阻塞性睡眠呼吸暂停综合征患者腭咽软组织病理改变

目的通过研究睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｐａｐｎｅａｓｙｎｄｒｏｍｅ，ＯＳＡＳ）腭咽软组织病理改变，探讨咽扩大肌在ＯＳＡＳ发病机理中的作用。方法对ＯＳＡＳ２７例，鼾症（ｓｉｍｐｌｅｓｎｏｒｉｎｇ，ＳＳ）１７例，对照（扁桃体摘除术患者）１５例的悬雍垂及腭咽肌进行ＨＥ、ＡＴＰ酶、还原型辅酶Ⅰ脱氢酶（ＮＡＤＨＴＲ）等染色，观察软组织病理结构改变。结果悬雍垂中部横截面所含肌肉百分比ＯＳＡＳ组明显低于ＳＳ组（Ｐ＜０．０５）；且与纤维组织百分比呈显著负相关；悬雍垂肌肌纤维总数量、Ⅰ型肌纤维数量、肌纤维面积及总面积，ＯＳＡＳ组均较ＳＳ组明显减少（Ｐ＜０．０５）；ＯＳＡＳ组腭咽肌Ⅰ型肌纤维所占百分比极其截面积明显低于对照组及ＳＳ组（Ｐ＜０．０５）。电镜下见ＯＳＡＳ肌原纤维结构紊乱，部分Ｚ带呈锯齿状排列，运动神经纤维水肿，轴突内出现空泡变性。结论ＯＳＡＳ患者咽扩大肌肌纤维萎缩、减少，肌肉自身功能紊乱可能是引起ＯＳＡＳ上气道异常塌陷的重要原因之一。     

阻塞性睡眠呼吸暂停综合征与口咽腔大小的相关分析

目的 探讨阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）与口咽放大小的关系。方法 对３０例该病患者进行了口咽腔的测量,并以３０例正常人作对照。结果：ＯＳＡＳ患者的悬雍垂基部至舌背间大腭弓间距,咽腭弓间距,悬雍垂表面积均与正常组有显著性差异（Ｐ〈０．００１）,其中悬雍垂基部至舌背间距,咽腭弓间距与睡眠呼吸紊乱指数（ＡＨＩ）呈负相关（Ｐ〈０．０５）,而悬雍垂表面积与ＡＨＩ呈正相关（Ｐ〈０．０５）,同是通过测量受     

阻塞性睡眠呼吸暂停患者口咽脂肪浸润的组织学研究

阻塞性睡眠呼吸暂停（ＯＳＡ）是一种与代谢、呼吸紊乱和神经异常有关的疾病。研究发现,ＯＳＡ患者咽腔气道比正常人狭窄是由咽组织过剩、舌后坠、咽和软腭张力低引起。明确咽组织中潜在的脂肪浸润有助于对ＯＳＡ进行组织学研究。把４６例研究对象分为３组,他们分别进行了扁桃体切除术或悬雍垂腭咽成形术（ＵＰＰＰ）,取其扁桃体前、后柱（舌、咽腭弓）和悬雍垂组织制成切片进行观察评估,对脂肪组织进行半定量法分析。这三组是：２５例肥胖ＯＳＡ患者组,６例正常体重ＯＳＡ患者组,１５例无ＯＳＡ患者对照组。结果发现,对照组中患者口…     

激光辅助下的悬雍垂腭咽成形术(LAUP)在OSA中的疗效

当前阻塞性睡眠呼吸暂停（ＯＳＡ）的内科治疗包括双水平正压通气（ＢＩＰＡＰ）、持续正压通气（ＣＰＡＰ）、减肥、控制舌位装置和各种不同的牙矫正器等。ＯＳＡ的手术疗法包括悬雍垂腭咽成形术（ＵＰＰＰ）、鼻成形术、正颌手术等,尤以ＵＰＰＰ最常用。ＬＡＵＰ通过悬雍垂、软腭和腭弓再塑而扩大口咽通气道。与在手术室施行的ＵＰＰＰ相比,ＬＡＵＰ具有适用于不同的门诊病人、费用低、出血少且不出现腭咽关闭不全或狭窄的优点。为探讨ＬＡＵＰ治疗ＯＳＡ的疗效,作者对４８例患者施行了ＬＡＵＰ,患者均有打鼾、Ｍｕｌｌｅｒ'ｓ法示软…     

