Computed tomography of the oropharynx in obstructive sleep apnea

Uvulopalatopharyngoplasty (UPPP) is currently the preferred method for treatment of the obstructive sleep apnea syndrome (OSAS). However, only 50 per cent of the patients operated upon are cured by this surgical procedure, and there is a demand for better and more objective selection criteria. Computed tomography (CT) of the oropharynx was obtained in 32 consecutive adult patients with proven OSAS. An additional 15 patients with the same complaints, but without objective evidence of OSAS, were used as a control group, together with 20 normal subjects. The axial widths of the tongue and the genioglossus and hyoglossus muscles were measured by CT. Both the tongue and genioglossus widths were significantly larger in the OSAS patients than in the two control groups (p less than 0.001). The increased tongue width will cause encroachment of the oropharyngeal airway below the level of the soft palate. Thus, CT can be used to measure the tongue size in order to evaluate its predictive value for the outcome of the UPPP procedure.     

正常人和阻塞性睡眠呼吸暂停综合征患者上呼吸道的CT测量及比较

目的：探讨上呼吸道各平面的正常参考值及对阻塞性睡眠呼吸暂停综合征(OSAS)的判断意义。方法：对42例健康人和27例OSAS患者采用螺旋CT自鼻咽顶壁平扫至环状软骨下缘平面，应用图像处理工作站有关测量技术，分别测量正常人和OSAS患者清醒状态下上呼吸道的软腭后区、悬雍垂区、舌后区和会厌后区的横截面积及冠、矢状径。将其测量数值分别除以环状软骨平面气道的相应值；探讨正常参考值范围，并与OSAS患者上呼吸道测量值比较。结果：上呼吸道四个平面的每组参考值各不相同，且男女之问参考值存在差异，而地区、身高和年龄等因素对其影响不大。42例健康人上呼吸道各平面横截面积低于参考值者5例(11．9％)，27例OSAS各平面的横截面积在正常参考值内者4例(14．8％)。结论：上呼吸道各平面的上述参考值有助于判断上呼吸道的狭窄，对OSAS的诊断和治疗方法选择有一定意义。     

Evaluation of the upper airway cross-sectional area changes in different degrees of severity of obstructive sleep apnea syndrome: cephalometric and dynamic CT study

BACKGROUND AND PURPOSE: The upper airway lumen is narrower in patients with obstructive sleep apnea syndrome (OSAS) than normal subjects. In this study, we examined changes of the upper airway cross-sectional area in each phase of respiration in different degrees of severity of OSAS with dynamic CT and investigated whether these changes have any correlation with sleep apnea severity parameters, including polysomnography (PSG) and cephalometry. MATERIALS AND METHODS: Between May and November 2004, 47 patients who had at least 2 of 3 major symptoms of snoring, daytime somnolence, and apnea with witness were included in this prospective study. As control group, 24 habitual snorers were studied. All patients underwent PSG and upper airway CT. The average number of episodes of apnea and hypopnea per hour of sleep (the apnea-hypopnea index, AHI) was calculated. An AHI of 5 -29 represented mild/moderate OSAS and an AHI > or = 30 represented severe OSAS. Cross-sectional area of the airway at the level of oropharynx and hypopharynx were obtained in each phase of quiet tidal breathing and at the end of both the forced inspiration and expiration. Six standard cephalometric measurements were made on the lateral scout view. All parameters were compared between controls and mild/moderate and severe OSAS groups. RESULTS: Twenty-seven patients had mild/moderate OSAS, and 20 patients had severe OSAS. Patients with severe OSAS had significantly narrower cross-sectional area at the level of uvula in expiration, more inferiorly positioned hyoid bone, and thicker soft palate compared with patients with mild/moderate OSAS (P < .05) and the control group (P < .05). In addition, severe OSAS patients had bigger neck circumference than those in the control group (P < .05). CONCLUSION: Patients with severe OSAS had significant differences in the parameters. Measurement of the cross-sectional area of oropharynx in expiration can especially be useful for diagnosis of severe OSAS as a new key point.     

Cine CT in obstructive sleep apnea

The upper airway was evaluated in eight patients with obstructive sleep apnea by using a rapid sequential CT scanner (Imatron C-100). Four patients also had simultaneous polysomnograms to determine the onset of sleep and apnea. The upper airway was scanned while the patient was awake (eight patients), asleep (four patients), and asleep and apneic (eight patients). Measurements of the cross-sectional area of the upper airway were correlated with the findings on sleep studies in four patients. During the awake state the airway was narrowed and showed increased collapsibility in all eight patients. Five of the eight patients had cross-sectional areas of less than or equal to 4 mm2 at one or more sites at some time during the respiratory cycle while awake. During apnea all patients had obstruction at the uvula and oropharynx, but the length of the obstruction varied from one patient to another. In three of the eight patients the obstruction extended inferiorly to the hypopharynx. Cine CT can be used to objectively evaluate patients with sleep apnea and may demonstrate the need to modify surgical treatment.     

