纤维鼻咽喉镜下观察经药物诱导睡眠的鼾症患者鼾声来源

目的 对睡眠呼吸障碍程度不同的鼾症患者进行药物诱导下睡眠, 通过纤维鼻咽喉镜下观察患者睡眠中鼾声来源, 为治疗鼾症提供依据。方法 经多导睡眠监测(PSG)诊断为单纯打鼾(SS)及轻、中、重度(AHI≤40次/h)阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的患者共52例, 用异丙酚复合右美托米啶进行诱导睡眠后, 通过纤维鼻咽喉镜观察不同组鼾症患者仰卧位打鼾时咽部组织的振动及塌陷情况。结果 鼾声可来源于软腭、咽侧壁、会厌及舌根的振动, 其中咽侧壁振动的发生率在各组中的差异有统计学意义。不同患者的鼾声来源表现为单纯软腭振动型(Ⅰ型)和混合振动型(Ⅱ型)两大类型, Ⅱ型又可分为软腭加会厌振动(或加会厌舌根振动, Ⅱa型)、软腭加咽侧壁振动(Ⅱb型)和软腭加咽侧壁及会厌舌根振动(Ⅱc型)3种亚型。Ⅰ型鼾声来源在SS和轻、中、重度OSAHS患者中的比例有逐渐降低的趋势, Ⅱb型来源多见于中、重度患者, Ⅱc型来源在重度患者中最多见。结论 鼾声来源具有多样性, 睡眠呼吸障碍程度不同的鼾症患者鼾声来源有不同的特点, 选择治疗措施时应对主要鼾声来源进行辨别。

Sources of snoring sound during drug-induced sleep observed with fiberoptic laryngoscope

Objective To investigate the sources of snoring sound in simple snores and in patients with different degrees of obstructive sleep apnea/hypopnea syndrome (OSAHS). Methods A total of 15 subjects with simple snores and 37 patients with mild to severe OSAHS were involved. Sites of vibration from nasopharynx to laryngeal pharynx while snoring in each patient were observed with fiberoptic laryngoscope during drug-induced sleep. Results Vibration of soft palate, lateral wall, epiglottis and tongue base could be observed during snoring, and the distribution of lateral wall vibration had statistical significance among different groups.52 snores showed two types of source of snoring in general: palatal fluttering only(type Ⅰ) and multisite vibration (type Ⅱ). The latter could be divided into 3 subtypes further: palatal fluttering with vibration of epiglottis (type Ⅱa), palatal fluttering with vibration of Lateral wall(type Ⅱb), and palatal fluttering with vibration of lateral wall, epiglottis and tongue base together(type Ⅱc). Percentage of type Ⅰ decreased as the severity of OSAHS increased. Type IIb was more common in patients with media and heavy OSAHS, and type IIc were most common in patients with heavy OSAHS. Conclusion Source of snoring is of diversity, snorers with different severity of sleep breath disorder shows different patterns of that. The main source of snoring should be identified when we choose treatment method for snorers.