阻塞性睡眠呼吸暂停综合征与咽喉反流性疾病相关研究进展

阻塞性睡眠呼吸暂停综合征(OSAS)与咽喉反流性疾病(LPRD)是耳鼻喉科两种常见的疾病,近年来由于发病率逐渐增高,影响着越来越多人的健康。随着对这两种疾病研究的深入,两者之间的相关性引起了广大学者的重视。回顾近几年研究二者的相关文献,得出两者之间存在相关性的结论,阐述两者之间相互影响的因素、机制,并分析OSAS与LPRD的治疗方法,为进一步探寻两者的诊治提供新思路。     

咽喉反流与阻塞性睡眠呼吸暂停低通气综合征

阻塞性睡眠呼吸暂停低通气综合征是一种较常见的呼吸道阻塞性疾病,通常伴有打鼾、睡眠结构紊乱、频繁发生血氧饱和度下降、白天嗜睡等,并可能导致心血管疾病、内分泌疾病等多器官多系统损害.随着生活质量及医疗水平的提高,咽喉反流性疾病越来越受到人们的重视,研究其与阻塞性睡眠呼吸暂停低通气综合征的相关性对临床诊断提供新的思路.     

儿童阻塞性睡眠呼吸暂停低通气综合征与咽喉反流

儿童阻塞性睡眠呼吸暂停低通气综合征病因复杂,并可导致心血管疾病、神经认知障碍及代谢综合征等并发症,已严重影响儿童的身心健康。咽喉反流性疾病为胃内容物反流至上食管括约肌以上的咽喉部所引起的疾病,这一近来逐渐成为研究新热点的反流性疾病与睡眠呼吸障碍性疾病关系的研究较少。本文就目前研究结果对儿童阻塞性睡眠呼吸暂停低通气综合征与咽喉反流相关关系进行综述。     

质子泵抑制剂在阻塞性睡眠呼吸暂停低通气综合征伴咽喉反流者中的应用

目的观察质子泵抑制剂(proton pump inhibitor,PPI)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴喉咽反流(laryngopharyngeal reflux,LPR)患者的疗效,探讨PPI对伴LPR的OSAHS患者的应用价值。方法 2008年10月～2011年3月经临床及睡眠呼吸监测(PSG)确诊为OSAHS并伴有LPR患者26例,所有患者自愿接受PPI口服泮托拉唑钠肠溶胶囊20 mg,2次/d,治疗并坚持完成3个月疗程。3个月后复查PSG,通过呼吸暂停低通气指数(AHI)评估疗效,并将结果进行统计学分析。结果2 6例患者治疗前AHI(5 0.5 2±19.61)次/h,治疗后(2 9.4 7±1 4.1 5)次/h,降幅为(3 6.2 3±1 2.3 2)%,治疗前后AHI比较采用配对t检验,其差异具有统计学意义(t=2.5 4 3,P=0.0 2)。LPR的临床症状及内镜检查喉咽部黏膜炎症体征均有不同程度改善。结论喉咽反流存在可能对OS-AHS有直接影响,PPI对伴有喉咽反流的OSAHS具有较好疗效,且具有一定的临床应用价值。     

阻塞性睡眠呼吸暂停低通气综合征与咽喉反流性疾病的相关性研究

目的　探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与咽喉反流性疾病（laryngophyngeal reflux disease,LPRD）的相关性。方法　回顾性分析2017年3～12月在我科以睡眠打鼾、憋气为主诉就诊,同步行Dx-pH与多道睡眠图监测确诊的成年OSAHS患者的临床资料。结果　92例OSAHS患者中轻度27例,中度33例,重度32例。呼吸暂停低通气指数（27.0±18.1）次/h,最低血氧饱和度81.1%±8.4%。18例（19.6%）患者伴LPRD,10例为直立位反流,2例为卧位反流,6例直立位、卧位均存在反流,其中轻度OSAHS组2例（7.4%）,中度OSAHS组5例（15.2%）,重度OSAHS组11例（34.4%）。三组LPRD患病率有统计学差异（χ2=7.404,P =0.024）。伴LPRD的OSAHS患者呼吸暂停低通气指数[（35.8±17.0）次/h]明显大于不伴LPRD的OSAHS患者[（24.9±17.8）次/h]（t =2.412, P =0.023）,但最低血氧饱和度无统计学差异（79.3%±8.4%vs 81.6%±8.4%）（P＞0.05）。结论　OSAHS与LPRD有一定的共患率,且病情越重,LPRD发病率越高。OSAHS患者伴发的咽喉反流仍以直立位为主。伴LPRD的OSAHS患者呼吸紊乱程度更重。但两种疾病相互影响的具体机制,尚需进一步研究。     

