Drug-induced sleep endoscopy: a two drug comparison and simultaneous polysomnography

The purpose of the present study was to compare pharyngeal and polysomnographical findings during drug-induced sleep endoscopy (DISE) performed with either propofol or midazolam as a single sedative agent. It is prospective, non-randomized, double-blinded case series study. Sixteen patients with sleep disordered breathing were sedated first with propofol and after full wake up with midazolam. Simultaneous polysomnography (PSG) was performed. We compared the zones of obstruction and vibration found with both drugs using the VOTE classification. Simultaneous PSG findings are also compared. There were 15 men and one woman; the mean age was 42.7 years old, mean body mass index 26.9 kg/m². Average DISE duration was 20 min with Propofol and 14.3 min with Midazolam. The induced sleep stage obtained was N2 with both drugs. Outpatient physical exam did not correlate with drug-induced sleep findings. There was a good correlation between DISE results with both drugs in all the areas of collapse except the velum (p < 0.005). Using a continuous perfusion, there is a good agreement in the findings observed in DISE performed with propofol and midazolam and PSG.     

鼾症患者模拟打鼾与药物诱导睡眠内镜下鼾声来源部位的对比研究

目的 对单纯打鼾(SS)及轻度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的患者,通过鼻咽纤维喉镜观察清醒状态下模拟打鼾及药物诱导睡眠下打鼾时的鼾声来源,研究这两种检查方法判断鼾声来源部位的一致性及模拟打鼾判断鼾声来源的可靠度。 方法 经多导睡眠监测(PSG)诊断为单纯打鼾患者及轻度OSAHS患者共40例,依次进行清醒状态下模拟打鼾及药物诱导睡眠,通过纤维鼻咽喉镜观察患者仰卧位打鼾时咽部组织的振动情况。 结果 在模拟打鼾及药物诱导睡眠两种状态下咽部组织的振动情况有所不同。统计学McNemar检验结果显示,两种方法对软腭振动及会厌/舌根振动判断的差异无统计学意义(P=0.774, 0.077),对咽侧壁振动判断的差异有统计学意义(P=0.002)。两种检查对软腭及会厌/舌根振动的检出率差异无统计学意义(P=0.770,0.110), 药物诱导睡眠对咽侧壁振动的检出率远高于模拟打鼾(P=0.005)。 结论 与药物诱导睡眠内镜检查相比,模拟打鼾能较好地判断软腭振动,其次为舌根/会厌,对咽侧壁振动则较难判断。     

Laser-assisted uvulopalatoplasty for snoring and obstructive sleep apnea: Results in 170 patients

Laser-assisted uvulopalatoplasty (LAUP) is a procedure for the treatment of snoring and, possibly, sleep apnea. Between July 1993 and December 1994, the authors prospectively evaluated 541 consecutive patients referred to their teaching hospital for possible LAUP to treat loud, disruptive snoring. Of these patients, 274 (51%) had one or more LAUP treatments. As of January 1995, LAUP treatment courses were completed in 170 patients. In this paper, the authors report preliminary results on the use of LAUP in these patients. Among the 170 patients, 105 (62%) had a diagnosis of snoring and 65 (38%) obstructive sleep apnea syndrome (OSAS) based on preoperative polysomnography. LAUP treatment in the snoring only patients resulted in complete or nearly complete elimination of snoring in 63 patients (60%), partial improvement of snoring in 30 patients (29%), and no improvement in 11 patients (10%). Of the 65 OSAS patients treated with LAUP, postoperative polysomnograms were obtained in 33 patients (51%). Surgical success was achieved in 16 (48%) of the 33 patients. However, 7 patients (21%) had repeat polysomnograms that were worse than their preoperative polysomnograms, and 5 patients (15%) had no significant change. The results of this study suggest that LAUP may be a viable surgical option for patients with snoring and mild sleep apnea.     

