阻塞性睡眠呼吸暂停低通气综合征患者咽腔大小和可塌陷性的研究

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)单纯鼾症患者及正常人之间咽腔截面积的大小和可塌陷性的情况。方法对171例OSAHS患者(轻度44例、中度51例、重度76例),47例单纯鼾症患者和47例正常人的上气道进行声反射测定,记录肺容积在功能残气位(FRC)和残气位(RV)时的曲线。结果FRC时咽腔截面积单纯鼾症组(2.63 cm2±0.42 cm2),轻、中、重度OSAHS组(2.70 cm2±0.44 cm2,2.62 cm2±0.52 cm2和2.57 cm2±0.46 cm2)均小于正常对照组(3.05 cm2±0.6 cm2)(均P<0.05)。当肺容积从FRC降至RV时,单纯鼾症组,轻、中、重度OSAHS组和正常对照组(从2.63 cm2±0.42 cm2降至1.96 cm2±0.35 cm2,2.70 cm2±0.44 cm2降至1.78 cm2±0.39 cm2,2.62 cm2±0.52 cm2降至1.79 cm2±0.37 cm2,2.57 cm2±0.46 cm2降至1.75 cm2±0.40 cm2和3.05 cm2±0.6 cm2降至2.38 cm2±0.47 cm2)咽腔截面积均降低,且轻、中、重度OSAHS组(33.93%±11.81%,31.13%±10.76%和31.31%±13.44%)和单纯鼾症组(25.07%±10.39%)咽腔截面积降低程度均明显大于正常对照组(21.11%±8.19%)(均P<0.05),而OSAHS组降低的程度更大。结论鼾症患者无论其是否伴有OSAHS其咽腔截面积在FRC时是相似的,都比正常人小,当肺容积从FRC降至RV时轻、中、重OSAHS患者和单纯鼾症患者咽腔可塌陷性均明显大于正常人,而OSAHS患者咽腔可塌陷性更大。

Pharyngeal size and collapsibility in patients with obstructive sleep apnea hypopnea syndrome

OBJECTIVE: To study the pharyngeal cross-sectional area and collapsibility among the patients with obstructive sleep apnea hypopnea syndrome (OSAHS), simple snorers, and normal persons. METHODS: 171 patients with OSAHS, 44 with mild, 51 with moderate, and 56 with severe OSAHS, 47 simple snorers, and 47 healthy subjects underwent upper airway cross-sectional area measurement using acoustic pharyngometer at the conditions of functional residual capacity (FRC) and residual volume (RV) in the upright sitting position. RESULTS: When the lung volume decreased from the condition of FRC to the condition of RV the pharyngeal cross-sectional area decreased from 2.63 cm(2) +/- 0.42 cm(2) to 1.96 cm(2) +/- 0.35 cm(2) for the simple snorers, 2.70 cm(2) +/- 0.44 cm(2) to 1.78 cm(2) +/- 0.39 cm(2) for the mild OSAHS patients, from 2.62 cm(2) +/- 0.52 cm(2) to 1.79 cm(2) +/- 0.37 cm(2) for the moderate OSAHS patients, and from 2.57 cm(2) +/- 0.46 cm(2) to 1.75 cm(2) +/- 0.40 cm(2) for the severe OSAHS patients, all with higher decrease rates (33.93% +/- 11.81%, 31.13% +/- 10.76%, and 31.31% +/- 13.44%) than that of the normal persons (25.07% +/- 10.39%), smaller than that for the normal persons (21.11% +/- 8.19%, from 3.05 cm(2) +/- 0.6 cm(2) to 2.38 cm(2) +/- 0. 47 cm(2), all P < 0.05). The change ratios of the 3 OSAHS groups were significantly higher than that of the simple snorer group (all P < 0.01). This indicated that the pharynges of OSAHS patients were more collapsible. CONCLUSION: Snorers with or without apnea have smaller pharyngeal cross-sectional area than nonsnorers. The collapsibility of the upper airway is greater in both OSHAS patients and simple snorers than in healthy subjects.