药物诱导睡眠内镜检查在阻塞型睡眠呼吸暂停低通气综合征患者上气道阻塞平面形态中的应用价值

Application value of drug-induced sleep endoscopy in obstructive upper airway plane morphology in patients with obstructive sleep apnea hypopnea syndrome

摘要:

目的 探讨药物诱导睡眠内镜检查在阻塞型睡眠呼吸暂停低通气综合征（OSAHS）患者上气道阻塞平面形态中的应用价值。方法 选取2018年7月－2020年10月该院106例OSAHS患者作为研究对象，均于清醒状态下行苗勒氏试验及药物诱导睡眠内镜检查，记录检查结果。对比患者不同状态下上气道阻塞平面形态和上气道腭咽、口咽侧壁、舌根和会厌（VOTE）评分，并分析VOTE评分与呼吸暂停低通气指数（AHI）、血氧饱和度的关联性。结果 106例患者气道阻塞形态分布：腭咽平面以环形阻塞为主，完全阻塞、部分阻塞分别占84.91%和7.55%；其次为前后阻塞，完全阻塞占4.72%；口咽侧壁平面均为左右阻塞，完全阻塞、部分阻塞分别占60.38%和16.98%；舌根平面均为前后阻塞，完全阻塞、部分阻塞分别占16.98%和22.64%；会厌平面均为左右阻塞，无完全阻塞，部分阻塞占比15.09%。清醒状态下上气道阻塞形态分布：腭咽平面均为环形阻塞，完全阻塞、部分阻塞分别占52.83%和39.62%；口咽侧壁平面均为左右阻塞，完全阻塞、部分阻塞分别占30.19%和24.53%；舌根平面均为前后阻塞，无完全阻塞，部分阻塞占4.72%；会厌平面均无阻塞。睡眠状态下检查阻塞平面数多于清醒状态，各平面阻塞程度评分均高于清醒状态（P < 0.05）。OSAHS患者睡眠状态下阻塞平面数、各平面阻塞程度均与AHI呈正相关，与平均及最低血氧饱和度呈负相关（P < 0.05）。结论 睡眠状态下阻塞平面数、各平面阻塞程度均与AHI、血氧饱和度密切相关，采用药物诱导睡眠内镜检查可为临床评估OSAHS患者上气道阻塞形态提供一种更有效的方法。

Abstract:

Objective To explore the application value of drug-induced sleep endoscopy in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with upper airway obstruction plane morphology.Methods From July 2018 to October 2020, 106 patients with OSAHS were selected as the research subjects. All of them underwent Mullerian test and drug-induced sleep endoscopy in a awake state, and the results of the examination were recorded. Compare the upper airway obstruction plane shape and upper airway velum, oropharyngeal lateral wall, tongue base and epiglottis (VOTE) scores in different states of patients, and analyze the correlation between VOTE scores and apnea-hypopnea index (AHI) and blood oxygen saturation.Results The morphology distribution of airway obstruction in 106 patients: the palatopharyngeal plane was dominated by ring obstruction, complete obstruction and partial obstruction accounted for 84.91% and 7.55%, respectively; Followed by complete obstruction of anterior and posterior obstruction, accounting for 4.72%. The lateral wall plane of oropharynx was left and right obstruction, complete obstruction and partial obstruction accounted for 60.38% and 16.98%, respectively; The plane of tongue base was anterior and posterior obstruction, complete obstruction and partial obstruction accounted for 16.98% and 22.64%, respectively; All epiglottis planes were left and right obstructions, no complete obstruction, partial obstruction accounted for 15.09%. Morphological distribution of upper airway obstruction under awake state: the palatopharyngeal plane was all annular obstruction, complete obstruction accounted for 52.83%, partial obstruction accounted for 39.62%; The lateral wall plane of oropharynx was left and right obstruction, complete obstruction and partial obstruction accounted for 30.19% and 24.53%, respectively; In the base plane of the tongue, there was anteroposterior obstruction, no complete obstruction, partial obstruction accounted for 4.72%, and no obstruction in the epiglottis plane. The number of blocking planes examined in sleep state was higher than that in awake state, and the blocking degree score in each plane was higher than that in awake state (P < 0.05). In OSAHS patients, the number of blocking planes and the degree of blocking planes were positively correlated with AHI, and negatively correlated with average and minimum blood oxygen saturation (P < 0.05).Conclusion The number of obstruction planes and the degree of obstruction of each plane are closely related to AHI and blood oxygen saturation in sleep state. Drug induced sleep endoscopy can provide a more effective method for clinical evaluation of upper airway obstruction in OSAHS patients.