佩戴口器时气道结构变化预测睡眠呼吸暂停患者咽腔塌陷性的改善

Prediction of improvement of pharyngeal collapsibility via anatomical changes in upper airway with oral appliance in patients with obstructive sleep apnea hypopnea syndrome

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者佩戴下颌前移型口腔矫治器(简称口器)时咽腔形态结构变化与咽腔不同平面塌陷度改善的关系。探索佩戴口器能改善咽腔塌陷的患者特征。方法31例OSAHS患者分别于平静呼吸和佩戴口器时,MRI获取上气道结构测量指标,药物诱导电子喉镜评估软腭后、口咽、舌根及会厌平面咽腔塌陷度。分析佩戴口器的气道结构变化与咽腔塌陷性改善间的关联性。对比咽腔塌陷改善者与未改善者的差异。结果研究对象年龄为(37.0±10.9)岁,AHI为(50.5±21.4)次/h。12例(38.7%)患者佩戴口器时软腭后/口咽区域塌陷显著改善,病情相对减轻,最低血氧更高(P=0.005);其佩戴口器时的腭后气道最小截面积、悬雍垂截面积和腭后气道体积增量优于改善不明显者(P=0.017,P=0.003,P=0.008)。22例存在舌后区塌陷者,11例(50%)改善者佩戴口器时舌后最小截面积的增大更加明显(P=0.008)。在会厌平面塌陷者,9例改善明显者悬雍垂和舌后最小截面积左右径增大更明显(P=0.004,P=0.018)。结论OSAHS患者清醒时佩戴口器的咽腔结构扩大量与睡眠时对应气道平面的塌陷性改善程度关联。有助于评估佩戴口器对各平面咽腔塌陷的改善情况。

OBJECTIVE To study the relationship between the morphological changes of pharyngeal cavity and the improvement of pharyngeal cavity collapses in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)when they wear mandibular advancement device(MAD).Exploring the characteristics of patients whose pharyngeal cavity collapse can be improved by wearing MAD.METHODS MRI evaluated upper airway structural changes wearing MAD during conscious and calm breathing.Drug-induced endoscopy was used to observe the collapse site of the pharynx in the retropalatal area(RP),oropharynx,tongue base,and epiglottic level.The correlation between structural changes in upper airway and improvement in pharyngeal collapsibility was analyzed.RESULTS The age of the study subjects was 37.0±10.9 years old.AHI was(50.5±21.4)times/h.The collapsibility of the soft palate/oropharynx area improved in 12 patients(38.7%)when wearing MAD.Those patients were with a relatively lower AHI(P=0.005)and larger increment in the minimum cross-sectional area in RP/uvula and retropalatal airway volume(P=0.017,P=0.003,P=0.008).Twenty-two cases had tongue base collapse,and the 11(50%)patients who had improved collapsibility in the retroglossal area showed a significant increase in the minimum cross-sectional area of tongue level after wearing MAD(P=0.008).The increment of lateral diameters of the minimum sectional areas of uvula and retroglossal area were larger in the 9 patients with epiglottic-level collapse improvement(P=0.004,P=0.018).CONCLUSION The enlargement of the pharyngeal cavity wearing MAD during conscious condition in OSAHS patients is associated with the improvement in airway collapsibility during sleep,which may have predictive value in screening potential candidates for MAD treatment.