不同性别阻塞性睡眠呼吸暂停低通气综合征患者与上气道影像学相关性的研究

Correlation between obstructive sleep apnea hypopnea syndrome and upper airway measurements of different genders

目的探讨上气道影像学在不同性别阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者病情严重程度中的预测作用。方法对163例经多导睡眠监测(PSG)确诊为OSAHS患者(男98例,女65例),行平静呼吸时上气道CT扫描,测量舌骨下缘距下颌骨下缘(颏下点)的垂直距离(D-HM)、舌骨最前点距下颌骨下缘(颏下点)的距离等CT参数,并进行各测量值与睡眠呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(LSaO_2)的相关性分析。结果 (1)AHI。男性患者14.2~52.3次/h,平均(36.22±5.64)次/h;女性患者9.6~46.4次/h,平均(29.38±3.90)次/h;(2)LSaO_2。男性患者48%~79%,平均(63.93%±10.51%);女性患者59%~87%,平均(70.92%±9.17%);(3)各研究平面的最小前后径、左右径及面积与AHI的大小均呈负相关,与LSaO_2呈正相关,且男性OSAHS患者AHI、LSaO_2与腭后区最小截面积相关性更明显(r=-0.441,P<0.01),而女性OSAHS患者AHI、LSaO_2与舌后区最小截面积相关性更明显(r=-0.403,P<0.01);(4)不同性别之间舌骨下缘距下颌骨下缘(颏下点)的垂直距离(D-HM)、舌骨最前点距下颌骨下缘(颏下点)的距离差异具有统计学意义(P<0.01);(5)对部分OSAHS患者行改良UPPP手术,术后3个月,男性OSAHS患者总有效率为84.31%,女性OSAHS患者总有效率为58.06%,CT测量值男性OSAHS患者有4个数值与术前相比有统计学意义,而女性患者有1个数值与术前相比有统计学意义。结论 OSAHS患者上气道CT的测量指标可对OSAHS病情的严重程度有一定预测作用,且不同性别之间的测量数值差异有统计学意义,需根据性别的不同来制定个体化诊疗意见。

Objective To investigate the ability of upper airway measurement to predict the severity of obstructive sleep apnea hypopnea syndrome （OSAHS） in different genders. Methods This study included 163 OSAHS patients （98 men and 65 women） diagnosed by polysomnography. Computed tomography （CT） scans of the upper airway during quiet breathing were performed. Parameters including the vertical distance from the inferior margin of the hyoid to the inferior mandibular margin （ submental point） （D-HM） and from the forefront points of the hyoid to the inferior man- dibular margin （ submental point） were measured. Results The AHI was 14.2-52.3/h （ mean, 36.22 ± 5.64/h） in men and 9.6-46.4/h （mean, 29.38 ± 3.90/h） in women. The LSaO2 was 48% -79% （mean, 63.93% ± 10.51% ） in men and 59% -87% （ mean, 70.92% ~9.17% ） in women. The minimal anteroposterior diameter, left and right di- ameters, and area of each plane were negatively correlated with the AHI and positively correlated with LSaO2. In men, the AHI and LSaO2 were strongly correlated with the minimal cross-sectional area of the retropalatal area （r = -0. 441 ; P 〈 0.01 ） ; the AHI and LSaO2 of women were strongly correlated with the minimal cross-sectional area of the lingual region （ r = - 0. 403 ; P 〈 0.01 ）. There was a significant difference in the vertical distance from the inferior margin of the hyoid to the D-HM, and in the distance from the forefront points of the hyoid to the inferior mandibular margin （ submental point）, between men and women （ P 〈 0. 01 ）. Some OSAHS patients received modified UPPP surgery. The effective rate in men and women 3 months after surgery was 84.31% and 58.06%, respectively. Significant post- operative differences as measured by CT scan were observed in four male OSAHS patients, but only one female patient. Conclusions CT measurements of the upper airway of OSAHS patients could help predict the severity of OSAHS. This study revealed a significant difference between the upper airway measurements of men and women. Individualized treatments should consider gender as a factor.