伴会厌塌陷鼾症的临床特点与手术治疗
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摘要
目的:探讨伴会厌塌陷鼾症的临床特点及其手术治疗方法。方法:回顾以打鼾、嗜睡为主诉,曾行诱导睡眠内镜(DISE)的18例患者,有8例伴会厌塌陷鼾症,其余10例无会厌塌陷。总结会厌塌陷病例的临床特点,从年龄、BMI、会厌形态(会厌上缘弯曲度)、AHI、最低血氧饱和度几方面对比伴有塌陷的病例与无会厌塌陷的病例,并评估合并会厌塌陷鼾症的手术疗效。结果:伴有会厌塌陷鼾症患者睡眠憋气症状常突出,与无会厌塌陷者相比较,会厌上缘弯曲度与BMI差异有统计学意义(P=0.03、0.04)。其确诊有赖于DISE。手术治疗目前主要以会厌成形术为主。结论:伴会厌塌陷的鼾症并不少见,可根据临床表现、会厌形态作初步筛查,DISE为确诊方法,会厌成形术对其有一定的疗效。
Objective:The aim of this study is to summary the characteristics of sleep breath disorder patients with epiglottis collapse and find out the way to treat them with surgery.Method:This is a retrospective study.There were eighteen patients who complained of snoring and somnolence,as well as had undergone DISE.Eight of them were diagnosed as epiglottis collapse.We analysis the clinical features,surgical treatments and prognosis of these eight patents,and compare their BMI,shape of epiglottis and AHI with the patients without epiglottis collapse.Result:Patients with epiglottis collapse usually complained of breathless during sleeping.The shape of their epiglottis was mainly flat and wide,as the cure of the upper margin of their epiglottises shows significant difference with those who are without epiglottis collapse(P=0.03,0.04).DISE is the diagnosis examination.The primary surgical treatment is Epiglottoplasty.Conclusion:It's not uncommon to see epiglottis collapse clinically.Whenever we meet the particular clinical manifestation,the diagnose of epiglottis collapse should be taken into consideration.DISE is the diagnosis examination.Epiglottoplasty can treat them to some degree.
Objective:The aim of this study is to summary the characteristics of sleep breath disorder patients with epiglottis collapse and find out the way to treat them with surgery.Method:This is a retrospective study.There were eighteen patients who complained of snoring and somnolence,as well as had undergone DISE.Eight of them were diagnosed as epiglottis collapse.We analysis the clinical features,surgical treatments and prognosis of these eight patents,and compare their BMI,shape of epiglottis and AHI with the patients without epiglottis collapse.Result:Patients with epiglottis collapse usually complained of breathless during sleeping.The shape of their epiglottis was mainly flat and wide,as the cure of the upper margin of their epiglottises shows significant difference with those who are without epiglottis collapse(P=0.03,0.04).DISE is the diagnosis examination.The primary surgical treatment is Epiglottoplasty.Conclusion:It's not uncommon to see epiglottis collapse clinically.Whenever we meet the particular clinical manifestation,the diagnose of epiglottis collapse should be taken into consideration.DISE is the diagnosis examination.Epiglottoplasty can treat them to some degree.
引文
[1]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学组.阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南解读[J].中华耳鼻咽喉头颈外科杂志,2009,44(2):95-96.
[2]CABALLERO P,ALVAREZSALA R,GARCARO F,et al.CT in the evaluation of the upper airway in healthy subjects and in patients with obstructive sleep apnea syndrome[J].Chest,1998,113:111-116.
[3]JR S J,THAWLEY S E.Localization of upper airway collapse during sleep in patients with obstructive sleep apnea[J].Am Rev Respiratory Dis,1990,141:1350-1355.
[4]MICHAEL F,HANI I,JOSEPH NINOS J.Staging of obstructive sleep apnea/hypopnea syndrome:a guide to appropriate treatment[J].Laryngoscope,2004,114:454-459.
[5]CARLOS T,MACARIO C,LIU Y C,et al.Epiglottis collapse in adult obstructive sleep apnea:a systematic review[J].Laryngoscope,2016,126:515-23.