64层螺旋CT评价阻塞性睡眠呼吸暂停低通气综合征

目的 探讨64层螺旋CT扫描在评价阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)上气道的阻塞平面和范围的诊断价值.方法 前瞻性连续纳入30例OSAHS患者和20例健康志愿者清醒状态下行上气道64层螺旋CT扫描,其中9例重度OSAHS患者在睡眠呼吸暂停时再次行上气道64层螺旋CT扫描,所有数据采用Mimics软件,测量和比较健康志愿者和OSAHS患者以及重度OSAHS患者清醒状态和睡眠呼吸暂停时上气道形态学上的差异.结果 (1)OSAHS患者清醒状态下上气道在软腭平面和舌后平面有不同程度的狭窄,与健康志愿者统计学有显著性差异(P＜0.05);(2)重度OSAHS患者清醒状态与睡眠状态的阻塞平面大致一致,然而睡眠呼吸暂停发作时软腭后区的最小截面积远小于清醒状态下的截面积或完全闭塞,二者统计学有显著性差异(P＜0.05).结论 64层螺旋CT扫描和图像后处理能够在体评价OSAHS患者上气道阻塞的平面和范围.     

慢性咳嗽与阻塞性睡眠呼吸暂停低通气综合征相关性探讨

 目的 探讨慢性咳嗽与阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)之间的关系。方法 对21例确诊为慢性咳嗽的患者,院外给予相关治疗后,咳嗽症状未见改善,入院后经标准多导联睡眠图(polysomnography, PSG)诊断为OSAHS,通过经鼻持续气道正压呼吸(continuous positive airway pressure,CPAP)治疗,评价治疗前后,慢性咳嗽症状变化情况。结果 经CPAP治疗后,慢性咳嗽患者咳嗽均有不同程度的改善,其中16例咳嗽症状好转,5例痊愈。结论 慢性咳嗽与OSAHS之间具有一定的相关性。     

阻塞性睡眠呼吸暂停综合征(OSAS)清醒和呼吸暂停时上气道形态改变的CT动态研究

目的 对比研究OSAS患者清醒和呼吸暂停时上气道的形态学改变。方法 对15例OSAS患者上气道进行清醒和睡眠呼吸暂停时的CT扫描，分析清醒和睡眠呼吸暂停时上气道最狭窄处截面积的动态改变。结果 14例OSAS患者睡眠呼吸暂停时上气道最狭窄处面积比清醒时明显变小，1例上气道最狭窄处完全阻塞。结论 OSAS患者睡眠呼吸暂停时上气道最狭窄处截面积比清醒时明显变小或完全阻塞。     

阻塞性睡眠呼吸暂停综合征与IL-6关系的研究

目的 :观察阻塞性睡眠呼吸暂停综合征 (OSAS)患者血清白介素 6 (IL - 6 )水平的变化。方法 :以 10名正常人做对照 ,采用放免法 (RIA)测定 40例OSAS患者血清IL - 6含量。结果 :OSAS患者血清IL - 6明显升高 (P <0 .0 5 ) ,且升高程度与病情有关。进一步分析与小于 90 %血氧饱和度占总睡眠时间百分比呈正相关 (r=0 .383,P <0 .0 5 ) ,与呼吸暂停时间占总睡眠时间百分比呈正相关 (r=0 .35 7,P <0 .0 5 ) ,与呼吸暂停 /低通气指数 (AHI)呈正相关 (r=0 .382 ,P <0 .0 5 )。结论 :IL - 6与OSAS关系密切 ,对于阐明睡眠相关因子在OSAS的变化规律及其在OSAS发病机制中的作用有一定意义。     

