Cephalometric analysis and surgical treatment of patients with obstructive sleep apnea syndrome. A preliminary report

Oropharyngeal soft tissue profiles were studied by cephalometric analysis in 25 patients with obstructive sleep apnea syndrome (OSAS) and 10 controls. The length of the soft palate was significantly longer in patients (mean 48 mm) than in controls (mean 35 mm), as was the distance of close contact between the tongue and the soft palate. The thickness of the soft palate measured in the midsagittal plane was larger (mean 14 mm) than in the control group (mean 11 mm). The hyoid bone was more inferiorly positioned in patients than in controls, apparently giving the tongue a more upright position with more of the tongue tissue at the hypopharyngeal level than found in normals. In patients, the nasopharyngeal airway space, as well as the oropharyngeal airway space, had significantly reduced anteroposterior dimensions. Based on these data a new and modified surgical technique for treatment of OSAS patients has been developed. The surgical procedure is described, and some preliminary results concerning the effect of this operation in 16 patients are reported.     

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.     

Predictive value of Müller maneuver in selection of patients for uvulopalatopharyngoplasty

Uvulopalatopharyngoplasty (UPPP) is an effective treatment for some patients with obstructive sleep apnea syndrome (OSAS). A major difficulty has been to select those patients who will have a good response to UPPP. Fiberoptic nasopharyngoscopy with Müller Maneuver (FNMM) was applied in preoperative evaluation of patients with OSAS to identify those in whom greatest pharyngeal collapse was in the region of the tonsillar fossae and soft palate. Those with pharyngeal changes on FNMM who were considered most likely to respond to surgery underwent UPPP. Comparison of pre and postoperative polysomnography reveals significant (p less than .001) improvement in indices of severity of OSAS The mean apnea index (apneas per hour) was diminished by 72%. Eighty-seven percent of patients had greater than 50% reduction in apnea index. Preoperative selection of OSAS patients by FNMM increases the likelihood of success of UPPP.     

头颅X线测量在阻塞性睡眠呼吸暂停综合征诊治中的意义

OBJECTIVES: To study the value of cephalometric analysis in the diagnosis, treatment option and evaluation of prognosis. METHODS: A detailed cephalometric analysis was performed using lateral X-ray films from 50 cases with obstructive sleep apnea syndrome (OSAS) and 30 age- and sex-matched controls. RESULTS: Statistical results showed that OSAS patients were different from controls in the following aspects: 1. Their uvula, soft palate and tongue were significantly enlarged. 2. The hyoid bone was displaced inferiorly and posteriorly. 3. The posterior airway space (palatopharyngeal plane) was narrow. 4. The hard palate was elongated. 5. The mandibular body was retropositioned. Fifty unselected consecutive OSAS patients(mean AHI 51.42 +/- 3.96, Medilog SAC 847, Oxford UK) underwent LAUPP using CO2 laser. Twenty-five cases were followed-up for 4-8 months. 10/25 had obtained a reduction in AHI > 50%, 15/25 had AI < 20 times. The success rate was compared with cephalomentric findings. CONCLUSION: Cephalometry has an important diagnostic and predictive value in the clinical investigation of patients suspected of having OSAS.     

