鼾症患者鼾声来源影响因素的初步研究

Preliminary analysis of influencing factors on source of snoring sound

目的:从解剖及生理指标探索鼾症患者鼾声来源的主要影响因素。方法:对73例经PSG确诊为单纯打鼾或睡眠呼吸暂停低通气指数(AHI)≤40的OSAHS患者行常规体检、清醒状态下咽部三维CT扫描和药物诱导睡眠内镜检查。睡眠内镜下观察每例患者的鼾声来源并分类。提取AHI、BMI、颈围和多项CT测量值进行单因素方差分析和Logistic逐步回归,寻找鼾声来源的影响因素。结果:将鼾声来源归为软腭振动为主组(Ⅰ组,34例)、咽侧壁振动为主组(Ⅱ组,16例)、软腭咽侧壁共同振动为主组(Ⅲ组,23例)3个组。方差分析显示,3组的AHI、软腭后区及舌后区最小左右径、软腭后区及舌后区最小前后左右径比值和咽侧壁平均厚度均差异有统计学意义(P<0.05)。Logistic回归分析显示,Ⅱ组与Ⅰ组之间鼾声来源的影响因素是软腭后区最小前后左右径比值(OR=10.9,P<0.05)和咽侧壁平均厚度(OR=2.166,P<0.05);Ⅲ组与Ⅰ组之间的影响因素是咽侧壁平均厚度(OR=1.874,P<0.05);Ⅱ组和Ⅲ组之间各因素均差异无统计学意义。结论:软腭后区最小前后左右径比值和咽侧壁平均厚度是鼾症患者鼾声来源的影响因素。

Objective：To investigate the main factors affecting the source of snoring sound of snoring patients.Method：Seventy-three patients with either simple snoring or obstructive sleep apnea-hypopnea syndrom（AHI≤40）underwent routine ENT examination,CT scanning（in awake condition）and drug-induced sleep endoscopy.The sources of snoring sound were observed.The neck circumference,body mass index and CT data were measured.Result：The sources of snoring sound of the 73 cases were divided into three types in general：palatal fluttering based group（Group Ⅰ）,lateral wall vibration based group（Group Ⅱ）and palatal fluttering together with vibration of lateral wall based group（GroupⅢ）.The minimum lateral caliber of retropalatal region and retroglossal region,the ratio of minimum anteroposterior/lateral caliber of the two regions,the thickness of pharyngeal lateral wall had statistical differences.The main influencing factors on the source of snoring sound between GroupⅡand Group Ⅰ were the ratio of minimum anteroposterior/lateral caliber of retropalatal region and the mean thickness of pharyngeal lateral wall.The influencing factor between GroupⅢand GroupⅠ was the mean thickness of pharyngeal lateral wall.Conclusion：The ratio of minimum anteroposterior/lateral caliber of retropalatal region and the mean thickness of pharyngeal lateral wall are the main factors affecting the source of snoring sound of snoring patients.