上气道测压阻塞平面判断与X线头影测量舌后间隙的相关性研究

Correlation study between obstructive level diagnosed by Apnea Graph and cephalometric posterior airway space in obstructive sleep apnea hypopnea syndrome

目的研究上气道测压系统（Apnea Graph，AG）判断阻塞平面与X线头影测量的舌后间隙（posterior airway space，PAS）在阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apneahypopnea syndrome，OSAHS）患者阻塞平面定位诊断中的关系，以提高术前OSAHS阻塞平面判断的准确性。方法对30例重症OSAHS患者，均行整夜便携式多道睡眠监测检查确诊，其中男28例，女2例；年龄35～59岁，中位数41．5岁；体质量指数平均（面±s，以下同）为（28．8±4．1）kg／m^2；呼吸暂停低通气指数平均（58．6±16．4）次／h；最低动脉血氧饱和度平均（0．69±0．09）。30例患者均行AG检查及X线头影测量，将AG判断为下平面阻塞的构成比和X线头影测量的舌后间隙做相关性分析。结果X线头影测量发现30例患者舌后间隙均明显狭窄，仅为4．4～10．8mm，平均（7．6±2．1）mm。AG判定的下平面阻塞构成比范围2％～87％，中位数[25分位数；75分位数]为15．5％[9．0％；35．8％]。下平面阻塞〉50％的2例和下平面阻塞30％-40％的8例中，6例的舌后间隙均小于6mm。AG判断为下平面阻塞的构成比和X线头影测量的舌后间隙呈直线相关（r=-0．6511，P〈0．01），有下平面阻塞构成比数值越高，舌后间隙越小的趋势。2例巨大扁桃体和2例小下颌患者的AG判断结果与趋势不符。结论初步研究发现，AG判定的下平面阻塞构成比与X线头影测量的舌后间隙狭窄程度有较好的一致性，但要注意排除过度肥大的扁桃体等对诊断的干扰。

Objective To study the correlation between Apnea Graph （AG） analysis of airway obstruction ancl cephalometric assessment of the posterior airway space in the diagnosis of obstructive level in patients with obstructive sleep apnea hypopnea syndrome （OSAHS）, so as to improve the preoperative diagnostic accuracy and the therapeutic outcome. Methods Thirty patients （28 males and two females） who were diagnosed with severe OSAHS （mean AHI 58.6） by overnight polysomnography in recent 3 months were enrolled. The ages of the patients ranged from 35 to 59 years old with the median age of 41.5 years old. The mean body mass index （ BMI, x ± s ） was （ 28. 8 ± 4. 1 ） kg/m^2. Mean apnea-hypopnea index （ AHI ） was （58.6 ± 16. 4）/h. The lowest oxygen saturation was averaged to 0. 69 ± 0. 09. All patients underwent AG study as well as cephalometric analysis preoperatively. A correlation analysis was performed between the percentage of lower level obstructions measured by AG and the posterior airway space （PAS） evaluated by cephalometric analysis. Results All of the 30 patients had the obvious narrow PAS of 4.4 - 10. 8 mm, with the average of （ 7. 6 ±2. 1 ） ram. Their constituent ratios of lower level obstruction ranged from 2 to 87 percent with the median ratio of 15.5% [9. 0% ; 35.8% ]. Among all the patients, only 2 cases had more than 50 percent obstruction of the airway at lower level, 8 cases had 30 to 40 percent obstruction, and 6 cases had the narrow PAS less than 6 mm. The constituent ratio of lower level obstructions had a negative rectilinear correlation with the data of PAS （r = - 0. 6511, P 〈 0. 01 ）, which meant the patient with a higher percentage of lower obstruction had the tendency to have a corresponding narrower PAS. Two cases whose constituent ratios of lower level obstructions were not compatible with the rectilinear tendency due to tonsillar hypertrophy were reported. Conclusions AG analysis of airway obstruction and cephalometric assessment of the PAS could provide comparable and consistent results for the diagnosis of obstructive level in OSAHS. However, the tonsillar hypertrophy should be considered when using AG to identify the airway obstruction.