悬雍垂腭咽成形加舌根射频消融联合手术的临床应用

目的探讨悬雍垂腭咽成形术加舌根射频消融联合治疗重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrom e,OSAHS)的疗效。方法对46例重度有腭咽和舌根平面阻塞的OSAHS的患者分两组,第一组22例(2000年8月至2002年8月)行单纯保留悬雍垂腭咽成形术,第二组24例(2002年9月至2004年8月)行保留悬雍垂腭咽成形术加舌根射频消融术。患者进行手术前后口咽腔的测量,并行睡眠监测。结果46例OSAHS患者手术后腭舌弓间距和腭咽弓间距变宽、软腭长度缩短,差异有统计学意义(P<0.001),而咽部后气道宽度(pharyngealposterior airway w idth,PPAW)在第一组没有变化,在第二组变宽,两组比较差异有统计学意义(P<0.001)。第一组患者术前睡眠呼吸暂停低通气指数(apnea hypopnea index,AH I)平均(56.5±6.0)次/h(x-±s,以下同),最低血氧饱和度(lowest SaO2,LSaO2)为0.626±0.060,术后AH I为(23.7±2.7)次/h,LSaO2(0.797±0.053);第二组术前AH I(58.4±5.1)次/h,LSaO2为0.650±0.057,术后AH I为(15.5±3.2)次/h,LSaO2为0.864±0.064。AH I、LSaO2两组术后均明显改善,差异有统计学意义(P<0.001),按照杭州会议疗效评定标准第一组有效率为72.7%(16/22),第二组有效率为87.5%(21/24)。第一组和第二组疗效相比差异也有统计学意义(R id it分析u=2.178,P<0.05)。结论对阻塞性睡眠呼吸暂停低通气综合征的患者,明确多平面阻塞,应进行联合治疗,保留悬雍垂腭咽成形加舌根射频消融术联合治疗可达到较好的疗效。     

Determination of obstructive site in obstructive sleep apnea

Patients with obstructive sleep apnea syndrome (OSAS) may have airway obstruction at various levels, including the uvula-soft palate complex, base of tongue, and/or possibly other sites. For patients with tongue base and/or laryngeal obstruction, uvulopalatopharyngoplasty (UPPP, ppp) will not alleviate the obstruction. Prior authors have proposed that the hyoid bone position as determined by cephalometric x-rays can predict which patients have obstruction at a lower site than the soft palate. In this study, patients with obstructive sleep apnea syndrome were evaluated with polysomnographic testing, fiberoptic endoscopy, and cine-CT scans (Imatron Scanner with multiple level rapid sequence scans) in an attempt to determine precisely the site of airway obstruction. Measurements of airway size taken at the time of fiberoptic pharyngoscopy were compared with those determined by the cine-CT studies. Initial results revealed that fiberoptic pharyngoscopy in the sitting and supine positions was helpful in confirming pharyngeal airway sites with smaller diameters in awake patients. However, the cine-CT exam performed in both sleeping and awake states provided more direct data regarding the airway during sleep. We feel that with more clinical experience the cine-CT technique will prove to be the most helpful study for identification of the obstructive airway site in obstructive sleep apnea syndrome.     

Multilevel temperature-controlled radiofrequency therapy of soft palate, base of tongue, and tonsils in adults with obstructive sleep apnea

OBJECTIVES/HYPOTHESIS: The concept of two-level pharyngeal collapse in patients with obstructive sleep apnea is too simplified. Aggressive multilevel surgeries addressing several airway segments, including skeletal surgery, demonstrate improved success rates. STUDY DESIGN: The study aimed to evaluate the safety and efficacy of multilevel radiofrequency application to soft palate, tonsils, and base of tongue in 16 white patients (mean age, 56.9 +/- 11.1 y; mean body mass index, 27.3 +/- 2.6 kg/m2) with obstructive sleep apnea. There was one dropout. Therapeutic effects after one treatment session were assessed 20.6 +/- 12.6 weeks postoperatively. Treatment outcome measurements were based on Epworth Sleepiness Scale, Likert scales, and polysomnography. METHODS: Every patient received 16 treatment sites with a total dose of 9750 J radiofrequency energy into soft palate, base of tongue, and tonsils. Success was defined as respiratory disturbance index equal to or less than 20 or at least 50% improvement if baseline respiratory disturbance index was less than 20. Statistical analysis was determined with the Spearman rank test. RESULTS: Mean score on Epworth Sleepiness Scale decreased from 11.1 to 8.2 (P =.0001). Of the patients, 53.3% reported improvement of their daytime sleepiness. Snoring was assessed with 10-point Lickert scale, and score decreased from 7.5 to 4.9 (P =.08). Mean respiratory disturbance index decreased from 32.6 +/- 17.4 to 22.0 +/- 15.0 (P =.003). By our definition of success, 5 of 15 patients (33%) have been treated successfully surgically and 4 of 15 (27%) had remarkable improvement after one treatment session; 1 patient (6.6%) demonstrated deterioration. There were two adverse effects, one superficial ulceration of the soft palate and one unilateral tonsillar abscess formation, with an overall complication rate of 13.3% for our patients and 0.41% for all treatment sites (n = 240). CONCLUSION: Moderate to severe obstructive sleep apnea usually requires multilevel pharyngeal surgery. Radiofrequency offers the potential of altering the upper airway on different sites.     

