阻塞性睡眠呼吸暂停低通气综合征患者软腭形态的动态磁共振研究
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摘要
目的观察阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者自然睡眠状态下软腭形态的变化,探讨其与疾病严重程度的相关性。方法 21例经术前多导睡眠监测(PSG)确诊为OSAHS的男性成年患者,分别在清醒和自然睡眠状态下行动态磁共振(cine magnetic resonance,CMR)扫描,在正中矢状位测量软腭长度、软腭厚度及硬腭与软腭夹角,比较两种状态下软腭形态的差异,并分析两种状态下上述软腭测量指标与PSG监测结果的相关性。结果与清醒状态(软腭长度、硬腭与软腭夹角、软腭厚度分别为40.94±5.57、126.34°±5.95°、10.02±1.79)相比,自然睡眠状态下软腭长度(42.02±5.07)、硬腭与软腭夹角(130.5°±5.75°)均变大(t=0.048,t=0.001;P<0.05),自然睡眠状态下软腭长度、软腭厚度、硬腭与软腭夹角与睡眠呼吸暂停低通气指数(AHI)(r=0.678,r=0.621,r=0.620;P<0.01)及血氧饱和度低于90%的时间占总监测时间的百分比(TS90)显著正相关(r=0.747,r=0.649,r=0.664;P<0.01),与最低血氧饱和度(LSaO_2)负相关(r=-0.507,r=-0.478,r=-0.503;P<0.05)。清醒状态下,软腭形态相关指标与PSG监测指标均有相关性(P<0.05)。结论自然睡眠状态下的CMR可以反映OSAHS发生时的软腭形态改变,能在一定程度上评估OSAHS的严重程度,对OSAHS的阻塞平面的判定和治疗方案的选择有重要指导意义。
Objective To investigate the morphological changes of the soft palates in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)during the sleep and assess the correlation with the severity of the disease.Methods A total of 21 male patients with preoperative polysomnography(PSG)diagnosed as 0 SAHS were followed by Cine-MRI during wakefulness and natural sleep.Parameters of soft palate morphology were measured and compared in these two states.The data analysis was carried out to find out significant correlations with the severity of the disease.Results During the natural sleep,the length of soft palate and the included angle of hard and soft palate were increased more than those during the waking state(t=0.048;t=0.001,P<0.05).The parameters of the soft palate morphology were significantly correlated with the apnea hypopnea index(AHI)(r=0.678;r=0.621;r=0.620,P<0.01)and TS90(r=0.747;r=0.649;r=0.664.P<0.01),and correlated with the lowest oxygen saturation(LSaO_2)(r=-0.507;r=-0.478;r=-0.503.P<0.05).During the wakefulness,the parameters of soft palate morphology were correlated with AHI,TS90 and LSaO_2(P<0.05).Conclusion The Cine MRI scanning during the natural sleep can reflect the morphological changes of the soft palates and be used in evaluating the severity of OSAHS in some ways,locating the obstruction sites and choosing the best treatment planning.
Objective To investigate the morphological changes of the soft palates in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)during the sleep and assess the correlation with the severity of the disease.Methods A total of 21 male patients with preoperative polysomnography(PSG)diagnosed as 0 SAHS were followed by Cine-MRI during wakefulness and natural sleep.Parameters of soft palate morphology were measured and compared in these two states.The data analysis was carried out to find out significant correlations with the severity of the disease.Results During the natural sleep,the length of soft palate and the included angle of hard and soft palate were increased more than those during the waking state(t=0.048;t=0.001,P<0.05).The parameters of the soft palate morphology were significantly correlated with the apnea hypopnea index(AHI)(r=0.678;r=0.621;r=0.620,P<0.01)and TS90(r=0.747;r=0.649;r=0.664.P<0.01),and correlated with the lowest oxygen saturation(LSaO_2)(r=-0.507;r=-0.478;r=-0.503.P<0.05).During the wakefulness,the parameters of soft palate morphology were correlated with AHI,TS90 and LSaO_2(P<0.05).Conclusion The Cine MRI scanning during the natural sleep can reflect the morphological changes of the soft palates and be used in evaluating the severity of OSAHS in some ways,locating the obstruction sites and choosing the best treatment planning.
引文
1 Jovani M,Anderloni A,Repici A.An unexpected cause of intestinalobstruction inan uncommon site[J].Gastroenterology,2015,148:304.
2 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会咽喉组.阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南[J].中华耳鼻咽喉头颈外科杂志2009,44:95.
3 刘继丽,林森,张春鸿,等.软腭影像学测量与阻塞性睡眠呼吸暂停低通气综合征的关系[J].实用医学杂志,2011,27:3714.
4 中华医学会耳鼻咽喉科学分会,中华耳鼻咽喉科杂志编委会.阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)[J].中华耳鼻咽喉科杂志,2002,37:403.
5 郭泾,高雪梅,曾祥龙.无阻塞性睡眠呼吸暂停低通气综合征的31名老年男性上气道及周围组织形态观察[J].中华口腔医学杂志,2007,42:206.