阻塞性睡眠呼吸暂停低通气综合征患者手术前后口咽腔测量分析

目的　探讨阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapnea hypopneasyndrome ,OSAHS)患者口咽腔扩大的程度与疗效的关系。方法　对 38例OSAHS行悬雍垂腭咽成形术 (uvulopalatopharyngoplasty ,UPPP)的病例进行手术前后口咽腔测量 :悬雍垂基底宽、悬雍垂长、悬雍垂至咽后壁间距、腭舌弓间距和腭咽弓间距。并观察呼吸暂停低通气指数 (apnea hypopneaindex ,AHI)、体块指数 (bodymassindex ,BMI)、血氧饱和度 (oxygensaturation ,SaO2 )的变化。结果　OSAHS患者手术前的腭舌弓间距和腭咽弓间距比对照组窄 (P <0 0 5 ) ,而至咽后壁的距离 ,悬雍垂长、宽两组数据间差异无显著性 (P >0 0 5 )。手术后腭舌弓间距、腭咽弓间距、至咽后壁的距离与对照组比较差异无显著性 (P >0 0 5 )。有效组和无效组比较 ,手术前呼吸暂停低通气指数、体块指数、最低SaO2 、平均SaO2 、悬雍垂至咽后壁间距、腭舌弓间距和腭咽弓间距、悬雍垂长、宽在统计学上差异无显著性(P >0 1)。结论　OSAHS患者的口咽部左右径小于健康人 ,而前后径与健康人相近。UPPP手术可以显著扩大咽腔口咽部左右径 ,达到健康人水平。UPPP手术疗效不仅仅与解剖结构异常有关 ,还存在其他影响因素     

Site of airway obstruction in patients with obstructive sleep apnea before and after uvulopalatopharyngoplasty

This study describes a simple method, based on a movable catheter technique, for use during routine polysomnography to identify the site of obstruction, and this has been applied to 51 patients with suspected sleep apnea. The obstruction was found to be retropalatal in 30, retrolingual in 7, and could not be determined in 14 patients (12 had no sleep apnea, 1 did not sleep, and 1 had central sleep apnea). Twelve of these patients had uvulopalatopharyngoplasty with preoperative and postoperative polysomnograms to determine the site of obstruction. The preoperative obstruction was retropalatal in nine and retrolingual in three. Postoperatively, four patients (one with retrolingual obstruction and three with retropalatal obstruction) no longer had sleep apnea. In the remaining eight patients, the site of obstruction was unchanged from the preoperative one. Several conclusions result: 1. the movable catheter technique offers a simple way to determine the site of obstruction in patients with significant obstructive sleep apnea, 2. most such patients obstruct in the retropalatal region, and 3. preoperative localization of the site of obstruction to the retropalatal region does not seem to improve the surgical outcome of uvulopalatopharyngoplasty.     

Four-year follow-up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnea syndrome

Fifty unselected consecutive patients with obstructive sleep apnea syndrome (OSAS) diagnosed by nocturnal recordings of respiration movements by a static charge sensitive bed (SCSB) and oximetry, alone or combined with polysomnography, were studied. Renewed SCSB—oximetry recordings evaluated treatment. Six months after surgery, 30 of 50 were classified as responders. Twenty-one months after surgery, 19 of 49 were responders. Patients who relapsed showed a significant increase in mean body mass index (BMI). Four years after surgery, 24 of 48 patients were responders. Preoperative BMI was significantly lower in the responder group. Subsequent treatment was required in 15 nonresponders. There was no correlation between patients' subjective improvement and objective results. The study resulted in the following conclusions: 1. The responder rate to UPPP in unselected patients is low. 2. Obesity and high indices of nocturnal respiratory disturbance are negative predictors. 3. The patients' subjective recovery alone must not be used for postoperative evaluation. 4. With regular follow-up and the use of the treatment alternatives available today, the majority of OSAS patients can receive effective treatment.     

以睡眠打鼾为首发症状的第二鳃裂囊肿1例

本文报道了1例以睡眠打鼾为主要表现的第二鳃裂囊肿（second branchial cleft cyst,SBCC）。患儿男,9岁5月,因“打鼾3年余,加重2个月,发现鼻咽部肿物1周”就诊。术前MR示右侧咽旁间隙延伸至鼻咽腔囊状肿物影,考虑第二鳃裂囊肿可能。在全身麻醉下行内窥镜下鳃裂囊肿切除术,肿物内含囊液,术后病理诊...     

