摘要
目的:基于动态MRI探讨上气道解剖结构与阻塞性睡眠呼吸暂停(OSA)严重程度之间的关系。方法:将2019年9月-2021年1月在本院经多导睡眠监测(PSG)确诊的45例OSA患者纳入本研究,依据呼吸暂停指数(AHI)将患者分为轻-中度组和重度组。所有患者行动态MRI检查,在正中矢状面及横轴面图像上分别测量软腭后区(RP)、舌后区(RG)和会厌后区(EPG)气道的相关解剖学参数。比较3个分区之间各项解剖学参数的差异,并分析OSA严重程度与各项参数之间的相关性。结果:三个分区的解剖学参数比较,软腭后区气道的最小横截面积和最大横截面积最小,塌陷率最大(P均<0.05)。与轻-中度组相比,重度组中软腭的长度、厚度和矢状面积及3个分区内气道的塌陷率均较大,三个分区内气道的最小横截面积及其在相应平面上的左右径、前后径均较小(P均<0.05)。相关性分析显示软腭的长度和矢状面积、软腭后区侧咽壁和后咽壁的厚度、舌后区侧咽壁的厚度均与呼吸暂停低通气指数(AHI)和血氧饱和度低于90%的时间占睡眠时间的百分比(Ts90%)呈正相关(0.341≤r≤0.574,P均<0.05);软腭后区和舌后区气道的最小横截面积及其在相应层面上的左右径、会厌后区的前后径均与AHI和Ts90%呈负相关(-0.315≤r≤-0.580,P均<0.05);各区的气道塌陷率均与AHI呈正相关(0.445≤r≤0.521,P均<0.05),舌后区和会厌后区的气道塌陷率均与Ts90%呈正相关(0.340≤r≤0.348,P均<0.05)。多元逐步回归分析显示软腭后区的侧咽壁厚度是Ts90%的独立影响因素,颈围和软腭后区气道的左右径是AHI的独立影响因素。结论:气道解剖结构与OSA严重程度具有显著相关性,气道塌陷率可以提示气道的狭窄程度。软腭后区的上气道最狭窄且最易塌陷,该区的侧咽壁厚度和气道左右径分别是Ts90%和AHI的独立预测因素。
Objective:To investigate the relationship between the severity of obstructive sleep apnea(OSA)and the anatomical structure of upper airway on dynamic magnetic resonance images.Methods:A total of 45 patients who were diagnosed by polysomnography in our hospital from September 2019 to January 2021 were enrolled and divided into the mild-to-moderate group and the severe group according to apnea and hypopnea index(AHI).Dynamic MRI examination was performed on every participant,the anatomic parameters of upper airway in retro-palatal(RP),retroglottal(RG)and epiglottis regions(EG)on the median sagittal and the transverse images were measured and recorded.The differences of the anatomical parameters among the three regions and between the two groups were compared statistically,and the correlation between OSA severity and the airway-related anatomical parameters was analyzed.Results:The minimum and maximum cross-sectional areas of airway in the RP region were the smallest among the three regions,while the collapse rate of airway was the largest,the difference was statistically significant(all P<0.05).Compared with the mild-moderate group,the thickness,length and sagittal area of the soft palate,and the airway collapse rate of each region in the severe group were bigger,and the minimum cross-sectional area and corresponding anteroposterior(AP)and left to right(LR)diameters of airway in each region were smaller(all P<0.05).Several anatomical parameters of the airway were positively or negatively correlated with AHI and Ts90%.The length and sagittal area of soft palate,the thickness of lateral pharyngeal wall and poste-rior pharyngeal wall in retro-palatal region,along with the thickness of lateral pharyngeal wall in retroglottal region were all positively correlated with AHI and Ts90%(0.341≤r≤0.574,P<0.05),while the minimum cross-sectional area and LR diameter on the corresponding images of airway in retro-palatal and retroglottal regions,and the AP diameter of airway in epiglottis region were negatively correlated wit
作者
冯晓瑜
蒋军广
刘菊敏
杨贝贝
FENG Xiao-yu;JIANG Jun-guang;LIU Ju-min(Department of Geriatric Respiratory Sleep,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《放射学实践》
CSCD
北大核心
2023年第8期971-976,共6页
Radiologic Practice
基金
国家临床重点专科建设基金(国卫办医函[2013]544号)。
关键词
动态磁共振成像
睡眠呼吸障碍
气道解剖学
塌陷率
Dynamic magnetic resonance
Sleep-disordered breathing
Airway anatomy
Collapse rate