阻塞性睡眠呼吸暂停低通气综合征伴咽喉反流性疾病患者焦虑抑郁与生活质量状况分析

目的 通过精神心理及生活质量状况调查分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与咽喉反流性疾病(laryngopharyngeal reflux disease,LPRD)的相关性.方法 选取2016年9月-2020年8月以打鼾为主诉的235例患者为研究对象,进行多道睡眠图(PSG)监测并填写反流症状指数量表(r...     

抗反流药物联合持续气道正压通气治疗阻塞性睡眠呼吸暂停综合征伴咽喉反流的疗效分析CSCD

目的探讨抗反流药物联合持续气道正压通气(CPAP)治疗阻塞性睡眠呼吸暂停综合征(OSAS)伴咽喉反流(LPR)的疗效。方法收集2020年5月~2022年5月于南京医科大学附属苏州医院和江苏大学附属人民医院耳鼻咽喉科就诊的81例男性中重度OSAS伴LPR的患者,分别予以药物(药物组)、CPAP(CPAP组)及药物+CPAP(药物+CPAP组)治疗14 d,三组均于治疗前后行多导睡眠监测(PSG),填写咽喉反流症状指数(RSI)量表和Epworth嗜睡量表(ESS)。结果三种治疗方法均可改善OSAS伴LPR的症状,其中药物+CPAP组的总有效率高于药物组和CPAP组(P<0.05)。药物组治疗14 d后RSI评分较治疗前降低,差异有统计学意义(P<0.05),ESS评分、呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)较治疗前无明显改善,差异无统计学意义(P>0.05);CPAP组治疗后RSI评分无明显改善,差异无统计学意义(P>0.05),ESS评分和AHI较治疗前下降,LSaO2较治疗前提高,差异有统计学意义(P均<0.05);药物+CPAP组治疗14 d后RSI评分、ESS评分、AHI均较治疗前降低,LSaO2较治疗前提高,差异有统计学意义(P均<0.05)。结论临床上对于OSAS伴LPR患者,使用抗反流药物联合CPAP治疗能更快速控制患者症状,且治疗效果更加快速有效。     

阻塞性睡眠呼吸暂停低通气综合征与胃食管反流关系的研究

目的 研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与胃食管反流(gastroesophageal reflux,GER)的关系.方法 76例OSAHS患者行多道睡眠监测及夜间远端食管pH监测.评估OSAHS患者GER的发生率.对其中32例合并GER并适宜手术的OSAHS患者行悬雍垂腭咽成形术等手术治疗,术后6个月复查多道睡眠监测及远端食管pH值,对比术前、术后呼吸暂停低通气指数(AHI)、微觉醒指数(micro-arousal index,MAI)、最低动脉血氧饱和度(lowest SaO2,LSaO2)、远端食管酸化指数(pH index,pHI)及食管酸暴露时间(acid contact time,ACT)百分比,并进行相关性分析.结果 76例OSAHS患者AHI为(38.6±29.5)次/h(x±s,下同),伴发GER 48例(占63.2%).32例合并GER的OSAHS患者术前及术后6个月AHI分别为(51.2±23.1)和(17.3±10.3)次/h;MAI为(38.3±21.4)和(14.5±10.0)次/h;LSaO2为(0.698±0.107)和(0.858±0.076);pHI为(12.5±6.6)和(6.3±4.2)次/h;ACT百分比为(10.3±5.2)%和(4.5±2.9)%,配对t检验差异均有统计学意义(t值分别为10.95、7.82、15.97、6.12、7.62,P值均<0.001).术后较术前AHI、MAI减少值与pHI的减少存在相关性(r值分别为0.775和0.764,P值均<0.001);AHI、MAI改善程度与ACT百分比减少存在相关性(r值分别为0.607和0.730,P值均<0.001).结论 OSAHS患者较易发生夜间GER,对OSAHS的治疗在显著降低AHI、MAI的同时也明显改善了GER,提示夜间胃食管反流的发生与呼吸及睡眠紊乱有关.     

