鼾症患者模拟打鼾与药物诱导睡眠内镜下鼾声来源部位的对比研究

目的 对单纯打鼾(SS)及轻度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的患者,通过鼻咽纤维喉镜观察清醒状态下模拟打鼾及药物诱导睡眠下打鼾时的鼾声来源,研究这两种检查方法判断鼾声来源部位的一致性及模拟打鼾判断鼾声来源的可靠度。 方法 经多导睡眠监测(PSG)诊断为单纯打鼾患者及轻度OSAHS患者共40例,依次进行清醒状态下模拟打鼾及药物诱导睡眠,通过纤维鼻咽喉镜观察患者仰卧位打鼾时咽部组织的振动情况。 结果 在模拟打鼾及药物诱导睡眠两种状态下咽部组织的振动情况有所不同。统计学McNemar检验结果显示,两种方法对软腭振动及会厌/舌根振动判断的差异无统计学意义(P=0.774, 0.077),对咽侧壁振动判断的差异有统计学意义(P=0.002)。两种检查对软腭及会厌/舌根振动的检出率差异无统计学意义(P=0.770,0.110), 药物诱导睡眠对咽侧壁振动的检出率远高于模拟打鼾(P=0.005)。 结论 与药物诱导睡眠内镜检查相比,模拟打鼾能较好地判断软腭振动,其次为舌根/会厌,对咽侧壁振动则较难判断。

Investigation of the consistency of sources of snoring sound induced by simulated snoring and drug-induced sleep endoscopy in patients with snoring

Objective To investigate the consistency of the sources of snoring sound induced by simulated snoring and drug-induced sleep endoscopy in simple snores (SS) and mild obstructive sleep apnea/hypopnea syndrome (OSAHS).Methods A total of 40 cases diagnosed as either SS or mild OSAHS by polysomnography (PSG) underwent simulated snoring and drug-induced sleep endoscopy successively.The vibration of soft tissue of upper airway was observed with fiberoptic laryngoscope.Results Under simulated snoring condition and drug-induced sleep endoscopy,there were different vibrations in the pharynx.The McNemar statistical results showed that there was no significant difference between simulated snoring and drug-induced sleep endoscopy in determining the vibration of soft palate and epiglottis/tongue base (P =0.774,0.077),while there was very significant difference between the two methods in determining the vibration of the lateral phaynged wall (P =0.002).Under these two conditions,there was no significant difference in the incidence rates of vibration of both soft palate and epiglottis/tongue base (P =0.770,0.110),while the incidence rate of vibration of lateral pharyngeal wall was much higer under drug-induced sleep endoscopy than that under simulated snoring (P =0.005).Conclusion Compared with drug-induced sleep endoscopy,simulated snoring is relatively reliable in determination of soft palate vibration,slightly inferior for epiglottis/tongue base,but is unreliable in the determination of lateral pharyngeal wall vibration.