口呼吸对阻塞性睡眠呼吸暂停患者上气道结构的影响  

Effect of mouth breathing on upper airway structure in patients with obstructive sleep apnea

作　　者：李彦如[1] 费南希 曹莉莉 施云瀚 鲜军舫[2] LI Yanru;FEI Nanxi;CAO Lili;SHI Yunhan;XIAN Junfang(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery,Ministry of Education,Beijing,100730,China;Department of Radiology, Beijing Tongren Hospital, Capital Medical University)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科、耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [2]首都医科大学附属北京同仁医院放射科

出　　处：《临床耳鼻咽喉头颈外科杂志》2023年第7期529-534,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金(No:81970866)。

摘　　要：目的:研究在经口或经鼻呼吸时,阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者和正常人的咽壁组织形态结构的变化,探索相关影响因素。方法:29例成人OSAHS患者及20例无鼾对照,分别于受试者清醒时及佩戴鼻夹经口呼吸时行MRI获取上气道结构测量指标。分析:(1)无鼾对照/OSAHS患者口呼吸与鼻呼吸上气道结构的变化;(2)OSAHS患者与对照口呼吸时上气道结构变化的差异及影响因素。结果:对照组男15例,女5例,呼吸暂停低通气指数(AHI)均<5次/h。OSAHS患者男26例,女3例,平均AHI(40.4±23.1)次/h,睡眠时最低血氧饱和度(LSaO_(2))平均79.5%±10.0%。对照组及OSAHS口呼吸时均观察到下颌骨与咽后壁的垂直距离变小(P<0.05);舌体长轴减小(P<0.05),舌体与软、硬腭接触区域减小。对照组软腭后及舌后气道总容积无显著改变(P>0.05)。而OSAHS患者软腭后气道最小截面积、气道体积明显减小(P<0.001)。OSAHS患者口呼吸时悬雍垂平面左右径减小,与对照组趋势相反(P=0.017)。患者的AHI与口呼吸时软腭后气道容积的减小量正相关(P=0.001);而下颌骨与咽后壁间距的减小量与气道长度呈正相关(P<0.001)。结论:口呼吸导致舌体长轴缩短、软腭与舌体接触面积减小,下颌骨与咽后壁的垂直距离减小、会厌平面截面积降低。OSAHS患者与对照的变化特点存在较大差异。口呼吸时患者软腭后气道的多个径线、面积及体积减小,且在重度患者更显著。Objective:To compare the changes of morphology of pharynx in patients with obstructive sleep apnea hypopnea syndrome(OSAHS) and healthy individuals during oral or nasal breathing,and explore the relevant influencing factors.Methods:Twenty-nine adult patients with OSAHS and 20 non-snoring controls underwent MRI to obtain upper airway structural measurements while the subjects were awake and during mouth breathing with a nasal clip.The following were analyzed.(1)The changes of upper airway structure of oral and nasal respiration in non-snoring control/OSAHS patients were observed;(2)The differences and influencing factors of upper airway structure changes between OSAHS patients and controls were compared during breathing.Results:The control group consisted of 15 males and 5 females,with an apnea-hypopnea index(AHI)5 events/h,while the OSAHS group comprised 26 males and 3 females with an AHI of 40.4±23.1 events/h and the mean lowest arterial oxygen saturation(LSaO_2) was 79.5% ±10.0%.In the both groups,the vertical distance between the mandible and the posterior pharyngeal wall decreased(P0.05);The long axis of tongue body decreased(P0.05),and the contact area between tongue and palate decreased.There was no significant change in the total volume of the retropalatine(RP) and retroglossal(RG) airway in the control group(P0.05).However,the minimum cross-sectional area and volume of the RP airway in OSAHS decreased(P0.001).The lateral diameters of uvula plane in OSAHS decreased during mouth breathing,which was contrary to the trend in the control group(P=0.017).The AHI of patients was positively correlated with the reduction of the volume of the RP airway during oral breathing(P=0.001);The reduction of the distance between the mandible and the posterior pharyngeal wall was positively correlated with the length of the airway(P0.001).Conclusion:Mouth breathing leads to the shortening of the long axis of the tongue,the reduction of the contact area between the soft palate and the tongue,vertical distance between the man

关 键 词：睡眠呼吸暂停 阻塞性 口呼吸 上气道 

分 类 号：R766[医药卫生—耳鼻咽喉科]