Correlation between otorhinolaryngologic evaluation and severity of obstructive sleep apnea syndrome in snorers

OBJECTIVES: To examine whether medical history and nasopharyngeal examination are useful for predicting obstructive sleep apnea syndrome (OSAS) and to compare these findings with those of the gold standard, polysomnography. DESIGN: Patients underwent polysomnography recordings for 2 nights and an otorhinolaryngologic examination, including flexible endoscopy and the Muller maneuver. Nasal and pharyngeal findings were scored in a semiquantitative way. The medical history of each patient was taken using a standardized questionnaire. Anatomic and functional findings and patient history were correlated with the mean apnea-hypopnea index (AHI). SETTING: An otorhinolaryngologic clinic. PATIENTS: A total of 101 patients presenting with a primary complaint of snoring. MAIN OUTCOME MEASURES: Differences between patients with OSAS and primary snorers were assessed using the Mann-Whitney test (anatomic findings), t test (Muller maneuver), and chi(2) test after Pearson correlation (questionnaire). P values less than .05 were considered statistically significant. RESULTS: The mean +/- SD AHI of the patients was 19.7 +/- 21.5); 52 patients had an AHI higher than 10, which confirmed the diagnosis of OSAS. These patients tended to report the occurrence of apneas more frequently than patients with an AHI of 10 or lower. The average ranks (Mann-Whitney findings) of patients with AHIs higher than 10 vs those with AHIs of 10 or lower were 52 vs 50 for septal deviation; 50 vs 52 for tonsil size; 53 vs 49 for low velum level; and 56 vs 46 for hyperplasia of the tongue base. None of these differences reached statistical significance. Mean +/- SD narrowing of the airway during the Müller maneuver was significantly (P<.05) more pronounced in patients with an AHI higher than 10 than in patients with an AHI of 10 or lower at the levels of the velum (80% +/- 20% vs 68% +/- 30%) and the tongue base (57% +/- 24% vs 44% +/- 27%). CONCLUSIONS: None of the reported medical history and/or anatomic parameters alone or in combination could be used to distinguish patients with OSAS from snoring patients. Snoring patients, therefore, should be examined at least by a nocturnal screening test for OSAS before any therapeutic decision is made.     

Surgery and obstructive sleep apnea syndrome: indications and precautions

Surgery has long been a therapeutic option for obstructive sleep apnea syndrome (OSAS). The first procedures targeted the soft palate but results of isolated uvulo-palatopharyngoplasty (UPPP) were inconstant. A better understanding of the mechanisms involved in pharyngeal collapse incited interest in the role of the tongue and the retropharyngeal space. Surgical procedures were then developed for this level of the upper airways. There are a large number of possibilities. Excepting tracheostomy which court-circuits the collapsed zone, all the other procedures are designed to widen more or less one or more of the upper airway levels. The target can be the nose, the soft palate or the tongue, alone or in combinations. In all cases, the surgical alternative should be balanced against a non-invasive option: continuous positive pressure ventilation. The objective is to minimize the operative risks and sequelae while assuring success equivalent to positive pressure ventilation. It is important to note that sufficiently effective and permanent results have not been proven for any surgical technique, excepting tracheostomy and to a lesser degree bimaxillary advancement osteotomy, due to the lack of objective long-term rigorous evaluation. A considerable effort must be made in this domain.     

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.     

Continuous pressure measurements in the pharynx and esophagus during sleep in patients with obstructive sleep apnea syndrome.

