应用X线头影测量结合Müller试验评估OSAHS患者上气道结构

上海口腔医学 ›› 2013, Vol. 22 ›› Issue (6): 684-689.

应用X线头影测量结合Müller试验评估OSAHS患者上气道结构

赵彦惠，朱敏，卢晓峰，孙红霞，聂萍，徐晓珑, 陶丽

(上海交通大学医学院附属第九人民医院?口腔医学院口腔颅颌面科, 上海市口腔医学重点实验室，上海 200011)

收稿日期:2013-06-03 修回日期:2013-07-05 出版日期:2013-04-12 发布日期:2013-04-12
通讯作者: 朱敏，Tel：021-23271699-5735，E-mail：zminnie@126.com
作者简介:赵彦惠 (1987-)，男，硕士研究生，E-mail：yanhui_zhao@live.com
基金资助:
上海市科学技术委员会科研基金(11140902001)

Evaluation of upper airway and surrounding structures in patients with obstructive sleep apnea using cephalometry combined with Müller’s maneuver

ZHAO Yan-hui, ZHU Min, LU Xiao-feng, SUN Hong-xia, NIE Ping, XU Xiao-long, TAO Li

Department of Oral and Craniomaxillofacial Science, Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology. Shanghai 200011, China

Received:2013-06-03 Revised:2013-07-05 Online:2013-04-12 Published:2013-04-12
Supported by:
Supported by Research Fund of Science and Technology Commission of Shanghai Municipality (11140902001).

摘要/Abstract

摘要： 目的：评估不同程度OSAHS患者在气道负压作用下上气道及周围组织解剖结构的变化差异。方法：收集2011年6月—2012年2月诊治的男性OSAHS患者39例，记录基本生理信息，多导睡眠监测结果，平静呼气末及Müller相侧位片。根据睡眠呼吸暂停低通气指数将纳入对象分为3组，轻度组5≤AHI<15， 11例；中度组15≤AHI<30，14例；重度组AHI≥30，14例。应用Cassos 2001计算机辅助测量软件对Müller试验实施前、后患者颅颌面软、硬组织、上气道及周围组织结构进行数据测量，采用SAS 9.13软件包对数据进行统计学分析。结果：Müller试验对OSAHS患者上气道及周围结构可产生显著影响。3组OSAHS患者在实施Müller试验后，软腭厚度增加，腭后区气道矢状径均有所减小，舌骨相对于下颌骨体的垂直距离增加(P<0.05)。此外，Müller试验对上气道长度亦产生显著影响，表现为轻、中度上气道长度有增加趋势，而重度患者上气道长度增加显著。结论：Müller试验与X线头影测量相结合，能在一定程度上阐明负压对上气道及周围结构的影响，反映不同程度患者咽腔在负压作用下的差异。

关键词: X线头影测量, 阻塞性睡眠呼吸暂停低通气综合征, Müller试验, 上气道结构

Abstract: PURPOSE: To evaluate the upper airway and surrounding structures under intraluminal pressure using cephalometry combined with Müller’s maneuver in obstructive sleep apnea and hypopnea syndrome (OSAHS) patients with different severity. METHODS: Thirty-nine male patients were enrolled in our department during June 2011 to February 2012. Polysomnography (PSG) and anthropometric measurements data were recorded prior to the study. The lateral cephalograms of each patient were obtained during both the end-expiration phase and Müller’s maneuver phase. The patients enrolled were classified into 3 groups according to the results of apnea-hypopnea index (AHI), including mild group (n=11), moderate group (n=14), and severe group (n=14). Craniofacial and upper airway structures were measured in lateral cephalometry by application of Cassos 2001 computed aided measurement software before and after the patients practicing Müller’s maneuver. The data was analysed using SAS 9.13 software package. RESULTS: [Müller’s] maneuver had a great influence on the upper airway and surrounding tissue, including increased thickness of the uvula, reduction in the anteroposterior dimension of retropalatal and increased vertical distance of the hyoid bone to the mandible in all groups (P<0.05). In addition, Müller’s maneuver also had an impact on the length of the upper airway, which was more significant in severe cases. CONCLUSIONS: Cephalometry combined with [Müller’s] maneuver can display how the intraluminal pressure function on the upper airway and surrounding tissues, and they also can distinguish some minor differences of the upper airway in patients with different security.

