CT测量在阻塞性睡眠呼吸暂停综合征上呼吸道狭窄定位诊断中的意义

目的　确定上呼吸道CT扫描测量对阻塞性睡眠呼吸暂停综合征 (obstructivesleepapneasyndrome,OSAS)患者上呼吸道狭窄或阻塞部位的定位诊断意义。方法　采用螺旋CT自鼻咽顶部到声门之间的区域进行连续扫描 ,应用图像工作站测量软腭后区、悬雍垂区、舌后区和会厌后区的气道横截面积和各径线长度以及咽壁厚度等指标 ,通过 2 2 5例健康人测量确立正常值范围。同样检测 5 4例经多导睡眠监测系统确诊的OSAS患者 ,其中 14例测量睡眠呼吸暂停发作时上呼吸道CT扫描的结果 ,与相应解剖区的正常值比较。结果　 5 4例OSAS患者中 ,12例无明显的上呼吸道狭窄 ,4 2例中有6 7个平面存在狭窄。仅有 1个平面狭窄者 2 4例 ,表现为软腭后区狭窄者 14例 ,悬雍垂区狭窄者 2例 ,舌后区狭窄者 3例 ,会厌后区狭窄者 5例。 14例表现为相邻的两个解剖区域的共同狭窄 ,其中为软腭后区 +悬雍垂区者 4例 ,悬雍垂区 +舌后区者 5例 ,舌后区 +会厌后区者 5例。 1例表现为软腭后区、悬雍垂区和舌后区的狭窄 ,有 3例表现为整个上呼吸道 4个解剖区域的狭窄。 14例OSAS睡眠呼吸暂停发作时上呼吸道CT扫描的结果与常规CT扫描测量所提示的上呼吸道狭窄部位基本一致。结论　大部分OSAS患者存在上呼吸道的解剖性狭窄 ,上呼吸道的CT扫描测量可以较好     

阻塞性睡眠呼吸暂停低通气综合征患者CT测量上呼吸道狭窄定位诊断的观察

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者CT测量上呼吸道狭窄定位诊断的临床意义。方法采用螺旋CT自鼻咽顶部到声门之间的区域进行连续扫描,应用图像工作站测量软腭后区、悬雍垂区、舌后区和会厌后区的气道横截面积和各径线长度以及咽侧壁和咽后壁软组织厚度等指标,选取88例健康人测量数值确立正常值范围。测量82例OSAHS患者上呼吸道cT扫描的结果并与相应解剖区的正常值比较。结果82例OSAHS患者中,仅有1个平面狭窄者17例,其中为软腭后区狭窄者5例,悬雍垂区狭窄者4例,舌后区狭窄者6例,会厌后区狭窄者2例。相邻的两个解剖区域共同狭窄45例,其中为软腭后区及悬雍垂区者26例,悬雍垂区及舌后区者15例,舌后区及会厌后区者4例。软腭后区、悬雍垂区和舌后区3个解剖区域共同狭窄20例。同时对88例健康人清醒状态下上气道4个平面截面积做测量分析,结果显示截面积软腭后区最为狭小,其次为舌后区,而会厌后区截面积最大。OSAHS组软腭长度及厚度均大于正常组,提示软腭增长、增厚是咽腔狭窄的原因之一。结论大部分OSAHS患者存在上呼吸道的解剖性狭窄,上呼吸道的CT扫描测量可以较好的确定具体狭窄部位,针对性手术治疗便于提高临床疗效。     

上呼吸道狭窄平面的CT定量评估

目的 探讨OSAHS患者上呼吸道狭窄平面的CT定量评估方法.方法 经PSG确诊的46例OSAHS患者,清醒平静呼吸状态下行上呼吸道螺旋CT扫描,分别测量软腭后区、悬雍垂后区、舌后区和会厌后区的气道横截面积,并与以往建立的南方正常人群上呼吸道CT测量正常值比较以确定狭窄平面,比较分析单平面狭窄量与AHI的相关关系.结果 46例患者中,无明显上呼吸道狭窄5例;仅有1个平面狭窄者23例,其中软腭后区狭窄5例,悬雍垂后区狭窄17例,舌后区狭窄1例;11例表现两个平面狭窄,其中软腭后区+悬雍垂后区狭窄6例,悬雍垂后区+舌后区狭窄2例,悬雍垂后区+会厌后区狭窄3例;6例为3个平面狭窄,其中悬雍垂后区+舌后区+会厌后区狭窄3例,软腭后区+悬雍垂后区+舌后区狭窄2例,软腭后区+舌后区+会厌后区狭窄1例;所有4个平面均狭窄1例.单纯悬雍垂后区狭窄者中,其狭窄量在轻中度组与重度组之间具有统计学意义,并与AHI存在显著正相关.结论 上呼吸道CT测量能较好定位OSAHS解剖性狭窄部位,量化评估其狭窄程度.     