阻塞性睡眠呼吸暂停综合征患者睡眠时咽腔观察

目的分析阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ，ＯＳＡＳ）患者睡眠时咽腔阻塞特点及解剖原因，并与清醒时Ｍｕｌｅｒ检查比较。方法纤维喉镜检查４３例睡眠ＯＳＡＳ患者咽腔。结果①所有睡眠患者都有腭咽部阻塞，７９％病例合并口咽和／或下咽部阻塞。②咽阻塞涉及软腭或悬雍垂后坠、咽壁内陷、扁桃体或咽腭弓肥大、咽皱襞和咽侧索冗赘、舌根肥厚及后坠等诸多解剖异常。同一部位，个体间引起阻塞的解剖机制可不同。③睡眠时发现咽腔阻塞阳性率与Ｍｕｌｅｒ检查比较：腭咽部（１００％／９１％）、口咽部（５８％／４２％）、下咽部（５１％／２８％）。结论ＯＳＡＳ患者咽腔多部位阻塞很常见，解剖机制复杂多样，个体间常各异，对指导临床治疗及预后有重要意义。清醒时Ｍｕｌｅｒ检查较睡眠时观察阻塞部位少，尤其在腭咽以下部分，临床应用有局限性。     

悬雍垂腭咽成形术失败原因分析（附9例报告）

悬雍垂腭咽成形术失败原因分析（附９例报告）李杰清１作者自１９９２年以来采用悬雍垂腭咽成形术（ＵＰＰＰ），治疗９０例阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）。其中手术失败９例，现将失败原因作一分析，报告如下。１临床资料９例中，男８例，女１例，年龄２２～３...     

阻塞性睡眠呼吸暂停综合征患者睡眠时咽腔观察

目的 分析阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅ ｓｌｅｅｐ ａｐｎｅａ ｓｙｎｄｒｏｍｅ,ＯＳＡＳ）,患者睡眠时咽腔阻塞特点及解剖原因,并与清醒时Ｍｕｌｌｅｒｘ检查比较。方法 纤维喉镜检查４３例睡眠ＯＳＡＳ患者咽腔。结果 ①所有睡眠患者都有腭咽部阻塞,７９％病例合并口咽和／或下咽部阻塞。②咽阻塞涉及软腭或悬雍垂后坠、咽壁内陷、扁桃体或咽腭弓肥大、咽皱襞和咽侧索冗赘、舌根肥厚及后坠等诸多     

悬雍垂腭咽成形术后持续正压通气治疗

观察悬雍垂腭咽成形术（ｕｖｕｌｏｐｌａｔｏｐｈａｒｙｇｏｐｌａｓｔｙ,ＵＰＰＰ）后疗效不佳的阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＳ）患者为手术组行持续正压通气（ｃｏｎｔｎｕｏｕｓｐｏｓｉｔｉｖｅａｉｒｗａｙｐｒｅｓｓｕｒｅ,ＣＰＡＰ）治疗的效果。方法１５例ＵＰＰＰ术后呼吸暂停低通气指数（ａｐｎｏｅａ－ｈｙｐｏｎｏｅａｉｎｄｅｘ,ＡＨＩ）仍大于     

阻塞性睡眠呼吸暂停综合征与心血管疾病

阻塞性睡眠呼吸暂停综合征与心血管疾病李杰清１黄纯１葛焕青１我科自１９９２年以来对９０例阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ），采用睡眠多导监测仪（ＰＳＧ）监测睡眠呼吸暂停（睡眠憋气）时，低血氧症对心血管的影响，并观察ＯＳＡＳ行悬雍垂腭咽成形术（ＵＰＰ...     

