儿童阻塞性睡眠呼吸暂停低通气综合征上气道形态的锥形束CT研究

Cone-beam computed tomography study of upper airway morphology in children with obstructive sleep apneahypopnea syndrome

目的运用锥形束CT(cone beam computed tomography,CBCT)结合多导睡眠图(polysomnography,PSG)评估阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)儿童上气道形态,为临床诊疗提供参考。方法回顾分析45例OSAHS患儿与45例对照组儿童的CBCT资料,通过NNT 9.0软件进行三维重建,测量并记录上气道总容积、鼻咽段容积、腭咽段容积、舌咽段容积、喉咽段容积、上气道最小横截面积及最小横截面积处的前后径和横径;根据多导睡眠图(polysomnography,PSG)监测结果,记录阻塞性呼吸暂停低通气指数(obstructive apnea hypopnea index,OAHI)和最低血氧饱和度(lowest oxygen saturation,LSaO_(2));记录身体质量指数(body mass index,BMI);分析气道容积参数、BMI与PSG检测结果之间的相关性。结果OSAHS组上气道总容积、鼻咽段容积、腭咽段容积、舌咽段容积、喉咽段容积、上气道最小横截面积及最小横截面积处的前后径和横径等测量结果均小于对照组,差异具有统计学意义(P<0.05)。OSAHS组上气道总容积、最小横截面积、最小横截面积处的横径与OAHI呈负相关(P<0.05)。OSAHS组上气道总容积、最小横截面积、最小横截面积前后径及横径与LSaO_(2)之间相关性无统计学意义(P>0.05)。OSAHS组儿童的BMI与PSG结果之间相关性无统计学意义(P>0.05)。结论OSAHS患儿上气道形态较正常儿童缩窄;CBCT三维气道分析技术对临床评估OSAHS患儿上气道形态及阻塞程度具有一定的价值。

Objective To evaluate the morphology of the upper airway of children with obstructive sleep apnea-hypopnea syndrome(OSAHS)using cone-beam computed tomography(CBCT)combined with polysomnography(PSG)and provide references for clinical practice.Methods CBCT data of 45 OSAHS children and 45 normal children and PSG data of the OSAHS group were retrospectively collected.Three-dimensional reconstructions were performed using NNT 9.0 software.The total upper airway volume,nasopharyngeal volume,palatopharyngeal volume,glossopharyngeal volume,laryngopharyngeal volume,minimum cross-sectional area,anterior-posterior diameter of the minimum cross-section,and lateral diameter of the minimum cross-section were measured and recorded.According to PSG monitoring results,patients with an obstructive apnea hypopnea index(OAHI)and lowest oxygen saturation(LSaO_(2))were assessed.Body mass index(BMI)was recorded.The correlation between airway volume parameters,BMI and PSG test results was analyzed.Results The total upper airway volume,nasopharyngeal volume,palatopharyngeal volume,glossopharyngeal volume,laryngopharyngeal volume,minimum cross-sectional area,anterior-posterior diameter of the minimum cross-section,and lateral diameter of the minimum cross-section of the OSAHS group were significantly reduced compared with those of the control group(P<0.05).In the OSAHS group,the total upper airway volume,the minimum cross-sectional area and the lateral diameter of the minimum cross-section showed moderate negative correlations with the obstructive apnea hypopnea index(OAHI)(P<0.05).Moreover,the total upper airway volume,minimum cross-sectional area,anterior-posterior diameter of the minimum cross-section and lateral diameter of the minimum cross-section showed no correlation with the minimum blood oxygen saturation(P>0.05).No significant correlation was noted between BMI and PSG in the OSAHS group(P>0.05).Conclusion The morphology of the upper airway of children with OSAHS was significantly smaller than that of normal children.CBCT three-dimensional technology for analyzing the upper airway has a certain value in evaluating the morphology and degree of obstruction of the upper airway in children with OSAHS.