阻塞性睡眠呼吸暂停低通气综合征的序列治疗

近年来，阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的病理生理学、病因学等方面的研究进展给治疗学提出了新的要求。OSAHS的治疗绝非某个单一的治疗方案能够奏效，需要有一个详细而有序的治疗计划。目前就其临床治疗而言，由某一科占绝对主导地位的治疗模式已逐渐被抛弃，形成     

Ryan指数与反流症状指数量表、反流体征量表在咽喉反流性疾病诊断中的相关性分析

目的 探讨Ryan指数与反流症状指数量表(RSI)、反流体征量表(RFS)在咽喉反流性疾病诊断中的相关性。 方法 回顾性分析以咽喉部不适症状就诊,病程1个月以上的行咽部pH检测的230例患者临床资料。所有患者均同时行电子喉镜检测,并行RSI、RFS评估。 结果 Ryan指数阳性率为15.2%(35/230)。RSI、RFS、RSI或RFS及RSI且RFS阳性率分别为46.5%、28.7%、60.9%、13.9%。Ryan指数阳性组患者RFS评分高于Ryan指数阴性组患者,RSI评分与Ryan指数阴性组患者差异无统计学意义。RFS阳性,RSI或RFS,RSI且RFS阳性组Ryan指数阳性率高于RFS阴性,RSI或RFS,RSI且RFS阴性组。Ryan指数阳性与RSI、RFS、RSI或RFS及RSI且RFS阳性的一致性检验的kappa值分别为-0.06,0.394,0.116和0.172。以pH监测作为金标准时,RSI、RFS、RSI或RFS及RSI且RFS的敏感性分别为37.1%,74.3%,82.9%,28.6%;特异性分别为51.8%,79.5%,43.1%,88.2%;阳性预测值分别为12.1%,39.4%,20.7%,30.3%;阴性预测值分别为82.1%,94.5%,93.3%,87.3%。RSI与直立位及平卧位Ryan指数的相关系数分别为-0.056和-0.083;RFS与直立位及平卧位Ryan指数的相关系数分别为0.425和0.166。 结论 咽部pH检测是直接反映咽喉部反流的客观、无创的检测方法。RFS与Ryan指数有一定的正相关性,但量表与Ryan指数一致性差。尚需进一步研究更准确的、反映咽喉反流的量表及pH诊断指数。     

The effect of obstructive sleep apnea surgery on laryngopharyngeal reflux with obstructive sleep apnea

Abstract

Background: Obstructive sleep apnea (OSA) may play a role in the occurrence of laryngopharyngeal reflux (LPR). OSA surgery also may have a significant curative effect on LPR with OSA.

Objectives: To analyze the role of OSA in LPR and the effect of OSA surgery on LPR with OSA.

Methods: Forty-five OSA patients with LPR symptoms were enrolled and were divided into the LPR positive group (RSI > 13) and the LPR suspicious group (1?≤?RSI ≤ 13) based on reflux symptom index (RSI). All the patients underwent OSA surgery. The RSI scores at three different time points postoperatively were compared with that preoperatively.

Results: In the LPR positive and LPR suspicious group, the result revealed that there were significant differences in RSI score between one month, three months, six months after surgery and before surgery (p?<?.001 for all). Moreover, in the LPR positive group, there was a significant difference in RSI score among one month, three months and six months after surgery (p?=?.01).

Conclusions and significance: The effect of OSA on LPR exists and OSA surgery can improve the symptoms of LPR with OSA obviously. For some LPR patients with OSA, the combination therapy of OSA and LPR is needed.     