多导联睡眠监护仪对阻塞性睡眠呼吸暂停综合征检测的意义

报告阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）２４例及其中手术１６例的临床资料和用多导联睡眠描记法（ＰＳＧ）行手术前后７ｈ夜间检测，从ＰＳＧ５个项目１２种检测数据的分析，能了解鼾声的响度值，心率和心率失常，呼吸道阻塞程度与呼吸暂停时间及血氧饱和度，手术前后ＰＳＧ值的改变，说明了ＰＧＳ对诊断ＯＳＡＳ及检测手术及效果有一定价值，并提示悬雍垂腭咽成形术（ＵＰＰＰ）是治疗ＯＳＡＳ的有效手段。     

Histological analysis of palatopharyngeal muscle from children with snoring and obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is an upper airway obstruction that occurs during the sleep. One of the suggested mechanisms involved in this process is a neuromuscular abnormality of the palatal muscles. Whether children with OSAS develop into OSAS adults, or children and adult OSAS are two distinct disorders occurring at different ages are questions to be answered. Here, we made the histological analysis of palatophryngeal muscle in 34 oral-breathing children of both genders, aged 5-12 years old, with hypertrophic tonsils and adenoids. According to the polysomnographic study the participants were divided into children without sleeping disorders (group I) and children with primary snoring (group II) or apnea (group III). The main histological findings were fiber size variability in 70% cases from groups II and III and in 71% from group I; perimysial connective tissue infiltration in 48% children from groups II and III and in 71% from group I; intracytoplasmatic mitochondrial proliferation in 63% cases from groups II and III and in 57% cases from group I. Muscle necrosis was only observed in one case, in association with subglandular inflammation. Others findings observed in all groups included fibers with internal architecture alteration, such as moth-eaten and lobulated fibers, type 2 fiber predominance, and small areas of fiber type grouping. The presence of similar histological findings in the palatopharyngeal muscle in children with primary snoring or apnea but also in children without sleeping disorders indicate that such changes could be a normal histological feature of this muscle rather than a neurogenic or myopathic pathology.     

不同程度阻塞性睡眠呼吸暂停低通气综合征患者腭咽肌病理形态的电镜观察

目的 研究不同程度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者的腭咽肌在透射电镜下的病理形态学改变,探讨腭咽组织在其发病机制中的作用.方法 38例接受悬雍垂腭咽成形术治疗的OSAHS患者(轻度组10例,中度组13例,重度组15例),对照组为5例无口咽部阻塞疾病行腭肿物或腭良性肿瘤切除术的成人患者.透射电镜下观察腭咽肌形态变化特点.结果 透射电镜下对照组腭咽肌的肌纤维排列规整,肌间线粒体基本正常.OSAHS轻度组腭咽肌的肌原纤维排列规则,Z线平直,大多线粒体结构正常;中度组肌纤维走行紊乱,Z线距离缩短、扭曲,线粒体大量空泡变性;重度组肌纤维呈点状或片状排列,Z线扭曲或消失,细胞器崩解,线粒体呈絮状改变,甚至消失,肌间可见脂质沉积.对照及OSAHS轻、中、重4组腭咽肌的肌纤维排列紊乱的发生比率分别为0、3/10、10/13、15/15,发生线粒体变性的比率为0、2/10、8/13、14/15,均有随病情程度加重而超微结构改变发生率增高的趋势.结论 OSAHS病情程度与腭咽肌病理形态变化有关,肌肉病变是OSAHS发病的重要环节,慢性间歇缺氧等病理损害可能进一步加重肌肉病变.     

The effect of tensor veli palatini stimulation on upper airway patency.

OBJECTIVE: To evaluate the effect of selective electrical stimulation of the tensor veli palatini muscle on upper airway patency. METHODS: Pressure-flow relationships were evaluated, in a feline isolated upper airway preparation, to determine the role of the soft palate musculature on airflow dynamics. The tensor veli palatini muscles were selectively stimulated while monitoring upper airway collapsibility (critical pressure), maximal inspiratory airflow, and the nasal resistance upstream to the flow-limiting site. RESULTS: Tensor veli palatini stimulation resulted (mean +/- SEM) in an increase in maximal inspiratory airflow from 74 +/- 13 mL/s to 93 +/- 18 mL/s (P= .04). The increase in maximal inspiratory airflow was associated with a decrease in critical pressure from -2.3 +/- 1.7 cm H2O to -4.7 +/- 2.7 cm H2O (P= .01) and an increase in nasal resistance from 32.4 +/- 24.3 cm H2O x L(-1) s(-1) to 50.8 +/- 29.7 cm H2O x L(-1) s(-1) (P= .02). CONCLUSIONS: Tensor veli palatini stimulation decreases upper airway collapsibility and is likely an integral component in maintaining airway patency. However, the effects of the isolated tensor veli palatini muscles are less significant than those seen previously with physiologic stimuli such as hypercapnia. These findings suggest that upper airway patency, although contributed to by the tensor veli palatini, requires the coordinated activation of palatopharyngeal muscles to adequately influence upper airway collapsibility.     