阻塞性睡眠呼吸暂停低通气综合征患者的多层螺旋CT表现

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者上呼吸道多层螺旋CT表现,为手术针对性治疗提供可靠依据。方法对经多导睡眠监测仪诊断为OSAHS的59例患者行多层螺旋CT扫描,测量上呼吸道横截面积及矢状径、冠状径,比较其与87例正常成人上呼吸道横截面积及各径线的差别。结果 59例OSAHS患者中上呼吸道横截面积有狭窄的计53例,共计8 5个平面存在狭窄。另有6例无法明确判断具体解剖层面狭窄。5 3例狭窄中34例患者仅存在1个狭窄平面,其中软腭后区狭窄者23例、悬雍垂区狭窄者4例、舌后区狭窄者3例、会厌后区狭窄者4例;9例患者相邻的两个平面共同狭窄,其中为软腭后区+悬雍垂区者4例、悬雍垂区+舌后区者3例、舌后区+会厌后区者2例;7例患者软腭后区、悬雍垂区和舌后区3个平面同时狭窄。3例患者整个上呼吸道4个解剖层面狭窄。结论大部分OSAHS患者上呼吸道存在解剖性狭窄,其中最为常见的狭窄部位是软腭后区。多层螺旋CT能够精确测量上呼吸道各层面,并对狭窄部位和范围进行定位,为手术方式的选择提供客观依据。     

咽科学

20021396 cT测量在阻塞性睡眠呼吸暂停综合征上呼吸道狭窄定位诊断中的意义/李树华…刀中华耳鼻咽喉科杂志一2()02,37(2)一1 33~1 36 [J的:确定上呼吸道(:’r扫描测童对阻塞性睡眠呼吸暂停综合征(OSAS)患者[呼吸道狭窄或阻塞部位的定位诊断意义方法:采用螺旋CT自鼻咽顶部到声门之间的区域进行连续扫描,应用图像工作站测量软愕后区、悬雍垂区、舌后区和会厌后区的气道横截面积和各径线长度以及咽壁厚度等指标,通过225例健康人测量确立正常值范围。同样检测54例经多导声门检测系统确诊的OSAS患者,其中14例测量声门呼吸暂停发作时上呼吸道…     

阻塞性睡眠呼吸暂停综合征上呼吸道CT测量及其对上呼吸道狭窄部位的定位诊断意义

目的 了解CT测量在阻塞性睡眠呼吸暂停综合征（OSAS）上呼吸道狭窄定位诊断中的意义。方法 OSAS病人59例为A组，上呼吸道阻塞部位者35例为B组，正常人53人为对照组，CT扫描并测量各平面呼吸道横截面积等参数。结果 A组和对照组比较，4个平面左右径向悬雍垂区前后径明显小于对照组；软腭后区，悬雍垂区和舌后区横截面积明显小于对照组；4个测定平面咽侧壁软组织厚度，软腭后区和悬雍垂区的咽后壁软组织厚度明显大于对照组。B组与对照组比较，各测量指标差异更加明显，B组中超出各测量值正常范围的病人比率明显多于A组。结论 常规CT测量对OSAS病人上呼吸道阻塞部位的定位诊断具有较好的价值。     

阻塞性睡眠呼吸暂停综合征患者上呼吸道的CT研究

目的 :探讨阻塞性睡眠呼吸暂停综合征 (OSAS)患者和正常人的上呼吸道CT资料的差异。方法 :对经多导睡眠监测 (PSG)确诊的OSAS患者和年龄性别相近的正常成年人各 5 3例 ,采用螺旋CT对上呼吸道进行连续扫描 ,测量并比较两组间有关数据。结果 :OSAS组软腭后区、悬雍垂区和舌后区的横截面积均明显小于对照组 ;左右径在所测量的 4个平面中均明显短于对照组 ;而前后径的比较除悬雍垂区以外 ,两组间差异均不明显 ;前后径 /左右径比值在会厌后区差异不显著 ,其余 3个区域差异明显 ;咽后壁的软组织厚度比较软腭后区和悬雍垂区差异明显 ,咽侧壁的软组织厚度比较 ,4个测量平面差异均显著 ,软腭后区咽侧脂肪面积比较差异不显著。结论 :上呼吸道的解剖性狭窄是OSAS的主要发病原因之一 ,造成上呼吸道解剖性狭窄的主要原因是咽侧壁软组织的明显增厚并导致气道左右径的缩短     

