药物诱导睡眠内镜下成人鼾声来源特点及分类方法研究

The Classification and Characteristic Analysis of the Sources of Snoring Sound during Drug-induced Sleep Endoscopy

目的 分析药物诱导睡眠内镜下不同严重程度的睡眠呼吸障碍患者鼾声来源的特点及分类。方法 选择74例(19~55岁,平均 37.9±8.70 岁)AHI<50的单纯打鼾(simple snoring,SS)和不同程度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者为研究对象,分为SS及轻度OSAHS组(39例)和中、重度OSAHS组(35例);各组分别用右美托咪定复合异丙酚进行诱导睡眠后,通过纤维鼻咽喉镜观察两组对象仰卧位打鼾时咽部组织振动及塌陷的情况,并进行分类比较。结果 74例患者中,鼾声来源及振动形式不同,分为软腭振动为主型(I型,前后型),咽侧壁振动为主型(II型,左右型),软腭+咽侧壁共同振动型(III型,向心型)三种类型;软腭振动为主型在SS及轻度OSAHS组和中、重度OSAHS组中的例数分别为24例(61.54%)和10例(28.57%);咽侧壁振动为主型在两组中的例数分别为9例(23.08%)和16例(45.71%);软腭+咽侧壁共同振动型在两组中的例数分别为6例(15.38%)和9例(25.71%),两组间鼾声来源类型及分布差异有统计学意义(P = 0.016)。结论 不同程度睡眠呼吸障碍的患者睡眠中鼾声来源部位及咽部组织振动形式不同;咽侧壁振动为鼾声的主要来源(Ⅱ型及Ⅲ型),且随打鼾者阻塞程度加重而占比增加;以鼾声主要来源为依据的分类法可为该类患者治疗方案的制定提供依据。

Objective To investigate the classification and characteristics of the source of snoring sound during drug-induced sleep endoscopy in patients with different degrees of sleep-disordered breathing.Methods A total of 74 patients (SS or OSAHS,AHI<50)in this study were divided into two groups,including 39 patients with SS or mild OSAHS and 35patients with moderate-severe OSAHS.The patients underwent drug (dexmedetomidine with propofol)-induced sleep endoscopy,sites of vibration and collapse from nasopharynx to laryngeal pharynx while snoring in each patient and were observed and classified.Results The source of snoring and types of vibration had different origin in 74 patients.They showed three types of source of snoring in general:palatal fluttering dominated (type I,antero-posterior),Lateral wall vibration dominated (type II,left-right),and palatal with Lateral wall(type III,concentric).In the SS or mild OSAHS group and moderate-severe OSAHS group,type I patients were 24(61.5%) and 10(28.6%),type II patients were 9(23.1%) and 16(45.7%),and type III patients were 6(15.4%) and 9(25.7%),respectively.There was statistical significance in the distribution of the 3 types between the two groups (P = 0.016).Conclusion Snorers with different severities of sleep breathing disorder show different pharyngeal vibration types,and different snoring sound origins.Lateral wall vibration is the main or partly main source of snoring (type II or type III),significantly associated with increased severity of obstructive sleep apnea (OSA).They may establish therapeutics strategy using the classification of the sources of snoring sound based on the main origin of snoring.