Muscle fiber types in the cat middle ear muscles. II. Tensor tympani

Using quantitative histochemical techniques, it was determined that the tensor tympani muscle of the cat consists of three muscle fiber types: type 1, type 2A (staining characteristics similar to the type 1 and type 2A muscle fibers found in the control tibialis anterior muscles), and a third unclassified fiber type (type 3) similar to the 2A fiber type except that it had extremely dense alkaline actomyosin adenosine triphosphatase staining (mean transmittance, type 2A = 33.6%; type 3 = 17.3%), as well as dense staining for periodic acid-Schiff, menadione-linked alpha-glycerolphosphate dehydrogenase, nicotinamide-adenine dinucleotide tetrazolium reductase, and succinic dehydrogenase. The type 1 fiber population was smaller in diameter (mean +/- SD, 14 +/- 4 microns) than the type 2A fiber (mean +/- SD, 21 +/- 5 microns) and the type 3 fiber (mean +/- SD, 22 +/- 6 microns) populations. In all muscles, intrafascicular and extrafascicular fat accumulations were found, with the majority being extrafascicular. Calculations indicate that the tendon occupies approximately 41% of the total muscle volume, while the muscle fibers constitute 59% of the volume.     

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.     

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.     

阻塞性睡眠呼吸暂停低通气综合征患者腭咽肌的病理变化

目的 研究阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者腭咽肌病理变化,探索腭咽肌在OSAHS发病机制中的作用.方法 30例行悬雍垂腭咽成形术的OSAHS患者为实验组(病情中度患者13例,重度患者17例),10例无OSAHS行扁桃体摘除术为对照组.利用电镜对两组患者腭咽肌行超微结构观察,并行免疫组化染色,观察腭咽肌的肌钙蛋白Ⅰ(troponin Ⅰ-SS)含量的改变.结果 透射电镜下可见30例OSAHS患者中29例腭咽肌的标本有不同程度的病理改变,如肌纤维萎缩,细胞核固缩,线粒体增多、固缩,肌纤维明带增宽等;对照组10例中2例仅有轻度的肌纤维萎缩或水肿.免疫组化观察:实验组30例标本有7例肌钙蛋白Ⅰ抗体表达阳性,1例表达强阳性,22例表达弱阳性;而对照组10例标本肌钙蛋白Ⅰ均显示阳性或强阳性表达.计算机图像分析实验组平均((-x)±s,下同)阴性灰度值为146.30±10.72,对照组平均阴性灰度值为107.50±4.81,二者差异有统计学意义(P＜0.05).但13例病情中度患者腭咽肌标本阴性灰度值平均为143.12,17例重度患者标本阴性灰度值平均为148.80,二者差异无统计学意义(P＞O.05).结论 OSAHS患者腭咽肌萎缩等不同程度的病理变化可能是引起患者上呼吸道异常塌陷的重要发病机制之一.     