Reflux symptom index and reflux finding score in 91 asymptomatic volunteers

Background: The primary goal of this study was to investigating the symptoms, in addition to the reflux-related laryngopharynx inflammation performance of asymptomatic, volunteers, and verified the ‘normal point’.

Methods: A total of 91 asymptomatic subjects were recruited for this cross-sectional study between March 2016 and September 2016. Participants completed the reflux symptom index (RSI) assessment and underwent laryngostroboscopic examination using a rigid endoscope. Their RFS were graded according to the laryngeal findings. The distribution and the relationship of the RSI and the RFS were analyzed.

Results: The mean RSI of individuals was 2.24?±?2.34 [95% confidence interval (CI)?=?1.75, 2.72], and the mean RFS of individuals was 5.78?±?1.74 (95% CI?=?5.42, 6.15). The Pearson product–moment correlation coefficient of the RSI and RFS scores was –0.084 (n?=?91, p?=?.428).

Conclusions: Asymptomatic people could present relatively high RFS scores, and no linear relationship existed between RSI and RFS.     

Clinical and polysomnographic predictors of laryngopharyngeal reflux in obstructive sleep apnea syndrome

IntroductionObstructive sleep apnea syndrome and laryngopharyngeal reflux are diseases with a high prevalence in the overall population; however, it remains unclear whether they are diseases with the same risk factors present in the same populations or if there is any association between them.ObjectivesTo evaluate and determine the prevalence of laryngopharyngeal reflux in patients with moderate and severe obstructive apnea syndrome and also to determine its predictive factors.MethodsHistorical cohort, cross-sectional study of patients aged 18–70 years, referred to a tertiary service Otorhinolaryngology outpatient clinic with a polysomnographic diagnosis of moderate or severe obstructive sleep apnea syndrome. The reflux symptom index questionnaire and the reflux finding score at indirect videolaryngoscopy were applied to the assessed population, considering the inclusion and exclusion criteria.ResultsFifty-six patients were evaluated, of which 64.3% had a positive laryngopharyngeal reflux (positive reflux symptom index and/or positive endolaryngeal reflux finding score). Body mass index was a predictor of reflux presence in this group of patients with moderate to severe obstructive sleep apnea syndrome. In patients with positive score for endoscopic findings and reflux symptom index (12.3%), there was a trend toward significance for a higher mean apnea–hypopnea index and a higher percentage of sleep time with oxyhemoglobin saturation below 90% (p = 0.05).ConclusionThe prevalence of laryngopharyngeal reflux was higher in this group of patients with moderate to severe obstructive sleep apnea syndrome, and the body mass index was a predictor of laryngopharyngeal reflux in these patients. There was a trend toward greater oxyhemoglobin desaturation in patients with a positive score for reflux symptoms index (RSI) and reflux finding score (RFS).     

The influence of laryngopharyngeal reflux in the healing of laryngeal trauma

The aim of this clinical study was to evaluate the effect of laryngopharyngeal reflux (LPR) on the healing process of surgical laryngeal trauma. A total of 112 consecutive patients, who suffered from LPR and were scheduled for operation of Reinke edema or laryngeal polyps/nodules (40 and 72 patients, respectively) during a period of 5 years, were included. Diagnosis of LPR was made on the basis of both history and dual pH probe recording during 24 h in the inferior esophagus and the hypopharynx. The reflux finding score (RFS) and the reflux symptom index (RSI) were used to estimate the clinical severity of LPR. In patients with LPR, proton pump inhibitors (PPI) were initiated in half of them, randomly chosen. Fifty LPR-free subjects operated for Reinke edema or laryngeal polyps during the same time period (19 and 31 patients, respectively) were used as controls. In six patients who had been administered PPI, resolution of the disease was observed and no surgical treatment was undertaken. The remaining patients were operated on under general anesthesia by a single surgeon. All patients had 1-year postoperative follow-up. Epithelization was complete in all vocal cords of both the control group and the group of patients who had been administered PPI. Within the group of patients who had not taken PPI, six patients presented granulation tissue or recurrence of the polyps and in two of them revision surgery was needed. RFS and RSI scores showed significant improvement postoperatively, across all the three groups of patients, with major differences observed in the group treated by PPI. Comparison of the postoperative RFS and RSI scores between the two groups of patients with LPR showed statistically significant differences in both, indicating better treatment outcome in those patients who had received PPI. It may be thus concluded that LPR influences epithelization and recurrence of laryngeal polyps or Reinke edema in vocal cords, after partial or total decortication. Surgical outcome is superior in patients with LPR with preoperative and postoperative anti-reflux treatment.     

