阻塞性睡眠呼吸暂停低通气综合征患者颈围与睡眠呼吸参数及上气道径线的相关性研究

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的颈围、睡眠呼吸参数和CT检查上气道径线的相关性。方法 应用多层螺旋CT对61例经多道睡眠监测确诊的OSAHS患者的咽部区域进行连续扫描,分别测量腭咽区和舌咽区最狭窄气道的截面积、各径线长度及气道面积与颈面积比值,统计分析颈围与体质量指数(BMI)、身高、体质量、睡眠呼吸参数、颈部CT测量值之间的相关性。结果 OSAHS患者的颈围与BMI呈正相关(r=0.623,P<0.01);颈围与氧饱和度低于90的时间占睡眠时间的百分比(T90)呈正相关(r=0.284,P<0.05)、 与氧减指数(ODI)呈正相关(r=0.260,P<0.05)、与最低氧饱和度(LSO2)呈负相关(r=-0.317,P<0.05);颈围与腭咽、舌咽气道面积与颈面积比值均呈负相关(r=-0.258,P<0.05;r=-0.276,P<0.05),与腭咽气道软组织前径、舌咽气道软组织后径均呈正相关(r=0.293,P<0.05;r=0.290,P<0.05)。结论 颈围增加可比例缩小OSAHS患者的上呼吸道横截面积,加重上呼吸道塌陷或狭窄、软腭悬雍垂的松弛肥厚及夜间低氧血症的严重程度。颈围对OSAHS的发病有一定预测意义。     

Value of pulse oximetry watch for diagnosing pediatric obstructive sleep apnea/hypopnea syndrome

Objective: To evaluate the clinical value of pulse oximetry watch (POW) for diagnosing pediatric Obstructive sleep apnea/hypopnea syndrome (OSAHS).

Methods: We selected 32 children (boys: 25, 4–16 years old) who came to the hospital for diagnosing OSAHS from July to October 2016. Polysomnography (PSG) and POW were used simultaneously and recorded the apnea hypopnea index (AHI), LSpO₂, and ODI₄. Pearson analysis, t test, and receiver-operating characteristic (ROC) were used to analyze the correlation between PSG-AHI and other indicators, the diagnosis accordance rate, and the sensitivity and specificity of POW, respectively.

Results: According to PSG-AHI, 32 children were divided into two groups: primary snoring (n?=?5) and OSAHS (n?=?27). There was no significant difference between PSG-ODI₄ and POW-ODI₄ (p?>?.05). A statistically significant correlation between PSG-AHI and POW-ODI₄ was found (r?=?.719, p?1, 5, 10, 15, and 20 events/h, the area under the curve (AUC) was 0.685 (p?>?.05), 0.733, 0.798, 0.922, and 0.929 (p?20 events/h level, whereas the sensitivity and specificity were unacceptable (<75%) at the level of AHI >1, 5, 10, and 15 events/h.

Conclusions: POW cannot replace PSG to diagnose pediatric OSAHS because of low sensitivity and specificity, but can be used for screening severe OSAHS in children.     

