中、重度OSAHS患者上气道不同阻塞部位鼾声声压级指标分析

目的：研究中、重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hyperpnoea syn-drome,OSAHS）患者上气道不同阻塞部位与鼾声声压级指标的关系。方法对46例经多导睡眠监测诊断为中度或重度OSAHS的患者进行整夜同步上气道测压和鼾声声压级记录,分析上气道阻塞部位构成比、每小时上部（软腭游离缘平面以上）和下部（软腭游离缘平面以下）阻塞次数与鼾声声压级分析指标中等效连续A声级（equivalent continuous A－weightedsound level,LAeq ）和最大声压级（L10）的相关性,以及上气道阻塞部位的类型、呼吸暂停低通气指数（AHI）及体质量指数（BMI）对鼾声声压级指标的影响。结果 OSAHS 患者上气道上／下部阻塞构成比和每小时上部及下部阻塞次数均与LAeq和L10无明显相关性,LAeq和L10的影响因素为AHI,而阻塞部位及BMI 对LAeq和L10无影响。结论 LAeq和L10的大小与AHI有关而与阻塞部位无明确关系,LAeq和L10可能有助于初步判断OSAHS患者的严重程度,对阻塞部位的辨别缺乏临床价值。     

阻塞性睡眠呼吸暂停低通气综合征患者鼾声的声学特征研究

目的:描述阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者鼾声的声学特征,为鼾声分析应用于OSAHS的诊断、治疗及结果评价奠定基础。方法:记录31例OSAHS患者整夜睡眠的鼾声和PSG监测。应用Adobe Audition软件提取鼾声,将鼾声信号转为数字信号,分别随机提取每个患者呼吸暂停后的第1个鼾声和不伴有呼吸暂停的鼾声各10个,共计620组鼾声数据。运用Matlab软件程序分析、比较两类鼾声的各项声学指标:鼾声的最大频率、中心频率、平均频率、峰频率、功率比等。结果:OSAHS患者的呼吸暂停后鼾声的最大频率、峰频率、平均频率、中心频率均大于连续鼾声,而800 Hz功率比则相反,这些指标的差异均有统计学意义(P<0.01或0.05)。将患者根据AHI值分为轻、中、重度三组,轻度组两类鼾声的峰频率、中心频率和800Hz功率比差异有统计学意义(P<0.01);而中、重度患者的指标中除了中心频率外,其余指标差异均有统计学意义(P<0.01或0.05)。结论:800Hz功率比可能是区别OSAHS患者呼吸暂停后鼾声与平稳呼吸时产生的连续鼾声不同的声学指标,提示将鼾声监测分析技术应用于OSAHS的诊断与筛查具有一定可行性,为进一步分析研究鼾声在临床中的应用提供了一个很好的线索。     

OSAHS患者上呼吸道阻塞临床评价系统的建立及应用

目的探讨建立临床评价阻塞性睡眠呼吸暂停低通气综合征的简易方法,综合评价OSAHS患者上呼吸道各部位的阻塞程度,以指导手术或器械治疗.方法将患者鼻、口咽、舌、喉等各部位定为0～4分,综合评价与确定阻塞的程度.结果各部位解剖阻塞评分为3～4分者对诊为呼吸暂停有重要意义,临床综合评分大于10分者手术效果好,小于10分者用CPAP治疗为好.结论目前OSAHS患者的手术指征及疗效标准仍有争议,参考国外制定的临床评价上呼吸道阻塞程度的标准并作了改进,可做为睡眠呼吸监测的补充,供门诊及无法进行睡眠监测的基层医院使用.     

不同性别的OSAHS患者临床特性的研究

目的:探讨OSAHS患者临床特征的性别差异.方法:4499例OSAHS患者经PSG监测和Epworth嗜睡量表(ESS)测评,按OSAHS严重程度分为轻、中、重度3组,对男、女性患者的结果进行比较,并行亚组分析.结果:女性OSAHS患者ESS评分[中位数(四分位间距)]8.0(4.0,13.0)低于男性10.0(5.0...     

