合并及不合并阻塞性睡眠呼吸暂停脑卒中患者的咽部MRI分析

Analysis of pharynx MRI in stroke patients with and without obstructive sleep apnea

目的通过对脑卒中阻塞性睡眠呼吸暂停（Obstructive Sleep Apnea,OSA）患者与非OSA患者咽部形态进行比较,了解咽部形态与脑卒中OSA的关系。方法发病30 d内的脑卒中患者入院后夜间行多导睡眠图监测后分为脑卒中OSA组及脑卒中非OSA组,两组患者均行咽部MRI检查并测得腭后距离、舌后距离、软腭长度、舌长、咽侧壁软组织的厚度、高口咽区面积、低口咽区面积、咽部最小面积等相关数值,将两组患者咽部测得相关值进行比较,将腭后距离与其他口咽测量指标、AHI、洼田饮水试验分级、年龄、病程、BMI、颈围行Pearson相关分析,并将腭后距离作脑卒中OSA患者受试者工作特征曲线（Receiver Operating Characteristic Curve,ROC曲线）分析。结果脑卒中OSA组患者腭后距离较非OSA患者的偏小（P=0.002）,脑卒中OSA患者腭后距离与舌后距离呈相关（R=0.502, P=0.017）;脑卒中OSA患者洼田饮水试验分级较非OSA患者偏高（P=0.049）;脑卒中OSA患者腭后距离与AHI值呈负相关（R=-0.873, P=0.000）,腭后距离对脑卒中OSA的ROC曲线下面积为0.888,腭后距离对于脑卒中OSA有中等程度的诊断价值。结论咽部形态学改变与脑卒中OSA相关,腭后距离对脑卒中OSA有一定的诊断价值,腭后距离与脑卒中OSA严重程度有关;脑卒中OSA患者的洼田饮水分级较非OSA患者高,脑卒中患者OSA可能与吞咽障碍有关。

Objective Based on stroke patients with and without Obstructive Sleep Apnea（OSA）with pharyngeal morphological comparison, to understand the relationship of pharyngeal anatomy and OSA in stroke patients. Methods Patients within 30 days of stroke underwent nocturnal polysomnography, were divided into two groups based on whether had OSA or not. 3.0 weighted magnetic resonance imaging（MRI）performed for clinical purposes was used to measure retropalatal distance, soft palatal length, soft palatal thickness, retroglossal space, and tongue length, lateral pharyngeal wall thickness,high retropharyngeal area,low retropharyngeal area, minimum retropharyngeal area. The pharyngeal measured data of two groups were compared. Pearson correlation analysis was conducted between the retropalatal distance and other measurement indexes of pharyngeal, AHI, sub-water test score, age, course of disease, BMI and neck circumference in OSA patients with stroke. A receiver operating characteristic curve（ROC） was plotted and the area under it was calculated to assess the ability of retropalatal distance to discriminate OSA status.Results The retropalatal distance of stoke OSA patients was shorter than that of the compared group（P=0.002）.The retropalatal distance of stoke OSA patients was related with retroglossal space（R=0.502, P=0.017）. The sub-water test score of OSA patients with stroke was higher than that of non-OSA patients（P=0.049）. The retropalatal distance of stoke OSA patients was related with AHI（R=-0.873, P=0.000）. The area under the ROC curve for retropalatal distance as a predictor of presence or absence of OSA was 0.888, which indicated moderate discrimination between groups. Conclusion The morphological changes of pharynx are associated with OSA in stroke patients. The retropalatal distance has certain diagnostic value for OSA in stroke patients, and the retropalatal distance is related to the severity of OSA in stroke patients. OSA patients with stroke have higher sub-water test score than non-OSA patients, and OSA in stroke patients may be related to dysphagia.