舌骨位置与多导睡眠监测指标及腭咽成形术后疗效的相关性分析

Correlation analysis of hyoid bone position with polysomnography parameters and prognosis of modified uvulopalatopharyngoplasty

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者舌骨位置与多导睡眠监测(PSG)参数指标以及腭咽成形手术疗效相关性,探讨舌骨位置对OSAHS患者疾病程度及腭咽成形手术预后的影响。方法收集2020年6月—2021年10月47例不同程度OSAHS行改良悬雍垂腭咽成形术(H-UPPP)患者术前上气道CT影像及术前、术后3个月PSG数据资料,回顾性分析颏下点至舌骨下缘的垂直距离(MH-v)、下颌骨颏棘至舌骨水平距离(MH-h)以及Friedman舌位(FTP)与阻塞性睡眠呼吸暂停低通气指数(AHI)、平均血氧饱和度(AvSpO_(2))、最低血氧饱和度(LSpO_(2))及血氧饱和度低于90%累积时间占总睡眠时间比(CT90)相关性,并进一步分析FTP、MH-v与H-UPPP手术疗效的相关性。结果MH-v与AHI、LSpO_(2)和AvSpO_(2)均呈中等程度相关(r=0.540,P=0.000;r=-0.523,P=0.000;r=-0.514,P=0.000),MH-v与CT90呈弱相关(r=0.495,P=0.000);MH-h与上述PSG指标均无相关性(P>0.05);FTP与AHI、LSpO_(2)、AvSpO_(2)及CT90均呈弱相关(ρ=0.329,P=0.024;ρ=-0.309,P=0.034;ρ=-0.370,P=0.01;ρ=0.325,P=0.026)。在H-UPPP手术有效组与无效组的MH-h比较差异无统计学意义(t=-0.448,P=0.656),MH-v差异具有统计学意义(t=-5.908,P=0.000),而两组之间FTP比较差异无统计学意义(χ^(2)=1.540,P=0.215),MH-v受试者工作特征ROC曲线下面积为0.884,在预测H-UPPP手术有效性方面具有中等诊断价值。结论作为影响OSAHS患者病情的解剖学因素,CT影像中的舌骨位置MH-v相比FTP与PSG诸多指标具有更好的相关性,对预测H-UPPP手术有效性具有一定的价值。

Objective To study the influence of hyoid bone position in upper airway CT images on severity of obstructive sleep apnea hypopnea syndrome(OSAHS)and prognosis of modified uvulopalatopharyngoplasty(H-UPPP)via exploring the relationship between hyoid bone position and polysomnography(PSG)parameters and the prognosis of H-UPPP in OSAHS patients.Methods Preoperative hyoid bone position in upper airway CT images and preoperative and postoperative PSG parameters of 47 OSAHS patients who underwent H-UPPP from June 2020 to Oct 2021 were collected.The vertical distance from the mandible menton to the lower margin of the hyoid bone(MH-v),the horizontal distance from the mandible mental spine to the hyoid bone(MH-h),and the Friedman tongue position(FTP)were conducted correlation analysis with apnea hypopnea index(AHI),lowest pulse oximeter oxygen saturation(LSpO_(2)),average pulse oximeter oxygen saturation(AvSpO_(2))and the ratio of cumulative time of oxygen saturation below 90%to total sleep time(CT90)in PSG respectively.The correlations between MH-v or FTP and prognosis of H-UPPP were further analyzed.Results MH-v was moderately correlated with AHI,LSpO_(2)and AvSpO_(2)(r=0.540,P=0.000;r=-0.523,P=0.000;r=-0.514,P=0.000),MH-v was weakly correlated with CT90(r=0.495,P=0.000).MH-h had no correlation with the above PSG parameters(P>0.05).FTP was weakly correlated with AHI,LSpO_(2),AvSpO_(2),and CT90(ρ=0.329,P=0.024;ρ=-0.309,P=0.034;ρ=-0.370,P=0.01;ρ=0.325,P=0.026).There was a statistically significant difference in MH-v between the effective and ineffective groups after H-UPPP(t=-5.908,P=0.000),while there was no statistically significant difference in FTP between the two groups(χ^(2)=1.540,P=0.215).The area under receiver operator characteristic curve of MH-v was 0.884,which has moderate diagnostic value in predicting the effectiveness of H-UPPP surgery.Conclusion As an anatomic factor affecting OSAHS patients,the MH-v has a higher correlation with PSG parameters than FTP,which is of certain value in predicting the effectiveness of H-UPPP surgery.