摘要
目的分析比较不同患病程度的阻塞性睡眠呼吸暂停(OSA)患者清醒、入睡初期以及睡眠状态下颏舌肌(genioglossus,GG)随腔内负压变化的活性差异及变化规律。方法该前瞻性研究纳入2019年8月至2021年1月就诊于北京清华长庚医院的OSA男性患者共42例,年龄21~59(38.77±8.42)岁。每例研究对象完成整夜多导睡眠监测(PSG)及上气道CT后,均进行药物诱导睡眠下的口内表面颏舌肌肌电(GGEMG)同步会厌水平咽内压力(P_(epi))监测。根据整夜PSG数据将患者分为轻度组(7例)、中度组(12例)、重度组(23例),对比组间患者上气道CT测量值以及在清醒及诱导睡眠状态下GGEMG各参数值和对应状态下P_(epi)的变化差异。采用SPSS 21.0进行统计学分析。结果轻度组和中度组的GGEMG各参数值的差异无统计学意义。清醒期仅有重度组的清醒峰值肌电较轻度组偏高(t=1.249,P=0.025),组间同步监测的对应P_(epi)水平差异无统计学意义。入睡初期重度组的肌电参数值均分别较轻、中度组偏高,且同步监测的对应P_(epi)水平也较高。将所有中重度OSA患者(35例)的阻塞性呼吸暂停(OA)末期的最大GGEMG肌电值和最大P_(epi)进行线性回归分析发现,二者不符合线性相关关系(r=0.28,P=0.694)。而舌咽腔的长度与OA最大P_(epi)存在线性相关(r=0.468,R^(2)=0.219,P=0.005)。结论OSA患者睡眠期间GG活性与患病严重程度(呼吸事件频次)相关。尤其在中度以上OSA患者,GG活性与对应腔内负压刺激存在不协调的表现,这可能是导致OSA加重的机制之一。
Objective To analyze genioglossus(GG)activation responses to the negative pressure of upper airway cavity during awake and different sleep stages in patients with different obstructive sleep apnea(OSA)graduation.Methods This prospective cohort study started from August 2019 to January 2021,recruited 42 male OSA patients aged from 21 to 59(38.77±8.42)years.After completing whole night polysomnography(PSG)and upper airway CT,each subject underwent drug-induced sleep with simultaneous monitoring of genioglossal electromyography(GGEMG)and pressure of epiglottis(P_(epi)).Subjects were divided into three groups of mild OSA(7 males),moderate OSA(12 males),and severe OSA(23 males).The differences in upper airway CT measurements,parameters of GGEMG and P_(epi)during awake and induced sleep were compared.Statistical analysis was conducted by SPSS 21.0.Results There was no significant difference in the GGEMG parameters between the mild and moderate groups.In wakefulness,the peak phasic GGEMG of the severe group was higher than the mild group(t=1.249,P=0.025),with no statistically difference in the corresponding P_(epi).In the sleep onset,the GGEMG parameters and P_(epi)in severe group were higher than the other two groups.Linear regression analysis of the maximum GGEMG and maximum P_(epi)at the end of obstructive apnea(OA)in all moderate plus severe patients(n=35)was shown nonlinear correlation(r=0.28,P=0.694).The airway length of the glossopharyngeal cavity was linearly correlated with the maximum P_(epi)of OA(r=0.468,R^(2)=0.219,P=0.005).Conclusions The individual difference of GG activation in OSA patients is related to the severity of the disease(frequency of respiratory events)and negative pressure stimulation.In moderate and severe OSA patients,GG activity is not in harmony with the corresponding negative pressure stimulation,which may be one of the mechanisms leading to the aggravation of OSA.
作者
周颖倩
顼晋昆
尹国平
曹鑫
李京京
张玉焕
叶京英
Zhou Yingqian;Xu Jinkun;Yin Guoping;Cao Xin;Li Jingjing;Zhang Yuhuan;Ye Jingying(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CSCD
北大核心
2023年第10期951-958,共8页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
国家自然科学基金(82200104)。
关键词
阻塞性睡眠呼吸暂停
药物诱导睡眠
颏舌肌肌电
负压反射
Obstructive sleep apnea
Drug-induced sleep
Genioglossus neuromuscular activity
Negative pressure reflex