上气道测压阻塞定位在阻塞性睡眠呼吸暂停低通气综合征外科治疗中的应用

目的 通过分析上气道测压阻塞定位指导的中、重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)外科随诊疗效,了解上气道测压阻塞定位的临床应用价值.方法 对51例中、重度OSAHS患者应用睡眠呼吸监测阻塞定位仪(ApneaGraph,AG)进行整夜睡眠呼吸监测和同步上气道压力测定.根据阻塞层面,分成2组.腭后区阻塞组:以上部阻塞为主,行腭后区手术;舌后区阻塞组:最低阻塞层面以下部为主,结合纤维喉镜观察阻塞结构,行腭部及不同的舌后区联合手术.以上两组患者,有鼻塞症状的,均同期行鼻部手术.术后6个月再次应用AG随访,评估手术疗效.结果 51例患者中,中度5例,重度46例,其中4例为UPPP失败再手术者.术后随访时间6～24个月,中位数为9个月.Epworth嗜睡评分(ESS)由术前(17.6±4.7)分((-x)±s,下同)降至(4.3±4.3)分(t=15.195,P<0.001),呼吸暂停低通气指数(AHI)由(52.4±17.5)次/h降至(16.3±18.2)次/h(t=10.873,P<0.001),最低血氧饱和度(LSaO2)由0.706±0.099提高至0.823±0.092(t=-8.396,P<0.001),差异均有统计学意义.总手术成功率(术后AHI<20次/h,且降幅≥50%)为76.5%,其中治愈14例,显效25例,有效6例,无效6例.腭后区阻塞组27例,手术成功率81.5%;舌后区阻塞组24例,成功率75.0%.结论 上气道压力测定法能较准确地判断上气道阻塞平面,与传统检查相结合,制定个体化手术方案,可能提高中重度OSAHS的手术疗效.     

Mucopolysaccharidosis: Otolaryngologic findings,obstructive sleep apnea and accumulation of glucosaminoglycans in lymphatic tissue of the upper airway

Objective

The aim of this study is to evaluate otolaryngologic problems (upper airway obstruction, obstructive sleep apnea, restriction of mouth opening, middle ear effusion, hearing and breathing problems) and their treatments on mucopolysaccharidoses (MPS) patients and to investigate accumulation of glucosaminoglycans (GAG) in the upper airway biochemically and pathologically.

Methods

76 MPS patients were evaluated. Forty-two MPS patients underwent polysomnography (PSG) for obstructive sleep apnea (OSA). Pre- and postoperative PSG results of 18 patients were compared. The success and complications of treatments for OSA in MPS were evaluated. Biochemical and histopathological accumulation of GAG in tonsil and adenoid tissue and middle ear effusion were analyzed and compared with the control group.

Results

Forty patients out of 42 tested with PSG had OSA (95%). Adenoid grade, Mallampati grade, restricted mouth opening, rate of difficult intubation were significantly different among MPS subtypes. MPS types III and IV had significantly lower Mallampati scores; type VI had significantly worse mouth opening; and type III had significantly better mouth opening and higher rate of easy intubation when compared to other MPS types. There was no significant difference between MPS subtypes according to tonsil grade, adenoid grade, rate of otitis media with effusion and OSA severity. Statistically significant difference was found between GAG accumulation in adenoid tissue and middle ear effusion of MPS and control group (p < 0.05). However, GAG accumulation in tonsil was not significantly different between MPS and control group. There was a statistically significant improvement in postop Apnea–Hypopnea Index (AHI) compared to preop AHI (p < 0.05).

Conclusions

Most MPS patients have airway obstruction and OSA due to adenotonsillar hypertrophy. Most of these children benefit from adenotonsillectomy, after which OSA significantly improves. They experience high recurrence rate after adenoidectomy; though this is not clinically problematic. They also suffer from conductive hearing loss due to OME, which has to be treated with ventilation tube insertion. However, such operations are usually complicated by difficult endotracheal intubation and restricted mouth opening. Sometimes tracheotomy may be necessary. Tracheotomy is also highly complicated in MPS patients. Significant accumulation of GAG in middle ear fluid and adenoid tissue is present; however, GAG appears not to accumulate in tonsillar tissue.     