阻塞性睡眠呼吸暂停低通气综合征患者手术前后口咽腔测量分析

OBJECTIVE: To explore the relationship between the extent of enlarged oropharynx and efficiency through measuring the anterior-posterior and transverse diameter of oropharynx of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) before and after uvulopalatopharyngoplasty (UPPP). METHODS: Thirty eight patients with OSAHS were studied. The following indexes were measured before and after UPPP: width of uvula base, length of uvula, distance between uvula and posterior pharyngeal wall (DBUP), distance between anterior pillar (DBPP), apnea-hypopnea index (AHI), body mass index (BMI) and SaO2. RESULTS: The preoperative DBAP and DBPP were significantly less than those of normal adults (P < 0.05). DBUP, length of uvula and width of uvula base has no significant difference between preoperative patients and normal adults (P > 0.05). There was no significance difference in DBAP. DBPP and DBUP between postoperative patients and normal adults (P > 0.05). The preoperative AHI, IBM, minimal SaO2, mean SaO2, DBUP, DBPP, DBAP, length of uvula and width of uvula base has no significant difference between good responders and nonresponders (P > 0.1). CONCLUSIONS: Transverse diameter of OSAHS patients is shorter than that of normal adults but anterior-posterior diameter of OSAHS patients has no difference compared with normal adults. Transverse diameter could be enlarged by UPPP. Not only anatomical abnormality but also other factors will contribute to the effect of UPPP.     

全长保留悬雍垂腭咽成形术后口咽腔解剖径线变化观察

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)行全长保留悬雍垂腭咽成形术后远期的口咽腔解剖径线的变化。方法:对31例行全长保留悬雍垂腭咽成形术后的OSAHS患者进行随访,并且根据其手术前后口咽腔测量结果进行比较分析,包括:悬雍垂长、悬雍垂基底宽、腭舌弓间距和腭咽弓间距、软腭长度、悬雍垂至咽后壁的间距,此外还有颈围和体质指数。结果:OSAHS患者术后与术前相比较,悬雍垂的长与悬雍垂的基底宽、两侧腭弓(腭咽弓或腭舌弓)间距、软腭的长度、悬雍垂至咽后壁的距离均差异有统计学意义(均P<0.05),而颈围及体质指数均差异无统计学意义(均P>0.05)。结论:全长保留悬雍垂腭咽成形术是解决上气道狭窄,尤其是口咽部狭窄的有效手术方法,可以扩大患者口咽部左右径达到健康人水平。     

阻塞性睡眠呼吸暂停综合征悬雍垂腭咽成形术的临床观察

目的探讨悬雍垂腭咽成形术（uvulopalatopharyngoplasty,UPPP）对阻塞性睡眠呼吸暂停综合征（obstructivesleepapneasyndrome，OSAS）的远期疗效及对糖、脂代谢的影响。方法对32例OSAS患者（中度6例，重度26例）连续观察术前、术后1个月、术后3年时的呼吸紊乱指数（respiratory disturbance     

Retrospective survey of long-term results and patient satisfaction with uvulopalatopharyngoplasty for snoring

The aim of this study was to retrospectively survey patients who had undergone the uvulopalatopharyngoplasty (UPPP) operation over a two-year period, assessing loudness of snoring, sleep quality and patient satisfaction. A total of 271 patients were sent questionnaires to assess snoring and sleeping habits, with additional questions about pain and satisfaction with surgery. Those who did not reply were contacted by telephone. Seventy-four per cent of the target population were surveyed. Taking an improvement in snoring level of 50 per cent or greater, immediately post-operatively the overall success rate was 76 per cent; however, after two years the success rate fell to 45 per cent. Variables such as alcohol consumption and smoking were not found to influence results. On a post-operative pain scale of 1-10 the average was 7.5 and on a satisfaction scale of 1-10 the average satisfaction with surgery was five, 61 per cent of patients stating that they would not have this operation again. This study shows that the UPPP operation is successful in only 45 per cent of patients after long-term follow-up, that the majority of patients experience severe pain and that the overall satisfaction with surgery is low.     

