应用X线头影测量结合Müller试验评估OSAHS患者上气道结构

Evaluation of upper airway and surrounding structures in patients with obstructive sleep apnea using cephalometry combined with Müller's maneuver

目的:评估不同程度OSAHS患者在气道负压作用下上气道及周围组织解剖结构的变化差异。方法:收集2011年6月—2012年2月诊治的男性OSAHS患者39例,记录基本生理信息,多导睡眠监测结果,平静呼气末及Müller相侧位片。根据睡眠呼吸暂停低通气指数将纳入对象分为3组,轻度组5≤AHI<15,11例;中度组15≤AHI<30,14例;重度组AHI≥30,14例。应用Cassos 2001计算机辅助测量软件对Müller试验实施前、后患者颅颌面软、硬组织、上气道及周围组织结构进行数据测量,采用SAS 9.13软件包对数据进行统计学分析。结果:Müller试验对OSAHS患者上气道及周围结构可产生显著影响。3组OSAHS患者在实施Müller试验后,软腭厚度增加,腭后区气道矢状径均有所减小,舌骨相对于下颌骨体的垂直距离增加(P<0.05)。此外,Müller试验对上气道长度亦产生显著影响,表现为轻、中度上气道长度有增加趋势,而重度患者上气道长度增加显著。结论:Müller试验与X线头影测量相结合,能在一定程度上阐明负压对上气道及周围结构的影响,反映不同程度患者咽腔在负压作用下的差异。

PURPOSE： To evaluate the upper airway and surrounding structures under intraluminal pressure using cephalometry combined with Mtfller＇s maneuver in obstructive sleep apnea and hypopnea syndrome （OSAHS） patients with different severity. METHODS： Thirty-nine male patients were enrolled in our department during June 2011 to February 2012. Polysomnography （PSG） and anthropometric measurements data were recorded prior to tile study. The lateral cephalograms of each patient were obtained during both the end-expiration phase and M tiller＇s maneuver phase. The patients enrolled were classified into 3 groups according to the results of apnea-hypopnea index （AHI）, including mild group （n=l l）, moderate group （n=14）, and severe group （n=14）. Craniofacial and upper airway structures were measured in lateral cephalometry by application of Cassos 2001 computed aided measurement software before and after the patients practicing M tiller＇s maneuver. The data was analysed using SAS 9.13 software package. RESULTS： Mtiller＇s maneuver had a great influence on the upper airway and surrounding tissue, including increased thickness of the uvula, reduction in the anteroposterior dimension of retropalatal and increased vertical distance of the hyoid bone to the mandible in all groups （P〈0.05）. In addition, Mtiller＇s maneuver also had an impact on the length of the upper airway, which was more significant in severe cases. CONCLUSIONS： Cephalometry combined with Mtiller＇s maneuver can display how the intraluminal pressure function on the upper airway and surrounding tissues, and they also can distinguish some minor differences of the upper airway in patients with different security. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality （11140902001）.