Pressure measurements were made preoperatively at six sites in the pharynx and esophagus in 18 obstructive sleep apnea syndrome (OSAS) patients, 3 social snorers, and 6 healthy normal controls. Repeat measurements were made approximately 2 months after uvulopalatopharyngoglossoplasty (UPPGP) in 10 of the OSAS patients. The pressure transducers were contained in a thin silicone tube inserted through one nostril, and measurements were made both in the awake state and throughout a night's sleep. Oxygen saturation was also continuously recorded and, additionally, nasal and oral airflow measurements were made as the postoperative control. The majority of patients had obstruction in more than one pharyngeal segment, and the site(s) of obstruction differed in the awake and sleeping states. After UPPGP, 3 of the patients had neither subjective nor objective evidence of obstruction, while the remaining 7, although subjectively improved, had varying degrees of residual obstruction in the nasopharynx and at the level of the soft palate.     

Quantitative assessment of the pharyngeal airway by dynamic magnetic resonance imaging in obstructive sleep apnea syndrome

Dynamic changes in the pharyngeal airway of patients with obstructive sleep apnea syndrome (OSAS) were evaluated by quantitating the findings of real-time imaging performed during wakefulness and spontaneous sleep by means of dynamic magnetic resonance imaging (MRI). Six patients with OSAS and 3 non-OSAS subjects, selected prospectively and randomly, underwent polysomnography and dynamic MRI. The cross-sectional areas of the soft palate and oropharynx and the anterior-posterior airway dimensions seen during wakefulness and spontaneous sleep were calculated by US National Institutes of Health imaging software. On the basis of a case control study, comparisons were made with age-matched and body mass index-matched obese non-OSAS snorers. Spontaneous sleep caused significant obstruction and narrowing of various sites of the pharyngeal airway in the OSAS patients, but not in the non-OSAS subjects. During wakefulness, the non-OSAS subjects showed no marked narrowing of the pharyngeal airways, whereas a transient but significant narrowing was observed in the OSAS patients. The mean values of both the cross-sectional area and the anterior-posterior diameter at the soft palate were significantly reduced by spontaneous sleep in the OSAS patients. Dynamic MRI in awake OSAS patients shows promise as a routine diagnostic tool for localizing the upper airway collapse for appropriate selection of surgical therapy.     

The predictive value of Muller maneuver in REM-dependent obstructive sleep apnea

To our knowledge, no studies up to date have investigated the correlation of rapid eye movement (REM) dependent obstructive sleep apnea syndrome (OSAS) and Muller maneuver. The aim of this study is to investigate whether REM-dependent OSAS is predicted by the findings of the Muller maneuver. The study was conducted on 149 patients with witnessed apnea and daytime sleepiness. Muller maneuver was performed to all patients and the obstruction site was determined using a five-point scale. Then, polysomnography of the patient was obtained and the apnea–hypopnea indexes were determined in total sleep time, REM-dependent sleep and non-REM-dependent sleep. The correlations between the Muller maneuver findings and polysomnographic data were analyzed. The ages of the patients included in the study ranged between 25 and 73 years with a mean age of 49.3 ± 10.1 years. Their mean body mass index was 30.8 ± 5.1 kg/m² (range 21.9–55.4 kg/m²). The patients’ mean apnea–hypopnea indexes in total sleep time was 28.1 and ranged between 5.4 and 124.3. REM-dependent OSAS was determined in 49 patients. When the data were analyzed, it was determined that there were no statistically significant correlations between tongue base or lateral pharyngeal band obstruction at the level of hypopharynx and the REM-dependent OSAS. At the level of the soft palate, the obstruction caused by the lateral pharyngeal bands or soft palate and REM dependency did not show any statistically significant correlation (p > 0.05). In conclusion, Muller maneuver does not provide useful data to predict REM dependency of OSAS.     