Effects of uvulopalatopharyngoplasty in adult patients with obstructive sleep apnea syndrome

We performed uvulopalatopharyngoplasty (UPPP) in 51 adult patients with obstructive sleep apnea syndrome (OSAS). After UPPP, there were statistically significant improvements in apnea-hypopnea index (AHI), the lowest value of oxygen saturation during sleep and total time of apnic episodes. 28 patients (54.9%) were good responders who represented more than 50% improvements in their AHI. Poor responders tended to be more severe and older than good responders. After cephalometric analysis, poor responders were revealed to show significantly poor mandibular prognatism and also lower positioned hyoid bone than good responders.     

阻塞性睡眠呼吸暂停低通气综合征患者HUPPP 手术前后食管压力的对比分析

摘要：目的探讨改良悬雍垂腭咽成形手术对阻塞性睡眠呼吸暂停低通气综合征患者食管压力的影响。方法选取阻塞平面为腭咽部的阻塞性睡眠呼吸暂停低通气综合征患者,术前行上气道-食管压力测定,分析食管压力,行改良悬雍垂腭咽成形术,并于术后6个月复查上气道-食管压力,对测量结果进行对比分析。结果①阻塞性睡眠呼吸暂停低通气综合征患者术前发生呼吸暂停时的最大平均食管压力与术前呼吸紊乱指数（r=0.604）、ESS评分（r=0.763）呈正相关,与术前最低血氧饱和度（r=-0.454）呈负相关,差异具有统计学意义（P<0.05）。低通气时的最大平均食管压力与术前呼吸紊乱指数（r=0.600）、ESS评分（r=0.609）呈正相关,与术前最低血氧饱和度（r=-0.322）呈负相关,差异具有统计学意义（P<0.05）。② 30例患者术后6个月复查上气道-食管压力,发生呼吸暂停时最大平均食管压力、低通气最大平均食管压力、呼吸事件时最大呼吸努力、呼吸努力次数、睡眠呼吸暂停低通气指数及最低血氧饱和度结果术后、术前对比分析差异均具有统计学意义（P<0.05）。结论食管压力可以作为评估阻塞性睡眠呼吸暂停低通气综合征患者术前严重程度的一项参考指标。改良悬雍垂腭咽成形术后患者的食管压力得到一定程度改善,进一步肯定了改良悬雍垂腭咽成形术对改善腭咽阻塞为主的阻塞性睡眠呼吸暂停低通气综合征患者的病情和生活质量各方面有确切疗效。     

UPPP术后阻塞性睡眠呼吸暂停低通气综合征患者皮质醇及促肾上腺皮质激素的变化

目的:通过研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者UPPP前后皮质醇及促肾上腺皮质激素(ACTH)的变化,探讨OSAHS患者下丘脑-垂体-肾上腺轴激素水平的改变.方法:选择OSAHS患者30例行PSG检查及UPPP术,并于术前及术后6个月均以放射免疫法检测入睡时及晨起ACTH水平及入睡后每2 h皮质醇(COR)血浆浓度测定,分析其变化关系.结果:OSAHS患者术前的COR水平明显高于术后,且分泌的节律发生改变[术前入睡时COR(170.4±56.5)μg/L,0:00时COR(252.2±62.3)μg/L,2:00时COR(276.9±70.4)μg/L,4:00时COR(285.9±63.2)μg/L ,晨起时COR(395.1±85.2)μg/L;术后入睡时COR(133.5±24.8)μg/L,0:00时COR(99.9±9.2)μg/L,2:00时COR(103.8±13.2)μg/L,4:00时COR(146.2±22.5)μg/L,晨起时COR(199.6±20.9)μg/L]而ACTH的分泌差异无统计学意义;术前术后的平均血氧饱和度与平均觉醒时间呈负相关(r=-0.713).结论:OSAHS患者的下丘脑-垂体-肾上腺轴水平异常,反馈调节紊乱,并与睡眠觉醒和夜间低氧有关.     