飞行员高血压与阻塞性睡眠呼吸暂停关系分析

目的探讨飞行员高血压与阻塞性睡眠呼吸暂停(obstructive sleep apnea，OSA)之间的关系，为高血压病的健康鉴定提出依据。方法49例高血压病飞行员为试验对象，进行动态血压及睡眠监测。根据所得结果区分为单纯高血压组(38例，Ⅰ组)和高血压合并OSA组(14例，Ⅱ组)。对两组睡眠质量指标及血压昼夜节律变化进行对比分析。结果两组在呼吸暂停／低通气指数(apnea／hypopnea index，AHI)、血减氧饱和度指数(oxygen desaturation index，0DI)及睡眠结构上差异有显著性意义。OSA对睡眠结构的改变呈正相关。在动态血压监测中两组对比收缩压昼间Ⅱ组与Ⅰ组有显著性差异，舒张压昼夜Ⅱ组均高于Ⅰ组。同时Ⅰ组中出现非杓型血压发生率(9／35)明显低于Ⅱ组(9／14)。结论OSA与血压有明显相关，不受年龄等因素的影响，随着睡眠呼吸紊乱的加重，夜间血压生理性下降减少。对高血压飞行员应做睡眠监测，及时发现OSA，给予有效的治疗。     

阻塞性睡眠呼吸暂停综合征患者睡眠状态下低剂量多层螺旋CT研究

目的对睡眠状态下的阻塞性睡眠呼吸暂停综合征（OSAS）患者行低剂量动态多层螺旋CT（MSCT）扫描，分析睡眠状态下气道实际阻塞或狭窄的部位、累及范围及动态变化，以修正静态气道测量的不精确性。方法16例OSAS患者分别行清醒平和呼吸状态下（简称清）与睡眠状态吸气末相（简称吸）、睡眠状态呼气末相（简称呼）下低剂量MSCT扫描，并于睡眠吸气末状态下气道最狭窄处行动态电影扫描。以睡眠吸气末状态下软腭后区（RP）、舌后区（RG）气道最狭窄处及会厌后区（EPG）会厌尖下5mm处为3种状态下的测量层面，比较3种状态下咽腔各层面的测量值并记录各期相气道最狭窄的具体部位。结果RP区气道最小横截面积（XSA）（M清=47．50mm^2，M呼=73．00mm^2，M吸=2．00mm^2；Z清呼=2．897，P清呼=0．003；Z清吸=4．192，P清吸〈0．01；Z吸呼：4．538，P吸呼〈0．01）的测量结果在3种状态下差异均有统计学意义；RP区前后径（AP）（M清=8．00mm，M呼=9．50mm，M吸=1．50him；Z清呼=1．933，P清呼=0．056；Z清吸=3．720，P清吸〈0．01；Z吸呼=4．230，P吸呼〈0．01）、左右径（LR）（M清：8．00mm，M呼=9．00mm，M吸=1．00mm；Z清呼=1．210，P清呼=0．246；Z清吸：4．203，P清吸〈0．01；Z吸呼：4．557，P吸呼〈0．01）、RP区气道体积（M清=4．06mm^3，M呼：5．50mm^3，肘吸=1．50mm^3；Z清呼=1．576，P清呼：0．125；Z清嗳=3．532，P清嗳〈0．01；Z吸呼=4．077，P吸呼〈0．01），RP（M清=7．00mm，M呼=6．00mm，M吸=10．50mm；Z清呼=0．557，P清呼=0．603；Z清吸=2．541，P清吸=0．011；Z吸呼=2．852，P吸呼=0．004）、RG（M清=5．00mm，M呼=3．00mm，M吸=9．50mm；Z清呼=0．747，P清呼=0．482；Z清吸=2．657，P清吸=0．007；Z吸呼=3．075，P吸呼=0．001）区咽后壁至椎体前缘垂直距离的测量结果，睡眠吸气末相与清醒或睡眠呼气末相差异有统计学意义。睡眠状态下动态电影扫描可直观、清晰地显示咽腔的形态学变化。结论（1）睡眠吸气末相对OSAS患者咽腔狭窄或闭塞的CT定位是最精确的，可明显降低清醒状态下测量的假阴性。（2）低剂量NSCT可明显减少对患者的放射剂量。     

呼吸睡觉障碍对老年人动态血压影响的临床观察

目的探讨老年睡眠呼吸障碍(SAS)患者24 h动态血压变化特点及可能的发病机制。方法对2005—2006年在我科住院诊治的患者进行问卷调查,患者配戴手握式脉搏血氧仪及24 h动态血压监测,选择老年SAS合并原发性高血压患者组30例、单纯SAS患者血压正常组30例、无SAS的高血压患者组20例为研究对象。结果三组患者呼吸紊乱指数、最低血氧饱和度、氧减指数等指标差异有统计学意义(均P<0.05);平均收缩压、平均舒张压三组患者比较差异有统计学意义(均P<0.05);睡前、晨起收缩压、舒张压三组比较差异有统计学意义(均P<0.05);SAS合并原发性高血压组晨起血压较睡前血压明显增高(均P<0.05)。结论睡眠呼吸紊乱和低氧血症是引起SAS患者高血压形成的重要因素,SAS合并原发性高血压患者血压整体水平较高,晨起舒张压升高尤为明显。     