幽门螺旋杆菌感染对症状性咽喉反流患者唾液胃蛋白酶浓度的影响

目的 探讨幽门螺旋杆菌(HP)感染对症状性咽喉反流(LPR)患者唾液胃蛋白酶浓度的影响。方法 将咽部异物感、反复清嗓等非特异性症状为主诉的229例LPR初诊患者作为研究对象。应用¹⁴C呼气试验将所有LPR患者分为HP阳性组和HP阴性组,并分别给予HP根除治疗(三联疗法)与抑酸治疗。所有患者在初诊及治疗后复诊时均收集唾液样本(HP阳性者复诊时复查¹⁴C呼气试验),并比较治疗前后反流症状指数量表(reflux symptom index, RSI)、反流体征评分量表(reflux finding score, RFS)评分和唾液胃蛋白酶浓度变化。结果 HP阳性的LPR患者其RSI及RFS总分与HP阴性者相比无显著差异(11.00 vs 9.00,P=0.077; 8.50 vs 9.00,P=0.415),但HP阳性者其声嘶(P=0.005)、烦人的咳嗽(P=0.016)等症状评分,声带水肿(P=0.002)体征评分及唾液胃蛋白酶浓度显著高于HP阴性者(94.90μg/mL vs 45.28μg/mL,P<0.001),且治疗后HP阳性的L...     

Laryngopharyngeal reflux in obstructive sleep apnoea patients: Literature review and meta-analysis

Purpose

Laryngopharyngeal reflux (LPR) is a frequent condition in Obstructive Sleep Apnoea (OSA) patients and different studies have been published in the last years about this topic. A review of the published literature regarding LPR in OSA patients has been reported. A meta-analysis to evaluate the incidence of LPR in OSA patients and correlate LPR positivity with OSA patients' characteristics has been performed.

Characteristics of laryngopharyngeal reflux in patients with chronic otitis media

Objective

To summarize the characteristics of laryngopharyngeal reflux (LPR) in patients with chronic otitis media.

窄带成像技术在咽喉反流诊断中的优势应用

目的 探讨窄带成像技术(NBI)在咽喉反流(LPR)诊断中的作用.方法 根据我国2015年咽喉反流性疾病诊断与治疗专家共识的标准招募39例咽喉反流阳性患者(LPR组)和19例阴性对照,参与者均完成反流症状指数评分量表(RSI)和反流体征评分量表(RFS)评分及NBI下的电子喉镜检查.结果 39例LPR患者中2例失访.与...     

Laryngopharyngeal reflux finding scores correlate with gastroesophageal reflux disease and Helicobacter pylori expression

Conclusion. The expression of Helicobacter pylori (HP) positivity and degree of gastroesophageal reflux disease (GERD) correlate with laryngopharyngeal reflux (LPR). HP positivity and degree of GERD were more adverse in patients with a reflux finding score (RFS) of 7 or more. Objective. We aimed to investigate the relationship between RFS and inflammation of the lower part of the esophagus as well as RFS and HP infection. Patients and methods. Forty-five consecutive patients were analyzed prospectively. The degree of LPR was evaluated using the RFS method. The degree of GERD, lower esophageal mucosal inflammation, and antral HP positivity were evaluated using endoscopic surveys. Results. The mean RFS of the whole population was 11.5±4.4. The mean RFS of patients who had lower esophageal mucosal inflammation was 7±0.1, 8.1±1.3, 13.9±3.7, and 16.6±3.5, for grades A, B, C and D, respectively. The RFS of patients according to HP expression was as follows: 7.2±0.4, 9.3±3.07, 12.7±3.16, and 17.8±2.1, for normal (score 0), score I, score II, and score III, respectively.