阻塞性睡眠呼吸暂停低通气综合征患者上气道CT测量值与睡眠呼吸暂停低通气指数的相关性

目的 应用多层螺旋CT对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的上气 道成像,探讨上气道各平面的测量参数与睡眠呼吸暂停低通气指数(AHI)的相关性。方法 经多导睡眠监测（PSG）确诊的42例OSAHS的患者行平静呼吸和深吸气末时的上气道CT扫描,测量上气道各平面的截面积及相应平面的左右径和前后径并计算气道塌陷度。结果 OSAHS患者上气道最小截面积主要位于腭后区;中度组与重度组患者腭后区不同时相各测量指标与AHI呈负相关,舌后区深吸气末各测量指标与AHI呈负相关;各组患者各平面塌陷度与AHI无相关性。结论 OSAHS患者气道塌陷度与AHI无明显相关性。     

Watch PAT200便携式睡眠呼吸监测仪对阻塞性睡眠呼吸暂停低通气综合征监测价值研究

目的：评价腕式睡眠呼吸监测仪（Watch PAT200）对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的诊断价值。方法：28例怀疑有OSAHS的患者入院行整夜PSG监测和腕式Watch PAT200监测。PSG监测根据标准规则判断睡眠呼吸事件;Watch PAT200监测根据计算机自动运算法则进行分析,计算每小时呼吸事件频率,监测外周动脉容积信号变化、氧饱和度及心率变化,根据变化综合得出睡眠呼吸暂停指数（PATAHI）。结果：平均PSGAHI（23．00±21．55）／h,平均PAT AHI（25．99±19．09）／h,PSG AHI和PAT AHI指数间显著相关（r=0．92,P％0．01）,为评估PAT检测的敏感度和特异度,构建ROC曲线,在PSG AHI分别为5、15、30时,PAT监测的敏感度和特异度分别是95．8／100,93．7／91.7,85．7／100。每30s一屏PSG及PAT对睡眠及觉醒判断的符合率为（89±6）％。结论：腕式睡眠监测仪是一种精确检测OSAHS的装置,监测简便,且能准确判断睡眠及觉醒状态。     

舌根隧道法射频损伤的三维重建研究

目的：研究舌根隧道法射频治疗中舌根不同部位损伤体积,探讨其治疗的安全性。方法：18个新鲜离体猪舌随机分成6个组,每组3只。参照Powell等介绍方法在猪舌根选取6个射频操作点。用低温等离子射频发生仪进行猪舌根射频操作,取能级6。作用时间10。作用后的舌根组织块进行连续冷冻切片,间隔200μm保留切片1张,苏木精伊红染色后,进行序列组织切片的全貌二维图像采集,对损伤区域进行图像分割,提取。将提取分割图像导入IPS图像处理软件,进行损伤区域的三维重建及体积计算。结果：各作用点体积分别为（359．5±5．6）mm^2、（364．3±7．0）mm^2、（363．7±7．2）mm^2、（354．1±11．8）mm^2、（349．4±17．2）mm^2、（353．5±7．9）mm^2,舌根各作用点射频损伤体积差异无统计学意义（P〉0．05）。结论：在舌根隧道法射频治疗中,相同作用能级和作用时间下不同作用点损伤体积一致。低温等离子射频治疗系统作用能量集中,舌根区域损伤范围局限,在舌根区域操作具有较高的安全性。     

上气道多平面扩容术对重度阻塞性睡眠呼吸暂停低通气综合征患者嗓音的影响

目的：探讨上气道多平面扩容术对重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者嗓音的影响。方法：对26例重度OSAHS患者于上气道多平面扩容术前后,分别应用针对嗓音相关的主观调查问卷和嗓音频谱分析软件进行客观统计学分析。结果：主观调查问卷结果显示,26例患者上气道多平面扩容术后4例（15．4％）出现短时间的轻度腭咽闭合功能不全所致的鼻腔反流现象,均于术后1周内消失;3例（11．5%）术后发声有轻度鼻音增高,尤以术后1周内较明显而后逐渐消失;2例（7．7％）扁桃体Ⅲ度肥大者诉发声清晰度较前提高,原有轻微含糖音消失;总体评价是嗓音障碍指数量表、嗓音相关生活质量量表评分手术前后均无明显变化（P〉0．05）。嗓音客观参数基频F0和F1、F2、F3及F4共振峰频率手术前后均无统计学差异。结论：上气道多平面扩容术能够解除重度OSAHS患者上气道的阻塞性因素,同时进行鼻腔和咽腔的塑形,在一定程度上改变了声道共鸣腔,但对重度OSAHS患者嗓音的主观心理听觉评估无明显变化,嗓音客观参数基频F0和F1、F2、F3及F4四个共振峰频率均无明显的变化。     