阻塞性睡眠呼吸暂停低通气综合征上气道的多层螺旋CT研究

目的　应用多层螺旋CT(MSCT)对确诊阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)患者进行上气道成像 ,回顾性分析其上气道形态特点 ,探索该方法在OSAHS临床综合诊断及病因研究中的应用价值。方法　经多导睡眠监测 (PSG)确诊的OSAHS患者 2 8例 ,年龄、性别相近的健康成年人 14例 ,于深吸气末、深呼气末、平静呼吸、闭口堵鼻深吸气 (M櫣ｌｌｅｒ)动作时行上气道MSCT扫描 ,测量各咽部水平的截面积及相应的矢径和横径、软腭的长度及厚度、判断上气道的阻塞情况、计算气道塌陷度。结果　 (1)结合运用MSCT图像后处理功能可理想观察上气道的形态特征 ,准确测量各所需数据并判断上气道阻塞情况。 (2 )OSAHS组腭后区及舌后区截面积与正常组相比存在明显的狭窄或阻塞 ,且多发生在吸气时相 (P值均 <0 0 5 )。 (3)OSAHS组腭后区及舌后区的气道塌陷度较正常人高 ,气道容易塌陷 (F =15 133,P =0 0 0 1;F =5 5 5 2 ,P =0 0 2 5 )。 (4 )OSAHS组软腭厚度较正常人厚 (F =15 90 8,P =0 0 0 0 )。结论　腭后区及舌后区气道明显狭窄或堵塞伴气道塌陷度的增加可能是OSAHS患者发病的主要因素 ,运用MSCT观察上气道简便、快捷、准确 ,在OSASH临床综合诊断及病因研究中具有实用价值     

CT demonstration of pharyngeal narrowing in adult obstructive sleep apnea

Sleep apnea is a major cause of daytime hypersomnolence. Among the proposed etiologies, focal obstruction of the airways at the level of the pharynx has been suggested but not proven. Using computed tomography, the cross-sectional area of the airway can be readily assessed. Thirty-three adults with clinically proven sleep apnea and 12 normal adults underwent systematic computed tomography of the neck. Significant airway narrowing was demonstrated in all the patients with obstructive sleep apnea, whereas no such narrowing was seen in the controls. In 11, the narrowing was at a single level, whereas in 22 patients two or more levels were affected. This study has shown that a structurally abnormal airway may serve as an anatomic substrate for the development of sleep apnea. On the basis of this evidence, uvulopalatopharyngoplasty has been performed in two patients with relief of symptoms in one.     

阻塞性睡眠呼吸暂停低通气综合征MSCT研究

目的:评价上气道多层螺旋CT多呼吸时相扫描及后处理技术对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的诊断价值.方法:对68例OSAHS患者和65例健康志愿者分别在平静呼吸、深吸气末、深呼气末及闭口堵鼻深吸气(Müller呼吸)这4个呼吸时相于清醒状态下行上气道MSCT扫描,测量不同呼吸时相鼻咽区、腭咽区、舌咽区和会厌...     

阻塞性睡眠呼吸暂停低通气综合征功能性腭咽成形术的疗效

目的 探讨功能性腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）的疗效.方法 采用功能性腭咽成形术治疗多平面阻塞OSAHS患者58例,术后6个月进行睡眠监测系统和CT上气道连续扫描复查,与术前数据比较,判定疗效.结果 全部患者均未出现严重并发症,治愈 3例（5.1%）,显效39例（67.2%）,有效8例（13.8%）,无效8例（13.8%）,总有效率 86.2%.手术前后睡眠呼吸暂停低通气指数（apnea hypopnea index,AHI）变化有统计学差异[（65.23±21.27）次/h vs（27.82±18.45）次/h,P〈0.05],最低血氧饱和度（SaO2）有显著变化[（68.35±10.16）% vs（83.73±9.68）%,P〈0.05],术后腭后区及舌后区截面积明显扩大（P〈0.05）.结论 功能性腭咽成形术是治疗OSAHS安全、有效的方法.     