阻塞性睡眠呼吸暂停程度与中性粒细胞／淋巴细胞比值的相关性研究

目的：探讨研究中性粒细胞／淋巴细胞比值（NLR）与阻塞性睡眠呼吸暂停综合征（OSAS）程度的关系。方法将158例按照睡眠期呼吸暂停低通气指数（AHI）情况分为4个组,分别为正常对照组（n ＝39）、轻度 OSAS组（n ＝38）、中度 OSAS 组（n ＝41）和重度 OSAS 组（n ＝40）,此外对重度 OSAS 组中的31例实施持续气道正压（CPAP）治疗3个月,对该31例进行 CPAP 治疗前后对比。比较的血细胞参数包括白细胞、中性粒细胞、淋巴细胞、中性粒细胞／淋巴细胞比值（NLR）。结果NLR 的组间比较显示重度 OSAS 组（3．29±1．19）显著高于正常对照组（1．71±0．69）、轻度 OSAS 组（1．70±0．71）,中度 OSAS 组较正常对照组和轻度 OSAS 组亦明显增高（均为P ＜0．05）,而正常对照组与轻度 OSAS 组间及中度 OSAS 组与重度 OSAS 组间差异无统计学意义（P ＞0．05）。重度 OSAS 患者 CPAP 治疗前后对比结果显示治疗后 NLR（1．98±0．81）较治疗前 NLR（3．28±0．62）显著降低（P ＜0．05）。此外4个组中 NLR 与睡眠期 AHI 是呈正相关的（r ＝0．758,P ＝0．034）,同时最低氧饱和度与 AHI呈负相关（r ＝－0．179,P ＝0．012）。结论NLR 可随着 OSAS 程度的加重而增高,因而可能作为一新的指标用来辅助评估 OSAS 患者体内炎症反应的严重程度。     

Experimental reinnervation of a strap muscle with a few roots of the phrenic nerve in rabbits.

In order to compare application of the roots of the phrenic nerve to the ansa hypoglossi for laryngeal muscle neurotization, 1 or more roots from the phrenic nerve were implanted into the right sternothyroid (RST) muscle of rabbits (n = 36). Controls were intact animals (in which RST innervation is provided by the ansa; n = 6) and denervated ones (n = 6). At 66 +/- 2 days (mean +/- SE) after neurotization, during quiet breathing, inspiratory electromyographic activity and isometric contraction force were observed in all reinnervated RST muscles (n = 24). During maximal inspiratory effort, electromyographic activity and force increased. In animals reinnervated by the C4 root alone, forces (46.22 +/- 7.8 g) were significantly higher than in intact animals (10.83 +/- 5.0 g). Retrograde labeling proved the phrenic origin of the neurotization. Electromyography of the diaphragm was recorded. We conclude that in rabbits, neurotization of a strap muscle by 1 or 2 roots of the phrenic nerve allows inspiratory contraction, even during quiet breathing. Such inspiratory activity is not observed in sternothyroid muscles of intact animals innervated by the ansa hypoglossi.     

Comparison of performance by otolaryngologists, pediatricians, and general practioners on an otoendoscopic diagnostic video examination

OBJECTIVE: To compare the performance of United States, South African, and Greek otolaryngologists, pediatricians, and general practitioners in recognizing the otoscopic examination findings of acute otitis media (AOM) and otitis media with effusion (OME) as presented in an otoendoscopic video evaluation test. DESIGN/SUBJECTS: Otolaryngologists, pediatricians, and general practitioners from the United States (n = 273, 2190, and 360 respectively), South Africa (n = 36, 36, and 206), and Greece (n = 58, 115, and 126) viewed nine different video-recorded otoscopic examinations, including pneumatic otoscopy of tympanic membranes. The ability to differentiate AOM, OME, and normal was ascertained. RESULTS: Overall, the average +/- standard deviation correct diagnosis on the otoscopic video exam by otolaryngologists was superior to pediatricians and general practitioners in all three countries: from the United States, it was 74 +/- 16% for otolaryngologists versus 51 +/- 11% for pediatricians (p < 0.000l) and 46+/-21% for general practitioners (p < 0.0001); from South Africa, it was 72 +/- 16% versus 53 +/- 21% (p = 0.16) and 47 +/- 19% (p = 0.002); and from Greece, it was 61 +/- 15% versus 36 +/- 12% (p < 0.003) and 39 +/- 10% (p = 0.009). CONCLUSIONS: A video-based otoscopy examination test may be a useful tool for evaluation of otoscopy-based diagnostic skills. Otolaryngologists performed significantly better than pediatricians in differentiating AOM, OME, and normal in such a test described here. However, all specialists who examine patients with AOM or OME may benefit from viewing video otoscopies to improve diagnostic accuracy.