脑卒中后阻塞性睡眠呼吸暂停患者口咽部形态学变化及其与功能恢复的相关性

The relationship between post-stroke obstructive sleep apnea patients oropharyngeal morphology and function

目的:分析卒中后阻塞性睡眠呼吸暂停(OSA)患者口咽部形态学变化及其与功能恢复之间的相关性,为寻求脑卒中并发OSA的康复治疗措施提供依据。方法:选取首次发病且病程1个月之内的脑卒中患者39例,排除发病前已确诊OSA的患者,入组患者均行多导睡眠图(PSG)监测、口咽部核MRI检查及各项功能评估,将并发与不并发OSA患者的咽部MRI测量相关指标进行比较,将脑卒中并发OSA患者的咽部测量指标与患者的功能评估指标进行相关分析。结果:1并发OSA的脑卒中患者腭后距离、舌后距离较不并发OSA者偏小、软腭长度较不并发OSA者偏大,两者相比有显著性差异(P=0.002/0.003/0.019)。2脑卒中并发OSA患者的腭后距离与改良Barthel指数评分呈正相关、与改良Rankin分级呈负相关;舌后距离与患者的NIHSS评分、改良Rankin分级呈负相关,与患者Fugl-Meyer评分、改良Barthel指数评分呈正相关(P<0.05)。结论:脑卒中并发OSA患者的口咽部形态学变化(腭后距离及舌后距离偏小)与患者的功能评估间有一定相关性,所以改善脑卒中后OSA患者口咽部形态学的变化有利于患者的功能恢复。

Objective： To analyze the change of post-stroke obstructive sleep apnea（OSA） patients＇ pharyngeal morphology and the relationship between pharyngeal morphology and function of post-stroke patients, so as to provide the basis for therapeutic interventions of rehabilitation. Method： Thirty-nine acute stroke with routine functional assessment were enrolled, which were all first onset 1 month ago. All of them accepted multi-night polysomnographic monitoring and the pharyngeal scanning and measurement with 3.0T MRI. The change of post-stroke OSA patients＇ pharyngeal morphology and the relation- ship between the pharyngeal morphology and the function of stroke patients were analyzed. Result： ① The retro-palatal distance and retro-glossal distance of post-stroke OSA patients were smaller than that of non-OSA patients （P=0.002/0.003）, the length of palatal was longer than that of non-OSA patients （P= 0.019）. ②The retro-palatal distance was positively relevant to modified Barthel index and was negatively rele- vant to modified Rankin scale, the retro-glossal distance was negatively relevant to NIHSS score and modified Rankin scale, and was positively relevant to Fugl-Meyer score and modified Barthel index （P 〈 0.05）.Conclusion： There were some relationships between pharyngeal morphology （retro-palatal distance and retro-glos- sal distance） and function of stroke patients with OSA, so some therapeutic interventions of rehabilitation could be used to amend the changes of pharyngeal morphology and to improve the function of stroke patients with OSA.