients and 37 healthy men were enrolled. One night polysomnographic examination was performed and a lateral cephalogram by digital image processing system was taken in each subject. Fifteen variables concerning the upper airway dimensions, area and head postures were measured using a computer software (NIH Image). Upper airway dimensions in the OSA group at all levels were significantly smaller than those in the control group and the results hold true when the age and body mass index were well controlled in these two groups. Significant forward inclination of the cervical column were found in patients with an apnea index (AI) greater than 35 episodes/hour. And changes in the head posture variables in the whole study group significantly correlated with AI and airway dimensions at various levels. There exist significant and extensive upper airway narrowing in OSA patients even in upright position and awake state; And as the apnea severity progresses, patients may assume certain compensatory head postures in an attempt to maintain an adequate airway patency.