Key words: Cephalometry, OSAHS, Müller’s maneuver, Upper airway structures

中图分类号:

R782

赵彦惠, 朱敏, 卢晓峰, 孙红霞, 聂萍, 徐晓珑, 陶丽. 应用X线头影测量结合Müller试验评估OSAHS患者上气道结构[J]. 上海口腔医学, 2013, 22(6): 684-689.

ZHAO Yan-hui, ZHU Min, LU Xiao-feng, SUN Hong-xia, NIE Ping, XU Xiao-long, TAO Li. Evaluation of upper airway and surrounding structures in patients with obstructive sleep apnea using cephalometry combined with Müller’s maneuver[J]. Shanghai Journal of Stomatology, 2013, 22(6): 684-689.

参考文献

[1] Baguet JP, Barone-Rochette G, Tamisier R, et al. Mechanisms of cardiac dysfunction in obstructive sleep apnea [J]. Nat Rev Cardiol, 2012, 9(12): 679-688.
[2] 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 Surg Oral Med Oral Pathol Oral Radiol Endod, 2011, 111(2): 239-243.
[3] de Mello Junior CF, Guimar?es Filho HA, Gomes CA, et al. Radiological findings in patients with obstructive sleep apnea [J]. J Bras Pneumol, 2013, 39(1): 98-101.
[4] Ahmed MM, Schwab RJ. Upper airway imaging in obstructive sleep apnea [J]. Curr Opin Pulm Med, 2006, 12(6): 397-401.
[5] Stuck BA, Maurer JT. Airway evaluation in obstructive sleep apnea [J]. Sleep Med Rev, 2008, 12(6): 411-436.
[6] 辛红哲, 贾培增. X线头影测量在分析OSAHS患者颅面结构特征中的应用进展 [J].北京口腔医学, 2005, 13(3): 202-204.
[7] Dempsey JA, Veasey SC, Morgan BJ, et al. Pathophysiology of sleep apnea [J]. Physiol Rev, 2010, 90(1): 47-112.
[8] 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 [J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(2): 95-96.
[9] Liao YF, Chuang ML, Huang CS, et al. Upper airway and its surrounding structures in obese and nonobese patients with sleep-disordered breathing [J]. Laryngoscope, 2004, 114(6): 1052-1059.
[10] Kurt G, Sismanb C, Akinc E, et al. Cephalometric comparison of pharyngeal airway in snoring and non-snoring patients [J]. Eur J Dent, 2011, 5(1): 84-88.
[11] Borowiecki B, Pollak CP, Weitzman ED, et al. Fibro-optic study of pharyngeal airway during sleep in patients with hypersomnia obstructive sleep-apnia syndrome[J]. Laryngoscope,1978,88(8pt1):1310-1313.
[12] Ritter CT, Trudo FJ, Goldberg AN, et al. Quantitative evaluation of the upper airway during nasopharyngoscopy with the Muller maneuver [J]. Laryngoscope, 1999, 109(6): 954-963.
[13] Trudo FJ, Gefter WB, Welch KC, et al. State related changes in upper airway caliber and surrounding soft-tissue structures in normal subjects [J]. Am J Respir Crit Care Med, 1998, 158(4): 1259-1270.
[14] Terris DJ, Hanasono MM, Liu YC. Reliability of the Muller maneuver and its association with sleep-disordered breathing [J]. Laryngoscope, 2000, 110(11): 1819-1823.
[15] Ko MT, Su CY. Computer-assisted quantitative evaluation of obstructive sleep apnea using digitalized endoscopic imaging with Müller maneuver [J]. Laryngoscope, 2008, 118(5): 909-914.
[16] Segal Y, Malhotra A, Pillar G. Upper airway length may be associated with the severity of obstructive sleep apnea syndrome[J]. Sleep Breath, 2008, 12(4): 311-316.
[17] Susarla SM, Abramson ZR, Dodson TB, et al. Cephalometric measurement of upper airway length correlates with the presence and severity of obstructive sleep apnea [J]. J Oral Maxillofac Surg, 2010, 68(11): 2846-2855.