重度阻塞性睡眠呼吸暂停患者的异常前庭诱发肌源性电位  

Subclinical disorder of otolith and its pathways in patients with severe obstructive sleep apnea

作　　者：罗慧娉 余菁 许信达 王璟 吴海涛 迟放鲁 LUO Huiping;YU Jing;XU Xinda;WANG Jing;WU Haitao;CHI Fanglu(ENT Institute and Department of Otorhinolaryngology,Eye&ENT Hospital,Fudan University,Shanghai Auditory Medical Center,NHC Key Laboratory of Hearing Medicine Research(Fudan University),Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻喉科,上海市听觉医学临床中心,卫生部听觉医学重点实验室,上海200031

出　　处：《中国眼耳鼻喉科杂志》2022年第1期53-58,62,共7页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：国家自然科学基金(81700915);上海市卫生局青年基金(20194Y0190);上海市“医苑新星”青年医学人才培养资助计划(沪卫人事[2020]87号);上海市科委创新计划(11411952300);上海市卫生计生委基金会项目(201740018);国家重点研究项目(2016YFC0905202)。

摘　　要：目的探索重度阻塞性睡眠呼吸暂停(OSA)患者的耳石器及其传导通路功能变化情况。方法2020年1~10月就诊于我院鼾症诊疗中心的重度OSA患者为病例组,30例(60耳);对照组为健康成年人21例(42耳),比较并分析2组眼肌前庭诱发肌源性电位(oVEMP)和颈肌前庭诱发肌源性电位(cVEMP)的引出率、潜伏期、波间期、振幅。结果对照组的oVEMP和cVEMP引出率分别为97.6%和100.0%,病例组为73.3%和81.7%,较对照组显著下降(P=0.001、0.003)。在oVEMP中,病例组的阈值为(115.68±6.52)dB SPL,显著高于对照组的(110.98±4.77)dB SPL(P<0.001);N1潜伏期为(11.85±0.85)ms,较对照组的(10.78±0.84)ms延长(P<0.001);病例组的N1-P1波间期缩短至(3.69±0.79)ms(P<0.001),N1-P1振幅下降至(9.30±8.17)µV,较对照组的(15.79±7.66)µV显著降低(P<0.001)。在cVEMP中,病例组的阈值为(114.18±6.64)dB SPL,较对照组的(104.52±4.53)dB SPL显著升高;P1潜伏期由(16.71±1.84)ms显著延长至(18.02±2.53)ms(P=0.005);P1-N1波间期也因此缩短为(6.88±2.03)ms(P<0.001);P1-N1振幅和N1-P2振幅分别降至(126.73±98.55)µV和(88.71±94.99)µV,较对照组的(254.99±113.74)µV和(154.89±71.13)µV显著降低(P值均<0.001)。对病例组30例患者进行分析发现,医患双方对平衡症状的关注度显著低于对打鼾症状的关注度(P<0.001)。结论在重度OSA患者中,oVEMP和cVEMP的波形出现典型异常变化,提示椭圆囊和球囊及其传导通路出现功能障碍。重度OSA患者的诊治应同时考虑耳石器功能障碍。Objective To define the profiles of ocular and cervical vestibular-evoked myogenic potentials(oVEMP and cVEMP,respectively)in patients with severe obstructive sleep apnea(OSA).Methods Thirty patients with severe OSA and 21 healthy volunteers were invest igated.The patients’medical records were collected and analyzed.The oVEMP and cVEMP were tested and analyzed.Results The oVEMP and cVEMP response rates in the patients with OSA were 73.3%and 81.7%,respectively,which were significantly less than those in the healthy volunteers.Regarding the oVEMP.The threshold of the OSA group was 115.68±6.52 dB SPL which was significantly higher than 110.98±4.77 dB SPL of the control group(P<0.001).The N1 latencies was(11.85±0.85)ms,which was also significantly prolonged(P<0.001).The N1-P1 interpeak latency was shortened as(3.69±0.79)ms(P<0.001),and the N1-P1 amplitude reduced from(15.79±7.66)μV to(9.30±8.17)μV(P<0.001).Similar changes were also observed in the cVEMP results.A significant elevation from(104.52±4.53)dB SPL to(114.18±6.64)dB SPL in the threshold(P<0.001).The P1 latency was prolonged from(16.71±1.84)ms to(18.02±2.53)ms(P=0.005).The P1-N1 interpeak latency was shorten from(8.58±1.91)ms to(6.88±2.03)ms(P<0.001).The P1-N1 amplitude and the N1-P2 amplitude were reduced from(254.99±113.74)μV and(154.89±71.13)μV,to(126.73±98.55)μV and(88.71±94.99)μV(P<0.001).However,neither the patients nor the doctors noticed balance problems or the loss of otolithic function in the summaries of the medical records of all 30 patients(P<0.001).Conclusions The utricular and saccular dysfunction in patients with severe OSA can be observed in VEMPs.Otolithic function should be paid attention in the diagnosis and treatment of severe OSA.

关 键 词：阻塞性睡眠呼吸暂停 眼肌前庭诱发肌源性电位 颈肌前庭诱发肌源性电位 椭圆囊 球囊 

分 类 号：R766[医药卫生—耳鼻咽喉科]