Hyoid myotomy with suspension under local anesthesia for obstructive sleep apnea syndrome

Upper airway obstruction of patients with obstructive sleep apnea syndrome (OSAS) occurring during sleep can appear at multiple sites. Successful results of hyoid myotomy with suspension (HM) in the treatment of hypopharyngeal obstruction performed under general anesthesia have been reported. However, many OSAS patients have difficulty at the induction of anesthesia and intubation. They are predisposed to specific complications owing to anatomical abnormalities of the airway and the existence of an underlying syndrome. The purpose of this study was to assess the safety and efficacy of HM for the treatment of OSAS under local anesthesia. Thirty-two OSAS patients with hypopharyngeal obstruction underwent HM under local anesthesia. The hyoid bone was suspended to the superior aspect of the thyroid cartilage. Uvulopalatal flap was an adjunct surgical procedure for palatal obstruction. Patients had a mean age of 39.2+/-5.7 years and a body mass index of 29.3+/-2.4 kg/m(2). Data on the patients were compared from preoperative to postoperative assessment points. Statistical analysis was performed using the Student's t-test. All patients tolerated the procedure well. The mean follow-up was 8.1+/-2.4 months (range 5 to 10 months). The mean RDI decreased from 44.5+/-8.7 to 15.2+/-5.6 ( P<0.001), and the lowest oxygen saturation increased from 82.1+/-3.7% to 87.9+/-2.7% ( P<0.01). The Epworth sleepiness scale improved from 14.1+/-2.2 to 8.2+/-2.3 ( P<0.01), and the snoring scale improved from 8.5+/-1.8 to 3.5+/-1.7 ( P<0.001). Postoperative complications included transient dysphagia in 3% of the patients and transient aspiration in 9%. Bleeding, infection and airway obstruction were not observed. Most patients had mild to moderate pain (visual analog scale 相似文献   

Minimal two-point discrimination in human tongue and palate

The distribution of minimal two-point discrimination values on the tongue and soft palate was investigated in normal subjects using electric stimulation. It was performed using square pulses of 0.35 ms duration, a rate 10 Hz, a voltage between 3.5 and 7.0 with an average of 4.09 using two silver-silver chloride electrodes (tip diameter, 0.4 mm), and a strain-guage device to control crimping pressure. The spatial threshold was 1.650 +/- 0.433 mm at the tongue tip and 2.650 +/- 0.856 mm and 1.675 +/- 0.269 mm on the anterior margin of each side of the tongue. The soft palate and lingual dorsum were almost completely insensitive. Electric stimulation is a convenient method of measuring two-point limen values.     

Radiation dose to the tongue and velopharynx predicts acoustic-articulatory changes after chemo-IMRT treatment for advanced head and neck cancer

The aim of this study was to investigate to what extent changes in speech after C-IMRT treatment are related to mean doses to the tongue and velopharynx (VP). In 34 patients with advanced hypopharyngeal, nasopharyngeal, or oropharyngeal cancer, changes in speech from pretreatment to 10 weeks and 1 year posttreatment were correlated with mean doses to the base of tongue (BOT), oral cavity (OC) and tonsillar fossa/soft palate (VP). Differences in anteroposterior tongue position, dorsoventral degree of tongue to palate or pharynx constriction, grooving, strength, nasality, and laryngeal rise, were assessed by acoustic changes in three speech sounds that depend on a (post-) alveolar closure or narrowing (/t/, /s/, /z/), three with a tongue to palate/pharyngeal narrowing (/l/, /r/, /u/), and in vowel /a/ at comfortable and highest pitch. Acoustically assessed changes in tongue positioning, shape, velopharyngeal constriction, and laryngeal elevation were significantly related to mean doses to the tongue and velopharynx. The mean dose to BOT predicted changes in anteroposterior tongue positioning from pre- to 10-weeks posttreatment. From pretreatment to 1-year, mean doses to BOT, OC, and VP were related to changes in grooving, strength, laryngeal height, nasality, palatalization, and degree of pharyngeal constriction. Changes in speech are related to mean doses to the base of tongue and velopharynx. The outcome indicates that strength, motility, and the balance between agonist and antagonist muscle forces change significantly after radiotherapy.     