上呼吸道咽壁顺应性的CT定量评估

目的:了解阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者和正常人的上呼吸道不同平面的咽壁 顺应性的差别。方法:经PSG确诊的OSAHS患者25例(OSAHS组)和正常成年人20例(对照组),平静呼吸时 采用螺旋CT对上呼吸道进行连续扫描,测量软腭后区、悬雍垂后区、舌后区和会厌后区的气道横截面积和气道 内径;然后保持体位不变,做Muller动作的同时,再次对上呼吸道相同区域进行连续扫描,测量相应平面的上呼 吸道横截面积和气道内径,计算上呼吸道各平面的总咽壁顺应性、咽侧壁顺应性和咽前后壁顺应性。结果: OSAHS组和对照组的总咽壁顺应性和咽侧壁顺应性在软腭后区、悬雍垂后区和舌后区差异均有统计学意义(均 P<0.01),在会厌后区则差异无统计学意义(P>0.05);两组间上呼吸道各平面的咽前后壁顺应性在软腭后区、 悬雍垂后区差异有统计学意义(分别为P<0.01和P<0.05),舌后区、会厌后区则差异无统计学意义(P>0. 05);两组中,上呼吸道4个测量平面的咽侧壁顺应性均明显大于前后壁的顺应性(均P<0.01)。结论:利用CT 扫描测量可以实现上呼吸道各平面咽壁顺应性的定量评估,为临床提供客观定量的指标;OSAHS患者和正常人 的上呼吸道咽壁顺应性差别明显,咽壁顺应性增大是OSAHS发病的重要因素之一。     

呼吸面罩内压力变化对阻塞性睡眠呼吸暂停低通气综合征患者上呼吸道形态的影响

目的:探讨呼吸面罩内压力变化对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者和正常人上呼吸道形态的影响.方法:采用16排螺旋CT自鼻咽顶部到声门之间的区域进行连续扫描,应用图像工作站测量软腭后区、悬雍垂区、舌后区和会厌后区的气道横截面积、左右径和前后径.对35例正常对照者和46例OSAHS患者分别行面罩内压力为0 kPa和0.784 kPa状态下的CT扫描,比较正常对照者和OSAHS患者间在各种条件下上呼吸道各测量指标的差异.结果:在面罩内压力相同的条件下,OSAHS患者上呼吸道CT测量的多数指标明显小于对照组(P<0.05或P<0.01);对照组和OSAHS患者上呼吸道多数测量指标在0.784 kPa正压条件下较0 kPa时有明显增加(P<0.05或P<0.01),其中对照组的增加幅度明显大于OSAHS组(P<0.05或P<0.01);以35例对照者确定面罩内压力由0 kPa增加到0.784 kPa时上呼吸道软腭后区、悬雍垂区、舌后区和会厌后区横截面积增加的最小正常值为标准,将46例OSAHS患者分为上气道正常扩张的17例和扩张度低于正常的29例,在0 kPa下这2组患者上呼吸道CT测量指标差异无统计学意义(P>0.05);而在0.784 kPa条件下,前者的上呼吸道多项测量指标均大于后者(P<0.05或P<0.01).结论:面罩内压力的增加可以在不同程度上导致OSAHS患者和对照者上呼吸道的扩张,其中OSAHS患者的扩张程度明显小于对照者;OSAHS患者上呼吸道扩张程度较小的原因与其上呼吸道存在解剖性狭窄和咽壁本身的可扩张性减弱有关.     

多层螺旋CT在阻塞性睡眠呼吸暂停综合征诊断中的应用价值

目的:应用多层螺旋CT(multi-slice spiralcomputed tomography,MSCT)对确诊阻塞性睡眠呼吸暂停综合征(obstructive sleep apneasyndrome,OSAS)患者进行上气道成像,分析其形态特点。方法:确诊的OSAS患者28例,对照者14例,于深吸气末、深呼气末、平静呼吸、(Muller)动作时行上气道MSCT扫描,测量各咽部水平截面积及相应的矢、横径、软腭的长度、厚度,判断上气道的阻塞情况,计算气道塌陷度。结果:(1)OSAS组腭后区及舌后区截面积比对照组明显狭窄,且多发生在吸气时相。(2)OSAS组腭后区及舌后区的气道塌陷度较正常人高。(3)OSAS组软腭…     