儿童OSAHS患者中耳功能分析

目的探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的中耳功能。方法对413例OSAHS患儿(OSAHS组)(3～岁144例、6～岁206例、9～16岁63例)术前进行声导抗检查,异常者行听力测试,术后3个月复查声导抗及听力,并与正常对照组279例(3～岁94例,5～岁104例,9～16岁81例)进行比较。结果 OSAHS组中288例328耳有不同程度的中耳功能损害,阳性率为69.73%(288/413),69例72耳(16.71%,69/413)有不同程度听力下降,中耳功能异常和听力下降的发生率均明显高于对照组的7.53%(21/279)和1.43%(4/279),其差异均有统计学意义(均为P<0.05);两组中中耳功能异常和听力下降的发生率均随年龄增长而逐渐降低。结论儿童OSAHS患者有不同程度中耳功能和听力损害的可能,但随着年龄增长,其发生率逐渐降低。     

OSAHS患者咽腔阻塞定位方法文献回顾

OSAHS是睡眠呼吸障碍性疾病中最有代表性的常见病、多发病,人群发病率为2%～4%〔1〕,有逐年增加的趋势。可以导致患者白天嗜睡、夜间打鼾、呼吸暂停、低氧血症,造成工作效率下降及生活质量降低,作为一种源头性致病因素,参与高血压病、心脑血管病、2型糖尿病的发病,并且与脑卒中和睡眠猝死相关。OSAHS病因学复杂,涉及上气道解剖狭窄、咽肌功能下降、咽壁顺应性增加、肥     

对鼾声响度测量及评价量的浅见

鼾声是鼾症、阻塞性睡眠呼吸暂停综合征(OSAS)的主要症状之一，几乎所有患者睡眠后都有鼾声。鼾声作为一种主要的临床症状是医生及患者家属观察疗效的指标之一。目前国内对鼾声响度的评价量仍无统一标准和测量参数，且评价量存在不足之处。由于该病涉及多个学科，制定统一的测量及评价标准对该病的诊治、普查，以及提高科研和教学水平有重要的现实意义。     

OSA H S患者与单纯打鼾者鼾声声学特性初步研究

目的利用鼾声监测及分析技术对OSAHS患者和单纯打鼾者的鼾声的声学特性进行初步研究。方法阻塞性睡眠呼吸暂停低通气综合征（OSAHs）患者22人,单纯打鼾（simple snoring）者15人,分别同步进行鼾声监测和睡眠呼吸监测。取每例单纯打鼾者10次鼾声和每例OSAHS患者10次阻塞性呼吸暂停后的第一次鼾声进行时域和频域特性分析。结果单纯打鼾者鼾声片断时域曲线表现为多个振幅、间隔大致相仿的复合波,频域曲线表现出明显的基一频谐波结构;OSAHS患者鼾声的时域曲线表现为多个振幅、间隔不规则的复合波,频域曲线中无明显的基频一谐波结构。OSAHS患者鼾声的峰频率、中心频率较单纯打鼾者高,800Hz功率比率较单纯打鼾者低,OSAHS组,中重度OSAHS患者的鼾声峰频率、中心频率较轻度者高,800Hz功率比率较轻度者低,中心频率和800Hz功率比率的差异有统计学意义（P〈0．05）。结论0SAHS患者和单纯打鼾者鼾声具有不同的时域特性和频域特性,表明两种鼾声在声学上有质的差别,提示将鼾声监测分析技术应用于OSAHS的研究具有一定可行性,并可能为确定阻塞部位及鼾声来源提供新的临床研究思路。     

不同术式治疗不同分度扁桃体肿大 及重度OSAHS患者的临床分析

：目的比较Z型腭咽成形术（Z uppp）和改良悬雍垂腭咽成形术（H uppp）对不同分度扁桃体肿大及重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者选择性治疗的临床疗效。方法选择2015年2月~2016年2月收治的有不同分度扁桃体肿大及重度OSAHS患者82例,随机或按患者要求分成两组,其中40例患者采用Z uppp手术为主的综合治疗,42例患者采用H uppp手术治疗为主的综合治疗。全部病例术后随访1年,比较其疗效。结果术后1年,38例Ⅰ度扁桃体肿大、重度OSAHS患者Z uppp术后总有效率为76.5%,H uppp术后总有效率为35.5%,前者总有效率明显好于后者,经比较差异有统计学意义（P<0.01）。术后1年,44例Ⅱ度及Ⅲ度扁桃体肿大、重度OSAHS患者Z uppp术后总有效率分别为76.7%、82.9%,H uppp术后总有效率分别为68.9%、75.5%,两者比较差异无统计学意义（P>0.05）。结论对于Ⅰ度扁桃体肿大、重度OSAHS患者Z uppp术式长期效果好于H uppp,而Ⅱ、Ⅲ度扁桃体肿大、重度OSAHS患者两种术式长期效果差异不明显。     

