肥胖青少年阻塞性睡眠呼吸暂停综合征患者上气道临界压的变化及其临床意义

Changes of pharyngeal critical pressure in obese adolescents with obstructive sleep apnea syndrome and its clinical significance

目的:观察肥胖青少年阻塞性睡眠呼吸暂停综合征(OSAS)患者上气道临界压(Pcrit)的变化,探讨其在青少年人群OSAS发病中的作用机制。方法:根据多导睡眠监测数据和体质量指数(BMI),将受试者分为肥胖OSAS组(n=16)、肥胖对照组(n=18)和正常体质量对照组(n=17)。在多导睡眠监测的基础上,应用上气道压力-气流流量分析技术计算3组受试者的压力-气流曲线斜率和Pcrit。并分析上气道压力气流曲线斜率与睡眠呼吸暂停指数(AHI)及上Pcrit与AHI的相关性。结果:肥胖OSAS组受试者上气道压力-气流曲线斜率和上气道临界压明显高于肥胖对照组和正常体质量对照组(P<0.01);肥胖对照组受试者Pcrit低于正常体质量对照组(P<0.05)。肥胖OSAS组受试者上气道压力-气流曲线斜率与AHI呈正相关关系(r=0.789,P=0.005);Pcrit与AHI呈正相关关系(r=0.654,P=0.032)。结论:Pcrit的增高是肥胖青少年OSAS上气道阻塞的原因之一;肥胖且非OSAS青少年的Pcrit的维持对预防上气道阻塞有重要作用。

Objective To observe the changes of pharyngeal critical pressure（Pcrit）in the obese adolescents with obstructive sleep apnea syndrome（OSAS）,and to investigate the role of Pcrit in the pathogenesis of OSAS in the adolescents.Methods According to the results from polysomnography and body mass index（BMI）measurements,the subjects were divided into obese OSAS group（n=16）,obese control group（n=18）,and lean control group（n=17）.On the base of polysomnography monitoring,the slope of pressure-flow curve and Pcrit were observed by pressure-flow relationship technology.Then the relationship between Pcrit and apnea hypopnea index（AHI）was analyzed.Results The slope of pressure-flow curve and Pcrit of patients in obese OSAS group were significantly higher than those in obese control group and lean control group（P〈0.01）;the Pcrit of objects in obese control group was lower than that in lean control group（P〈0.05）.In obese OSAS group,the positive correlation was found between the slope of pressure-flow curve and AHI（r= 0.789,P=0.005）,as well as Pcrit and AHI（r= 0.654,P=0.032）.Conclusion The increase of Pcrit is one of the reasons for upper airway obstruction in the obese adolescents with OSAS.To maintain Pcrit is important for the obese adolescents without OSAS to protect the upper airway from occlusion.