Computer-assisted fiberoptic pharyngoscopy in obstructive sleep apnea syndrome

OBJECTIVE: To investigate the upper airway (UA) characteristics of patients with obstructive sleep apnea syndrome (OSAS) using computer-assisted fiberoptic pharyngoscopy with Muller's maneuver (CFPMM). METHODS: The pharyngeal cavity were measured and calculated by CFPMM in 30 OSAS patients and 30 controls. The correlation between UA anatomy and polysomnography data was analyzed. RESULTS: CFPMM can measure the cross-section area of UA accurately. All OSAS patients had minimal cross-section areas of pharyngeal apertures below 40 mm(2) during Muller's maneuver and 60% of cases had complete occlusion. Obstruction sites at the velopharynx were observed in all cases and 40% had multiple obstruction sites. Diminished pharyngeal apertures and increased collapsibility were associated with increased rates of apnea and hypopnea index (p < 0.05). CONCLUSION: CFPMM is able to evaluate UA's characteristics and help determine the site of obstruction. Complete occlusion of UA during Muller's maneuver is the criterion to determine the obstruction site in OSAS patients.     

Determining the site of airway obstruction in obstructive sleep apnea with airway pressure measurements during sleep

OBJECTIVE: To determine the site(s) of upper airway obstruction in patients with obstructive sleep apnea syndrome (OSAS) and their changes during sleep with upper airway (UA) pressure measurement; and to analyze the correspondence between the UA pressure measurement and polysomnography (PSG). METHOD: Thirty patients with OSAS underwent UA pressure measurement. The catheter with five solid-state ultraminiature sensors was inserted through the patients' upper airway to the esophagus. The sensors were located at the nasopharynx, oropharynx, tongue base, hypopharynx, and esophagus. The lower limit of UA obstruction was determined by relying on the observed pressure pattern. RESULT: 1) During inspiration, obstruction occurred associated with an increased negative inspiratory pressure inferior to the site of obstruction and a disappeared negative inspiratory pressure above the site of obstruction; 2) three patterns of obstruction were observed; 3) the site of obstruction was located at the site of the palate; 4) velopharyngeal obstruction and tongue-pharynx obstruction were all present; 5) nasopharyngeal obstruction velopharyngeal obstruction and tongue-pharynx obstruction were all present; and 6) peak inspiratory pressure differences between the normal breath and apnea were associated with the longest apnea interval (P <.05). CONCLUSION: UA pressure measurement can evaluate the site of obstruction in patients with OSAS and their changes during sleep. Peak inspiratory pressure differences between normal breath and apnea can show the severity of OSAS.     

鼻咽腔大小对阻塞性睡眠呼吸暂停综合征的影响

目的 既注对阻塞性睡眠呼吸暂停综合征２的上气道研究在口咽部位，作者观察ＯＳＡＳ患者鼻咽部的三维影像特征，探讨鼻咽腔大小对ＯＳＡＳ发病影响。方法 ２３例中性别、年龄配经的无鼾对照进行上气道ＭＲＩ影像比较；并做睡眠呼吸紊乱指数与上气道ＭＲＩ指标的相关与回归分析。结果 ＯＳＡＳ患者鼻咽显著小于无鼾对照，在矢状径、横向径、截面积、体积的比较中都有在显著性。咎咽指标睡眠呼吸紊乱相关密切，鼻咽太径与呼吸暂停低     

鼻咽腔大小对阻塞性睡眠呼吸暂停综合征的影响

目的既往对阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＳ）患者的上气道研究集中在口咽部位。作者观察ＯＳＡＳ患者鼻咽部的三维影像特征,探讨鼻咽腔大小对ＯＳＡＳ发病影响。方法２３例ＯＳＡＳ患者与１２名性别、年龄配比的无鼾对照进行上气道ＭＲＩ影像比较;并做睡眠呼吸紊乱指数与上气道ＭＲＩ指标的相关与回归分析。结果ＯＳＡＳ患者鼻咽显著小于无鼾对照,在矢状径、横向径、截面积、体积的比较中都有较大显著性。鼻咽指标与睡眠呼吸紊乱相关密切,鼻咽矢状径与呼吸暂停低通气指数（ａｐｎｏｅａｈｙｐｏｎｏｅａｉｎｄｅｘ,ＡＨＩ）和最低血氧饱和度（ＳａＯ２）相关,鼻咽体积与呼吸暂停指数（ＡＩ）相关。结论虽然ＯＳＡＳ上气道狭窄主要在口咽部,但鼻咽大小对ＯＳＡＳ的发病及严重性均有影响。     

Upper airway occlusion sites of obstructive sleep apnea]