6 刘川川,黄志纯,杨明,等.阻塞性睡眠呼吸暂停低通气综合征患者上气道MRI测量值与其病情严重程度的相关性研究[J].中国耳鼻咽喉头颈外科,2016,23:201.
7 Shigeta Y,Ogawa T,Ando E,et al.Influence of tongue/mandible volume ratio on oropharyngeal airway in Japanese male patients with obstructive sleep apnea[J].Oral Surgery,Oral Medicine,Oral Pathology,Oral Radiology,and Endodontics,2011,111:239.
8 林忠辉,张红蕾,王廷础.阻塞性睡眠呼吸暂停综合征患者上气道MRI观察[J].中华耳鼻咽喉科杂志,2000,35:51.
9 Friedman M,Ibrahim H,Joseph NJ.Staging of obstructive sleep apnea/hypopnea syndrome:aguide to appropriate treatment[J].Laryngoscope,2004,114:454.
10 李铮,鲜军舫,叶京英,等.阻塞性睡眠呼吸暂停低通气综合征患者自然睡眠时上气道及相关结构电影磁共振测量研究[J].中国耳鼻咽喉头颈外科,2016,23:196.
11 钱备,汤光宇,刘勇,等.阻塞性睡眠呼吸暂停低通气综合征患者软腭的动态磁共振研究[J].临床耳鼻咽喉头颈外科杂志,2010,24:1108.
12 McGinley BM,Schwartz AR,Schneider H,et al.Upper airway neuromuscular compensation during sleep is defective in obstructive sleep apnea[J].Journal of Applied Physiology,2008,105:197.
13 Silverstein K,Costello BJ,Giannakpoulos H,et al.Genioglossus muscle attachments:an anatomic analysis and the implications for genioglossus advancement[J].Oral Surgery,Oral Medicine,Oral Pathology,Oral Radiology and Endodontics,2000,90:686.
14 史春海,商晓敏,刘富超,等.阻塞性睡眠呼吸暂停低通气综合征患者腭舌比值与症状程度的相关性分析[J].山东大学耳鼻喉眼学报,2016,30:24.
2 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会咽喉组.阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南[J].中华耳鼻咽喉头颈外科杂志2009,44:95.
3 刘继丽,林森,张春鸿,等.软腭影像学测量与阻塞性睡眠呼吸暂停低通气综合征的关系[J].实用医学杂志,2011,27:3714.
4 中华医学会耳鼻咽喉科学分会,中华耳鼻咽喉科杂志编委会.阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)[J].中华耳鼻咽喉科杂志,2002,37:403.
5 郭泾,高雪梅,曾祥龙.无阻塞性睡眠呼吸暂停低通气综合征的31名老年男性上气道及周围组织形态观察[J].中华口腔医学杂志,2007,42:206.
6 刘川川,黄志纯,杨明,等.阻塞性睡眠呼吸暂停低通气综合征患者上气道MRI测量值与其病情严重程度的相关性研究[J].中国耳鼻咽喉头颈外科,2016,23:201.
7 Shigeta Y,Ogawa T,Ando E,et al.Influence of tongue/mandible volume ratio on oropharyngeal airway in Japanese male patients with obstructive sleep apnea[J].Oral Surgery,Oral Medicine,Oral Pathology,Oral Radiology,and Endodontics,2011,111:239.
8 林忠辉,张红蕾,王廷础.阻塞性睡眠呼吸暂停综合征患者上气道MRI观察[J].中华耳鼻咽喉科杂志,2000,35:51.
9 Friedman M,Ibrahim H,Joseph NJ.Staging of obstructive sleep apnea/hypopnea syndrome:aguide to appropriate treatment[J].Laryngoscope,2004,114:454.
10 李铮,鲜军舫,叶京英,等.阻塞性睡眠呼吸暂停低通气综合征患者自然睡眠时上气道及相关结构电影磁共振测量研究[J].中国耳鼻咽喉头颈外科,2016,23:196.
11 钱备,汤光宇,刘勇,等.阻塞性睡眠呼吸暂停低通气综合征患者软腭的动态磁共振研究[J].临床耳鼻咽喉头颈外科杂志,2010,24:1108.
12 McGinley BM,Schwartz AR,Schneider H,et al.Upper airway neuromuscular compensation during sleep is defective in obstructive sleep apnea[J].Journal of Applied Physiology,2008,105:197.
13 Silverstein K,Costello BJ,Giannakpoulos H,et al.Genioglossus muscle attachments:an anatomic analysis and the implications for genioglossus advancement[J].Oral Surgery,Oral Medicine,Oral Pathology,Oral Radiology and Endodontics,2000,90:686.
14 史春海,商晓敏,刘富超,等.阻塞性睡眠呼吸暂停低通气综合征患者腭舌比值与症状程度的相关性分析[J].山东大学耳鼻喉眼学报,2016,30:24.