Radiofrequency ablation for the treatment of mild to moderate obstructive sleep apnea

OBJECTIVES/HYPOTHESIS: Obstructive sleep apnea syndrome is due to pharyngeal obstructions, which can take place at the level of the soft palate. Temperature-controlled radiofrequency ablation has been introduced as being capable of reducing soft tissue volume and excessive compliance. The aim of the study was to evaluate prospectively the possible efficacy of temperature-controlled radiofrequency ablation applied to the soft palate in subjects with mild to moderate obstructive sleep apnea syndrome. STUDY DESIGN: Twenty-nine patients with a respiratory disturbance index between 10 and 30 events per hour, body mass index equal to or less than 30 kg/m2, and obstruction at the level of the soft palate were included in a pilot, prospective nonrandomized study. METHODS: Snoring and daytime sleepiness were evaluated subjectively. Treatment (maximum of three sessions) was discontinued when the bed partner was satisfied with the snoring level. A full night recording was performed at least 4 months after the last treatment. RESULTS: Mean snoring level decreased significantly from 8.6 +/- 1.3 to 3.3 +/- 2.5 on a visual analogue scale (0-10). Daytime sleepiness decreased nonsignificantly. Mean respiratory disturbance index decreased significantly from 19.0 +/- 6.1 events per hour to 9.8 +/- 8.6 events per hour. Mean lowest oxygen saturation value increased nonsignificantly from 85.3% +/- 4.1% to 86.4% +/- 4.4%. Of the patients, 65.5% were cured of their disease. CONCLUSIONS: Temperature-controlled radiofrequency ablation was effective in selected patients with mild to moderate obstructive sleep apnea syndrome. A full-night polysomnography is required after completion of treatment to rule out residual disease.     

完全肌松状态下阻塞性睡眠呼吸暂停患者上气道塌陷性的评估

目的 完全肌松条件下评估阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者软腭后气道的塌陷特性(被动塌陷性),评价解剖结构因素异常在OSAHS发病机制中的作用.方法 OSAHS患者30例,无鼾对照者14例,全麻完全肌松后次序给予软腭后气道3～20 cm H_2O(1 cm H_2O=0.09806 kPa)的正压,纤维喉镜定标记录各压力值时咽腔面积.测压并分析能使软腭后咽腔刚刚开放所需的腔内压,即软腭后临界开放压,代表该气道段被动塌陷性.结果 30例OSAHS患者完全肌松后气道硬腭平面完全塌陷的1例(3.3%),无鼾对照组14例均无塌陷;全部患者软腭悬雍垂平面完全塌陷,即临界开放压力均大于大气压,对照组有5例仍维持开放(35.7%);舌咽平面全部塌陷的患者共23例(76.7%),对照组7例(50.0%).OSAHS患者软腭后区平均临界开放压力中位数8.3[5.9;11.5]cm H_2O[25分位数;75分位数],与对照组2.7[-3.9;6.0]cm H2O比较差异有统计学意义(U=58.500,P=0.000).相关分析发现临界开放压力与AHI呈正相关(r=0.377,P=0.04).结论 OSAHS患者气道被动塌陷性异常增加,咽腔的开放必须依赖咽壁扩张肌主动作用,以软腭后区和舌后区为主.不同OSAHS个体肌松状态下软腭后区临界开放压力及咽壁顺应性存在差异.     

咽通道管治疗阻塞性睡眠呼吸暂停综合征

OBJECTIVE: To investigate the therapeutical effect of pharyngeal passage tube for OSAS. METHODS: Fifty-seven patients were treated during May 1995 to August 1999. All patients were examined by GKD-405 A polysomnography for apnea index (AI), hypnea index (HI), AHI (AI + HI) at cetera 7 items index before and after pharyngeal passage tube treatment. RESULTS: After treatment, the longest time of apnea shortened from (54.82 +/- 20.83) s to (25.74 +/- 9.50) s, the AHI lessened from 70.82 +/- 18.06 to 30.00 +/- 10.10, the oxygen desaturation increased from (62.36 +/- 11.53)% to (78.68 +/- 12.09)%. After treatment, the recorded parameters showed obvious therapeutical effect (P < 0.05-0.001, t values is from 2.20 to 15.29, the snore loudness of all patients dropped from (84.32 +/- 18.51) dB to (32.64 +/- 10.16) dB. The therapeutical successful rate was 87.72%. The long-term use rate (over 6 months) was 72.73%. CONCLUSION: The pharyngeal passage tube has obvious effect for patients suffering from severe OSAS. It is recommended for the treatment of OSAS as a conservative method.     

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.