阻塞性睡眠呼吸暂停低通气综合征患者听力学损害研究进展

阻塞性睡眠呼吸暂停低通气综合症(obstructive sleep apnea hypopnea syndrome,OSAHS)是一种常见的睡眠障碍性疾病,长期的呼吸暂停和低通气可引起不同程度的低氧血症及高碳酸血症,继发组织缺氧,最终导致多器官功能损害,其中包括第8对颅神经-听神经的损害.临床观察中也发现了部分OSAH...     

Association between Positional Dependency and Obstruction Site in Obstructive Sleep Apnea Syndrome

Objectives

The purpose of this study is to find out associations between positional dependency and obstructive levels based on sleep videofluoroscopy (SVF) in patients with obstructive sleep apnea syndrome (OSAS).

Methods

Retrospective review was made of 91 OSAS patients who underwent polysomnography and SVF from August 2009 through June 2010. Polysomnography variables including apnea-hypopnea index (AHI), supine AHI, non-supine AHI, time spent in supine sleep position of the total sleep time and positional dependency (PD) were analyzed. Obstruction sites were evaluated as SVF variables.

Results

Of 91 patients, 65 (71.4%) were positional patients (PP) and 26 (28.6%) were non-positional patients (NPP). An analysis of polysomnography variables according to PD revealed that overall AHI, non-supine AHI and supine AHI in PP was significantly lower than that in NPP. The patients with soft palate obstruction (SP type) were more likely to have PD than the patients with tongue base obstruction (TB type; P=0.046). PD was inversely related to OSAS severity significantly (P=0.001).

Conclusion

These results provide evidence that positional dependent patients may have higher success rate of soft palate OSA surgery alone than non-positional dependent patients. Although PD may be associated with obstruction site, PD only itself may not be useful in planning surgical treatment for OSAS.     

电影磁共振及纤维喉镜对阻塞性睡眠呼吸暂停低通气综合征患者上气道阻塞部位检查对比研究

目的 探讨电影磁共振(cine magnetic resonance,CMR)检查及纤维喉镜下Müller试验对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome , OSAHS)患者进行上气道阻塞部位定位的应用价值.方法 选取2015年9月~2016年4月到郑州大学第一附属医院咽喉头颈外科就诊并经多导睡眠监测(PSG)及专科检查确诊的阻塞性睡眠呼吸暂停低通气综合征患者22例,于术前行纤维喉镜下Müller试验检查并分别在睡眠及清醒状态下行电影磁共振检查,观察软腭区、舌后区及会厌区狭窄或阻塞发生情况.结果 电影磁共振与纤维喉镜下Müller试验对于软腭区阻塞的定位(22例对22例)具有完全的一致性(Kappa=1),而对于舌后区(13例对6例)(Kappa=0.412)、会厌区(4例对2例)(Kappa=0.621)及多部位同时阻塞的定位(13例对6例)(Kappa=0.412),二者一致性一般.结论 对多部位阻塞的中重度OSAHS患者,术前应用电影磁共振及纤维喉镜检查能够更好地明确阻塞部位.     

Preliminary Findings from Our Experience in Anterior Palatoplasty for the Treatment of Obstructive Sleep Apnea

Objectives

Obstructive sleep apnea (OSA) is a common disorder affecting at least 2% to 4% of adult population characterized by the collapse of the pharyngeal airway. It is well established that retropalatal region is the most common site of obstruction. Consequently, many surgical techniques have been introduced. The purpose of this study is to present our preliminary results in the anterior palatoplasty (AP) compared with results of uvulopalatal flap (UPF).