[6]GENTA P R,SANDS S A,BUTLER J P,et al.Airflow shape Is associated with the pharyngeal structure causing OSA[J].Chest,2017,16:299-304.
[7]MELANIA M,GENTA P R,SANDS S A,et al.Effect of Sleeping position on upper airway patency in obstructive sleep apnea is determined by the pharyngeal structure causing collapse[J].Sleep,2017,40:1-8.
[8]FAIZA S,IOANNIS K,DE VRIES N.Upper airway collapse during drug induced sleep endoscopy:head rotation in supine position compared with lateral head and trunk position[J].Eur Arch Otorhinolaryngol,2015,272:485-488.
[9]DEDHIA R C,ROSEN C A,SOOSE R J.What is the role of the larynx in adult obstructive sleep apnea[J]?Laryngoscope,2014,124:1029-1034.
[10]TORRE C,LIU S Y,KUSHIDA C A,et al.Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug-induced sleep endoscopy[J].Clin Otolaryngol,2017.42:1218-1223
[11]ASIT A,KONSTANTINOS C,GEORGE G,et al.Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment[J].Sleep Breath,2016,20:739-747.
[12]D'AGOSTINO MARK A.Transoral robotic partial glossectomy and supraglottoplasty for obstructive sleep apnea[J].Otolaryngol Clin North Am,2016,49:1415-1423.
[13]SOARES D,HADEER SINAWE B S,FOLBE A J,et al.Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery[J].Laryngoscope,2012,122:473-479.
[14]VICTORES A J,OLSON K,TAKASHIMA M.Interventional drug-induced sleep endoscopy:a novel technique to guide surgical planning for obstructive sleep apnea[J].J Clin Sleep Med,2016,13:169-174.
[2]CABALLERO P,ALVAREZSALA R,GARCARO F,et al.CT in the evaluation of the upper airway in healthy subjects and in patients with obstructive sleep apnea syndrome[J].Chest,1998,113:111-116.
[3]JR S J,THAWLEY S E.Localization of upper airway collapse during sleep in patients with obstructive sleep apnea[J].Am Rev Respiratory Dis,1990,141:1350-1355.
[4]MICHAEL F,HANI I,JOSEPH NINOS J.Staging of obstructive sleep apnea/hypopnea syndrome:a guide to appropriate treatment[J].Laryngoscope,2004,114:454-459.
[5]CARLOS T,MACARIO C,LIU Y C,et al.Epiglottis collapse in adult obstructive sleep apnea:a systematic review[J].Laryngoscope,2016,126:515-23.
[6]GENTA P R,SANDS S A,BUTLER J P,et al.Airflow shape Is associated with the pharyngeal structure causing OSA[J].Chest,2017,16:299-304.
[7]MELANIA M,GENTA P R,SANDS S A,et al.Effect of Sleeping position on upper airway patency in obstructive sleep apnea is determined by the pharyngeal structure causing collapse[J].Sleep,2017,40:1-8.
[8]FAIZA S,IOANNIS K,DE VRIES N.Upper airway collapse during drug induced sleep endoscopy:head rotation in supine position compared with lateral head and trunk position[J].Eur Arch Otorhinolaryngol,2015,272:485-488.
[9]DEDHIA R C,ROSEN C A,SOOSE R J.What is the role of the larynx in adult obstructive sleep apnea[J]?Laryngoscope,2014,124:1029-1034.
[10]TORRE C,LIU S Y,KUSHIDA C A,et al.Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug-induced sleep endoscopy[J].Clin Otolaryngol,2017.42:1218-1223
[11]ASIT A,KONSTANTINOS C,GEORGE G,et al.Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment[J].Sleep Breath,2016,20:739-747.
[12]D'AGOSTINO MARK A.Transoral robotic partial glossectomy and supraglottoplasty for obstructive sleep apnea[J].Otolaryngol Clin North Am,2016,49:1415-1423.
[13]SOARES D,HADEER SINAWE B S,FOLBE A J,et al.Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery[J].Laryngoscope,2012,122:473-479.
[14]VICTORES A J,OLSON K,TAKASHIMA M.Interventional drug-induced sleep endoscopy:a novel technique to guide surgical planning for obstructive sleep apnea[J].J Clin Sleep Med,2016,13:169-174.