腭标准触觉阈值与睡眠中气道阻塞及缺氧程度相关性分析

Correlation analysis of standardized palatal sensory threshold with airway obstruction and hypoxia during sleep

目的研究腭标准触觉与睡眠中气道阻塞及缺氧程度的相关性,推断其在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)发病机制中的作用.方法本研究为前瞻性研究.2016年8月至2017年5月,海军军医大学附属长海医院耳鼻咽喉头颈外科92例OSAHS患者作为试验组,招募48名健康志愿者作为对照组,使用触觉测量套件Semmes-Weinstein Monofilaments测量两组患者硬腭两侧和软腭中央触觉阈值,软腭触觉阈减去硬腭触觉阈平均值作为腭标准触觉阈值(SPST),下唇中央作为试验组、对照组对照测量点,采用两独立样本比较的Mann-Whitney U检验及偏相关性分析.结果试验组、对照组间唇触觉阈值差异无统计学意义(0.020[0.008,0.020]g/mm^2比0.020[0.008,0.020]g/mm^2,Z=293.0,P=0.221);试验组硬腭触觉阈值(0.040[0.140,0.055]g/mm^2比0.138[0.064,0.400]g/mm^2,Z=4.5,P=0.000)、软腭触觉阈值(0.400[0.280,0.400]g/mm^2比1.400[1.000,4.000]g/mm^2,Z=0,P=0.000)、腭标准触觉阈值(0.355[0.125,0.373]g/mm^2比1.285[0.896,3.025]g/mm^2,Z=0,P=0.000)均高于对照组;SPST与呼吸暂停低通气指数(AHI)正相关(r=0.835,P=0.000),与夜间睡眠最低血氧负相关(r=-0.636,P=0.000).结论SPST愈大,OSAHS病情愈重,夜间最低动脉血氧饱和度愈低;上气道感觉功能减退在OSAHS发病机制中发挥重要的作用.

Objective To study the correlation between the standardized palatal sensory threshold and airway obstruction and hypoxia during sleep,and to infer its role in the pathogenesis of OSAHS.Methods From August 2016 to May 2017,92 OSAHS patients as experimental group and 48 non-OSAHS volunteers as control group were recruited in Department of Otorhinolaryngology Head and Neck Surgery,Changhai Hospital Affiliated to the Naval Medical University.The tactile sense was measured by Smmes-Weinstein Monofilaments in the middle of uvula and both side of hard palate,then the threshold of the uvula minus,the average threshold of the hard palate as the standardized palatal sensory threshold(SPST).The control point of both groups was located in the central underlip.Mann-Whitney U test for comparing two independent samplesand partial correlation analysis.Results There was no difference in tactile threshold of underlip between the experimental group and the control group(0.020[0.008,0.020]g/mm^2 vs.[0.020(0.008,0.020]g/mm^2,Z=293.0,P=0.221);the tactile sense of the experimental group was larger than that of the control group in thehardpalate(0.040[0.140,0.055]g/mm^2 vs.0.138[0.064,0.400]g/mm^2,Z=4.5,P=0.000),soft palate(0.400[0.280,0.400]g/mm^2 vs.1.400[1.000,4.000]g/mm^2,Z=0,P=0.000)and SPST(0.355[0.125,0.373]g/mm^2 vs.1.285[0.896,3.025]g/mm^2,Z=0,P=0.000).The SPST was positive correlation with apnea hypopneaindex(AHI)(r=0.835,P=0.000)and negative correlation with the nadir oxyhemoglobin saturation(r=-0.636,P=0.000).Conclusion The greater the standardized palatal sensory threshold,the worse the condition of OSAHS,the lower,the lowest blood oxygen at night,and the impaired upper airway sensory function plays an important role in the pathogenesis of OSAHS.