阻塞性睡眠呼吸暂停综合征的质子磁共振波谱研究

目的:探讨阻塞性睡眠呼吸暂停综合征(OSAS)的质子磁共振波谱(1H-MRS)改变及其临床应用价值.方法:分别对33例OSAS患者和20例健康志愿者行1H-MRS,经多导睡眠仪监测将患者分为轻度OSAS(16例)和中重度OSAS(17例),分别测量脑灰质和脑白质的代谢物包括氮-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)和乳酸(Lac)的波峰下面积,计算NAA/Cho、NAA/Cr、Cho/Cr,对组间代谢物比值的差异进行统计学分析.结果:中重度OSAS患者白质区NAA/Cho(1.56±0.21)低于轻度OSAS患者(1.88±0.23)及正常对照组(1.89±0.25),差异有显著性意义(P<0.01),NAA/Cr轻度降低,Cho/Cr轻度升高,但与轻度OSAS患者和正常对照组比较,无统计学意义(P>0.05).轻度OSAS患者灰、白质NAA/Cho、NAA/Cr、Cho/Cr 与正常对照组之间差异均无显著性意义(P>0.05).结论:1H-MRS能够早期发现OSAS患者的脑代谢异常,对临床诊断和治疗具有重要价值.     

阻塞性睡眠呼吸暂停低通气综合征的多体素~1H-MRS研究

目的探讨多体素质子磁共振波谱(1H-MRS)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)中的临床应用价值。材料与方法分别对20例临床诊断为中重度OSAHS病人(病变组)及年龄、性别相匹配的20名健康志愿者(对照组)行头颅多体素1H-MRS检查,记录两组半卵圆中心区、基底节区各代谢物比值,比较两组间的差异,观察有无乳酸(Lac)峰出现。记录病人相关临床指标,包括:睡眠呼吸暂停和低通气指数(AHI)和夜间平均血氧饱和度(SpO2),并与各代谢物比值进行相关性分析。结果病变组半卵圆中心区NAA/Cr、NAA/Cho低于对照组,Cho/Cr高于对照组,差异有统计学意义(P0.05)。基底节区NAA/Cr、NAA/Cho较对照组稍降低,Cho/Cr较对照组稍升高,差异无统计学意义(P0.05)。两组均未检测到Lac峰。AHI与半卵圆中心区NAA/Cho呈负相关(P0.05),SpO2与NAA/Cho呈正相关(P0.05),而AHI和SpO2与NAA/Cr、Cho/Cr无相关性(P0.05)。结论多体素1H-MRI能够早期发现OSAHS脑代谢改变,为临床诊治提供客观的影像学依据。     

睡眠时体位对儿童阻塞性睡眠呼吸暂停低通气综合征的影响

目的评估阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿与正常儿童在睡眠时体位上的差异及体位对儿童睡眠呼吸紊乱的影响。方法比较358例经多导睡眠检测(PSG)诊断为OSAHS的儿童(OSAHS组)与161例在年龄、性别上相匹配的儿童(对照组)的PSG结果,并进一步比较睡眠时不同体位对睡眠呼吸暂停低通气指数(AHI)和暂停指数(AI)的影响。结果睡眠时OS-AHS组儿童采用仰卧位、侧卧位和俯卧位的时间占总的睡眠时间的百分比分别为45·4%±36·3%、39·5%±34·5%和15·1%±32·6%,而对照组则分别为32·8%±24·5%、54·7%±23·9%和12·5%±17·2%。OSAHS组仰卧位睡眠时间比对照组儿童明显增加(P<0·01),侧卧位的时间明显减少(P<0·01),但俯卧位的睡眠时间没有差异(P>0·05)。OSAHS组在3种不同体位睡眠时平均AHI为14·5/h,平均阻塞性AI为3·80/h。仰卧位时的AHI和AI较侧卧位和俯卧位时明显增加(P<0·01),而对照组的AHI和AI在3种睡眠体位中无明显差异。结论睡眠时,OSAHS儿童更多采用仰卧位,提示这种体位可能是促使OSAHS儿童发生上气道阻塞的原因。     

Videoradiography at submental electrical stimulation during apnea in obstructive sleep apnea syndrome. A case report

Percutaneous submental electrical stimulation during sleep may be a new therapeutic method for patients with obstructive sleep apnea syndrome (OSAS). Electrical stimulation to the submental region during obstructive apnea is reported to break the apnea without arousal and to diminish apneic index, time spent in apnea, and oxygen desaturation. The mode of breaking the apnea by electrical stimulation has not yet been shown. However, genioglossus is supposed to be the muscle responsible for breaking the apnea by forward movement of the tongue. To visualize the effect of submental electrical stimulation, one patient with severe OSAS has been examined with videoradiography. Submental electrical stimulation evoked an immediate complex muscle activity in the tongue, palate, and hyoid bone. This was followed by a forward movement of the tongue which consistently broke obstructive apnea without apparent arousal. Time spent in apnea was diminished but intervals between apnea were not affected.