清醒及诱导睡眠状态下电子喉镜对阻塞性睡眠呼吸暂停低通气综合征定位诊断的比较

目的：比较在清醒及诱导睡眠两种不同状态下，电子喉镜对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）定位诊断结果的差异。方法：经多导睡眠监测确诊的98例OSAHS患者，分别在清醒状态及用咪唑安定诱导睡眠后用电子喉镜对其上呼吸道进行动态观察，以确定阻塞部位，并对两组结果进行比较。结果：98例患者在清醒状态下经电子喉镜定位诊断，存在多部位阻塞者占58．2％（57／98）；而在诱导睡眠后存在多部位阻塞者占77．5％（76／98），两组差异有统计学意义（P〈0．01）。结论：大部分的OSAHS患者上呼吸道存在多部位阻塞；在诱导睡眠状态下，阻塞部位要比清醒状态时多。     

OSAHS患者药物诱导睡眠内镜检查状态下咽喉部评分情况及其影响因素探讨

目的 探究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者药物诱导睡眠内镜(DISE)检查状态下腭咽、口咽、舌根和会厌(VOTE)评分情况及其影响因素。方法 选取2019年3月—2021年3月石家庄市人民医院95例OSAHS患者,均行DISE检查,由两名经验相近的医师进行VOTE评分,采用组内相关系数评价两名医师评估OSAHS患者总VOTE评分的一致性。并比较不同临床参数患者VOTE评分,通过多元线性逐步回归模型分析VOTE评分的影响因素。结果 95例OSAHS患者4个阻塞平面总VOTE评分为(4.07±0.81)分,其中腭咽平面评分(1.49±0.13)分,以环形阻塞为主;口咽平面评分(1.38±0.15)分,均为左右阻塞;舌根平面评分(1.05±0.10)分,均为前后阻塞;会厌平面评分(0.15±0.02)分,均为左右阻塞;两名医师评估OSAHS患者腭咽平面评分的一致性相关系数为0.912(95%CI为0.846～0.972),评估口咽平面评分的一致性相关系数为0.926(95%CI为0.871～0.984),评估舌根平面评分的一致性相关系数为0.975(95%CI为0.891～0...     

Effects of long-term nasal continuous positive airway pressure therapy on morphology, function, and mucociliary clearance of nasal epithelium in patients with obstructive sleep apnea syndrome

OBJECTIVES/HYPOTHESIS: The objective was to investigate the possible modification of nasal mucosa function and mucociliary clearance in a group of patients with severe obstructive sleep apnea syndrome receiving mechanical ventilation with long-term nasal continuous positive airway pressure (n-CPAP), without nasal diseases. STUDY DESIGN: The study design was experimental. Eight (six male and two female) nonsmoker patients were selected on the basis of two sleep questionnaires, were identified as needing n-CPAP therapy, and showed normal values of mucociliary transport time, ciliary beat frequency, and anterior rhinomanometry. METHODS: After a full polysomnographic examination, the authors recorded respiratory disturbance index (RDI), apnea/hypopnea index, nadir arterial oxygen saturation, and sleep stage. Every patient underwent pulmonary function test; arterial blood gas analysis; chest radiography; electrocardiography; ear, nose, and throat evaluation with rhinoscopy; anterior rhinomanometry; a saccharine test to measure the mucociliary transport time; and a brushing of nasal epithelium for study of ciliary beat frequency. All patients underwent polysomnographic examination in basal condition with overnight n-CPAP (without humidifier) and repeated this examination after 1 and 6 months with Auto CPAP (Autoset Res Care, Sidney, Australia) to titrate n-CPAP pressure and measure the new respiratory disturbance index. RESULTS: The mean basal respiratory disturbance index (number of respiratory events during sleep per hour of recording time) was 53.7 +/- 21.5 events/h; after 6 months of n-CPAP therapy (mean value, 7.5 +/- 0.7 cm H2O) the respiratory disturbance index was 5.7 +/- 3.76 events/h. Values for nasal resistance, mucociliary transport time, and ciliary beat frequency were normal before and after the ventilatory treatment. CONCLUSION: In the study group of patients with severe obstructive sleep apnea syndrome, the nocturnal use of n-CPAP without humidifier did not modify the function and mucociliary clearance of nasal epithelium.     