Methods

Thirty-eight consecutive patients with mild-moderate OSA were prospectively enrolled into a randomised surgical protocol. Surgical success was measured primarily by satisfactory reduction in snoring, as reported by snoring assessment questionnaire (SQ) of sleep partners. Secondary outcomes measures included improvement in the Epworth Sleepiness Scale (ESS) scores, changes in the magnitude of pharyngeal collapse, and postoperative pain intensity.

Results

The ESS after AP improved from a preoperative value 8.5±3.7 to a postoperative mean of 4.9±3.2 (P<0.001) after UPF improved from a preoperative value of 8.1±3.5 to 5.2±3.2 postoperatively (P<0.001). The results of satisfactory reduction in the volume of snoring and response at polysomnographic data were also similar in both procedures. We reported a statistically significant difference of the collapse noted at Müller manoeuvre that improved from 2.7±1.0 on average, to 1.1±0.9 (P<0.001) after AP and with a lesser extent, (from 2.8±1.1 on average to 1.8±1.1; P<0.05), after UPF. The mean duration of pain was 10.8 days for UPF patients and 7.1 days for AP patients. The mean pain score in the first 3 days, was 6.8 in UPF patients and 5.1 in AP patients.

Conclusion

The subjective and objective improvements evidenced may suggest how AP is far superior to other techniques aimed at creating a palatal fibrotic scar. In the light of these results we can suggest AP procedure as more practical and comfortable when compared to UPF.     

Relationship Between Snoring Intensity and Severity of Obstructive Sleep Apnea

Objectives

The aim of this study was to determine the relationship between the intensity of snoring and severity of sleep apnea using Watch-PAT (peripheral arterial tone) 100.

Methods

A total of 404 patients (338 males and 66 females) who underwent home-based portable sleep study using Watch-PAT 100 for obstructive sleep apnea (OSA) from January 2009 through December 2011 were included in this study. Subjects were divided into 4 groups; no OSA (PAT apnea hypopnea index [pAHI]<5/hour), mild OSA (5≤pAHI<15/hour), moderate OSA (15≤pAHI<30/hour), or severe OSA groups (pAHI≥30/hour). Mean snoring intensity and percent sleep time with snoring intensity greater than 40, 50, and 60 dB were measured by Watch-PAT 100. Correlations of these parameters with apnea hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index were assessed.

Results

The mean age and body mass index were 46.5±14.8 years and 24.7±3.4 kg/m², respectively. Mean AHI and RDI were 16.5±15.3/hour and 20.8±14.3/hour, respectively. The mean snoring intensity in the no, mild, moderate, and severe OSA groups was 44.0±2.7, 45.4±6.0, 47.7±5.0, and 50.5±5.6 dB, respectively (P<0.001). There was a positive correlation between snoring intensity and pAHI or PAT RDI (pRDI) (r=0.391 and r=0.385, respectively, both P<0.001). There was also a positive correlation between percent sleep time with the snoring intensity greater than 50 dB and pAHI or pRDI (r=0.423 and r=0.411, respectively, both P<0.001).

Conclusion

This study revealed that the intensity of snoring increased with the severity of sleep apnea, which suggests that the loudness of snoring might be an indicator of the severity of OSA.     

OSAHS患者H-UPPP术后嗓音变化研究

目的探讨成人阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OS-AHS）患者行改良悬雍垂腭咽成形术（H-uvulopalatopharyngoplasty,H-UPPP）前后声道共鸣腔的变化对发音的影响。方法用美国Tiger公司的DrSpeech4．0软件,对56例成人OSAHS患者于H～UPPP手术前后,平稳自然的发／e／音,行嗓音声学参数及共振峰分析,并与40例正常对照组比较。结果除标准化噪声能量在手术前后有显著性差异外,OSAHS患者手术前后的其他嗓音声学参数均无统计学差异。OSAHS患者术前第一共振峰及带宽、第二共振峰及带宽、第三共振峰均明显低于正常;术后一周时的第一及第二共振峰均低于正常对照,但与术前无统计学差异;术后一月时的共振峰均与正常对照无显著性差异。结论H-UPPP手术通过解除OSAHS患者上气道的阻塞性因素及进行咽腔的塑形,改变声道共鸣腔,能够改变OSAHS患者的发声特点及音质,术后随时间的延长,共振峰频率逐渐增高,接近正常水平。