OBJECTIVE: To locate the obstruction sites in patients with obstructive sleep apnea syndrome (OSAS) during sleep by MRI imaging and dynamic fiberoptic pharyngoscopy. METHODS: Fifteen OSAS patients confirmed by polysomnography (PSG) underwent ultrafast MR imaging during sleep. Their sequential midline sagittal and axial images were obtained and displayed in the cine mode. Then we examined the upper airway of the retropalate region (RP), retroglottal region (RG) and epiglottal region (EPG). We also did dynamic fiberoptic pharyngoscopy examination during sleep in 8 patients in another night. RESULTS: Among the 15 patients, 3 had only RP region obstruction, 2 had only RG region obstruction, and the other 10 had both RP & RG airway obstruction. In the 8 cases monitored with both MRI and fiberoptic pharyngoscopy, the results obtained from the 2 methods were identical. CONCLUSION: MRI and fiberoptic pharyngoscopy are useful in locating the pharyngeal airway obstruction sites of OSAS patients and would be helpful in selecting treatment measures.     

A comparison of cephalometric analysis using radiographs and craniofacial computed tomography in patients with obstructive sleep apnea syndrome: preliminary report

The aim of this study was to describe the similarities and differences as well as the convenience in using of cephalometric radiographs and craniofacial computed tomography in obstructive sleep apnea syndrome (OSAS) patients and to demonstrate the relationship between the severity of sleep-disordered breathing and severity of cephalometric abnormalities. A total of 28 randomly selected patients with snoring, and varying degrees of sleep-disordered breathing were included in this study. A control group included 22 patients. These patients had no snoring or clinical evidence of sleep-disordered breathing as evaluated by polysomnographic test. No patients had prior pharyngeal or maxillomandibular surgery. All patients were evaluated by otolaryngological examination and had polysomnography, cephalometric radiographs and craniofacial CT scans. In study group the evaluation between cephalometric analysis on radiographs and CT scans was made. The comparison between the control and the study group was also assessed as far as cephalometric data are concerned. The cephalometric parameters revealed major differences between controls and patients with OSAS regarding the size and position of soft palate and uvula, volume and position of tongue, hyoid position, mandibulo-maxillary protrusion and size of the pharyngeal airway space. OSAS is associated with statistically significant changes in cephalometric measurements. Lateral cephalometric analysis and craniofacial CT scans add further information to the anatomical assessment of patients with OSAS. We found craniofacial CT scan measurements to be easier and more accurate especially when applying to soft tissues. We believe that this method may also be useful for patient classification to surgical procedures.     

The study about the characteristics of upper airway in obstructive sleep apnea syndrome]

OBJECTIVE: To investigate the upper airway (UA) characteristics of the patient's with obstructive sleep apnea syndrome (OSAS) and analyses the value of computer assisting fiberoptic pharyngoscopy with müller's maneuver (CFPMM) in topodiagnosis of OSAS. METHODS: The pharyngxes of 30 cases with OSAS and 30 controls were examined by CFPMM. The cross-section area at velo- and tongue-pharyngeal, pharyngeal collapsibility, sites of UA obstructive and their anatomical factors were measured and calculated and the correlation between the anatomical abnormalities of UA and outcomes of polysomnography (PSG) were analysed. RESULTS: 1. CFPMM can accurately measure and calculate the cross-section area of the upper airway. 2. mean areas of velopharyngeal and tongue-pharyngeal were significantly less than those in control subjects (all P < 0.05). OSAS patient's also showed relatively much larger collapsibility at sach site of the UA than controls. 3. At müller's maneuver, all the areas of OSAS patient's were below 40 mm2 and 60% cases appeared complete occlusion in pharyngeal. 4. All patient's had obstruction at velopharymx and airway collapses at multiple sites in 40% of cases. 5. At velopharyngeal the anatomical factors causing obstruction mainly were posterior displacement of soft palate, thicken and collapse of the pharyngeal wall. Besides the redundant lymph tissue at tongue base and posterior displacement of the tongue base, enlarged inferior pole of tonsil and collapse of pharyngeal wall played an important role at tongue-pharyngeal obstruction. 6. Diminished pharyngeal apertures and collapsibility were associated with increased rates of apnea and hypopnea index (P < 0.05). CONCLUSION: 1. CFPMM is able to measure and calculate UA's cross-section area and collapsibility, determine the site of obstruction, and helping the treatment. 2. Complete occlusion of UA at müller's maneuver is the criterion to determine site of UA obstruction in OSAS patient's during waking hours. 3. The anatomical abnormalities of UA of patients is reflects the severity of the OSAS.