The palatal septal cartilage implantation for snoring and obstructive sleep apnea

Objective

Patients with snoring and obstructive sleep apnea frequently have nasal and palatal obstruction. The objective of this study was to investigate the safety and feasibility of a palatal septal cartilage implant (SCI) for snoring and obstructive sleep apnea.

软腭、舌根舌体低温等离子消融配合咽黏膜减张缝合治疗阻塞性睡眠呼吸暂停低通气综合征

目的 探讨软腭、舌根舌体低温等离子消融配合咽黏膜减张缝合治疗中、重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的有效性。方法 38 例中度及42例重度OSAHS患者行软腭、舌根舌体低温等离子消融,将咽腭弓折返减张半荷包式缝合于扁桃体窝内,术前及术后6个月行睡眠监测、爱泼沃斯嗜睡量表(ESS)调查及咽腔测量。结果 80例患者均在术后6个月嗜睡状况改善,咽腔前后径、左右径扩大;睡眠结构得到明显改善。结论 咽黏膜减张缝合有效避免了咽腭弓术后撕裂、咽部黏膜重新松弛塌陷;软腭、舌根舌体低温等离子消融配合是治疗OSAHS的有效方法之一。     

A comparison of the long-term outcome and effects of surgery or continuous positive airway pressure on patients with obstructive sleep apnea syndrome

OBJECTIVES: To compare the long-term (3-year) outcome and effects of continuous positive airway pressure (CPAP) and extended uvulopalatoplasty (EUPF) treatment on patients with obstructive sleep apnea syndrome. METHODS: Eighty-four patients who received CPAP titration and bought a CPAP machine to use from March 2000 to October 2001 were included as the CPAP group. Another 55 patients who underwent EUPF surgery were included as the EUPF group. Overnight polysomnography was performed 6 months and 3 years after CPAP titration or EUPF. The disease-specific questionnaire-Snore Outcome Survey (SOS), Epworth Sleepiness Scale (ESS), and the generic health questionnaire-MOSF-36 were administered at the 6-month and 3-year follow-up examinations. RESULTS: The age, body mass index, respiratory disturbance index, and ESS before treatment were higher in the CPAP group. The snore index was higher in the surgery group. Fifty-four patients (64.3%) in CPAP group continued treatment for 6 months; the success rate for EUPF at 6 months was 82%. The polysomnographic variables improved significantly in both groups. Improvements in the SOS and ESS scores were better in surgery group than the CPAP group. The subscales of SF-36 in surgery group were more than those in CPAP group. CONCLUSIONS: EUPF had a better effect on snoring than CPAP 6 months after treatment in patients with obstructive sleep apnea syndrome (OSAS). This effect had gradually declined at the 3-year follow-up examination. Improvement in the quality of life of OSAS patients receiving EUPF is equal to those receiving CPAP treatment.     

Efficacy and safety assessment of expiratory positive airway pressure (EPAP) mask for OSAHS therapy

Objective

We have designed the expiratory positive airway pressure (EPAP) mask to provide a new sort of therapeutic strategies for Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). And this study aims to assess the safety, efficacy and compliance of the EPAP therapy.