阻塞性睡眠呼吸暂停综合征患者悬雍垂腭咽成形术后对嗓音影响的初步探讨

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)行悬雍垂腭咽成形术(UPPP)是否影响患者的嗓音质量和发音的难易程度。方法对15例无嗓音功能障碍的OSAS患者行UPPP术,对术前和术后的声学及空气动力学参数进行分析。结果 OSAS患者行UPPP术后发音质量和发音难易程度与术前相比并没有显著性差异(P0.05)。结论本文初步观察表明,UPPP对OSAS患者的嗓音质量无明显影响,值得进一步研究。     

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

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(AvSpO₂)、最低血氧饱和度(LSpO₂)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、LSpO₂和AvSpO₂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、LSpO₂、AvSpO₂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(χ²=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。     

阻塞性睡眠呼吸暂停综合征悬雍垂腭咽成形术的临床观察

目的 探讨悬雍垂腭咽成形术（uvulopalatopharyngoplasty,UPPP）对阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS)的远期疗效及糖、脂代谢的影响。方法 对32例OSAS患者（中度6例，重度26例）连续观察术前、术后1个月、术后3年时的呼吸紊乱指数（respiratory disturbance index,RDI)、体块指数、血压、血糖、甘油三酯、胆固醇的变化。结果 以RDI下降75％为OSAS显效作标准：手术后1个月时显效率37．5％，3年后降为13．8％；有效率术后1个月为87．5％，3年后为55．2％。手术后3年体块指数、血压、血糖、甘油三酯、胆固醇均较手术前显著下降，统计学处理P值均＜0．05，差异有显著性意义。结论 UPPP能改善中、重度OSAS患者的低氧血症，降低血压，血糖、甘油三酯、胆固醇；远期疗效差于近期疗效。术后疗效可能与术前体块指数、RDI、上气道的骨骼结构及术后体重变化有关。     

便携睡眠监测阻塞定位仪与多道睡眠仪及纤维喉镜检查的比较

目的研究整合了便携式多道睡眠仪（polysomnography，PSG）和上气道测压功能的便携睡眠监测阻塞定位仪（ApneaGraph）的临床应用价值。方法经PSG确诊为阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）的32例患者，均行传统的上气道纤维喉镜检查判定阻塞部位。ApneaGraph进行整夜睡眠呼吸监测和同步上气道压力测定。上气道阻塞部位分为上下两部分：上部阻塞主要为腭后区，下部阻塞主要为舌后区。①分析ApneaGraph与传统PSG的呼吸暂停低通气指数（apnea hypopneaindex，AHI）之间相关性；②通过上气道压力测定，分析各平面阻塞特点，判定阻塞平面及计算各平面阻塞次数占气道阻塞总次数的比率，并与传统喉镜阻塞定位进行比较。结果呼吸事件分析：PSG和ApneaGraph测定的AHI（x^-±s）分别为（52．2±18．1）次／h和（50．2±16．0）次／h，两者高度相关（r=0．876，P〈0．001）。阻塞定位分析：①上气道测压：可见单纯上部阻塞和上下部联合阻塞两种模式，28例（87．5％）上部气道阻塞次数占气道阻塞总次数的比率〉50％，4例（12．5％）下部气道阻塞次数占气道阻塞总次数的比率〉50％；②纤维喉镜检查：可见单纯腭后区阻塞和腭后区、舌后区联合阻塞两种阻塞模式，其中18例单纯腭后区狭窄，13例腭后区和舌后区联合狭窄，1例腭后区和舌后区均未见明显狭窄；③上气道测压与传统纤维喉镜检查比较：上部（腭后区）阻塞时，两种检查方法的符合率为84．4％（27／32）；下部阻塞（舌后区）的符合率为53．1％（17／32）。结论ApneaGraph可作为便携PSG，对睡眠呼吸疾病作出初步定性诊断，并通过上气道压力测定，与纤维喉镜检查相结合，较好地判断睡眠时患者气道阻塞部位。