药物诱导睡眠内窥镜检查时的家庭睡眠研究鼻气流模式和会厌塌陷。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Sleep and Breathing Pub Date : 2025-03-28 DOI:10.1007/s11325-025-03305-3

Abhay Sharma, Jacob Noel, B Tucker Woodson

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引用次数: 0

摘要

目的：阻塞性睡眠呼吸暂停（OSA）的特点是咽部的不同部分塌陷。会厌萎诊断困难，可能影响治疗耐受性。以往的研究表明会厌梗阻时鼻腔气流模式明显，表现为信号不连续。据推测，药物性睡眠内窥镜检查（DISE）中出现的原发性会厌塌陷与家庭睡眠研究中发现的鼻气流不连续信号有关。方法：采用VOTE评分系统对2016年12月至2021年8月期间接受过DISE和家庭便携式睡眠研究的临床记录的患者进行会厌萎或无会厌萎筛查。排除有舌根塌陷的患者。将鼻气流信号表征为不连续性是基于先前发表的数据。急性血流不连续由两名盲法观察者（AS， JN）进行评分，他们来自使用鼻压插管（Apnea Link Plus）进行的家庭心肺研究。每个患者的呼吸统计数据（呼吸总数和受限呼吸流量）由家用心肺装置捕获。DISE在异丙酚麻醉下进行至拉姆齐5级。会厌萎陷由形状、方向（前向或侧向）和时间（延长或间歇）来描述。结果：回顾性分析了18例考虑手术治疗的患者的家庭睡眠研究和病情。纳入的患者有完全的（n=11）或没有会厌萎陷（n=7）。平均AHI分别为21.3和19.7。非会厌和会厌塌陷组在总间断呼吸（中位数7 vs 29， p=0.002）、间断呼吸/小时（中位数0.91 vs 5.3, p=0.001）和间断呼吸占总流量受限呼吸的比例（0.5% vs 1.9%, p=0.001）方面存在显著差异。会厌塌陷的形态学改变不影响不连续性。结论：本研究数据显示，来自家庭睡眠研究的鼻气流信号与DISE会厌塌陷相关。

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Home sleep study nasal airflow patterns and epiglottic collapse during drug induced sleep endoscopy.

Purpose: Obstructive sleep apnea (OSA) is characterized by collapse of various portions of the pharynx. Epiglottic collapse is difficult to diagnose and may affect treatment tolerance. Previous research shows a distinct nasal airflow pattern during epiglottic obstruction characterized by signal discontinuities. It was hypothesized that primary epiglottic collapse characterized during drug-induced sleep endoscopy (DISE) correlates with nasal airflow discontinuity signals seen on home sleep studies.

Methods: Patients with clinical records of undergoing both DISE and home portable sleep studies with raw data available from December 2016 to August 2021 were screened for epiglottic collapse or no epiglottic collapse using the VOTE scoring system. Any patient with tongue base collapse was excluded. Characterization of nasal airflow signals as discontinuities was based on previously published data. Acute flow discontinuities were scored by two blinded observers (AS, JN) from home cardiorespiratory studies using nasal pressure cannulas (Apnea Link Plus). Breath statistics (total number of breaths and flow limited breaths) for each patient were captured by the home cardiorespiratory device. DISE was performed under propofol anesthesia to a Ramsay level 5. Epiglottic collapse was described by shape, direction (AP or lateral), and timing (prolonged or intermittent).

Results: The home sleep studies and DISE of 18 patients being considered for surgical therapies were retrospectively analyzed. Patients included had either complete (n=11) or no epiglottic collapse (n=7). The mean AHI was 21.3 and 19.7, respectively. There was a significant difference between nonepiglottic and epiglottic collapse groups in the total discontinuity breaths (median 7 vs 29, p=0.002), discontinuity breaths/hour (median 0.91 vs 5.3, p=0.001), and fraction of discontinuity breaths over total flow limited breaths (0.5% vs 1.9%, p=0.001). Morphological changes in epiglottic collapse did not affect discontinuities.

Conclusion: The data from this study demonstrates nasal airflow signals from home sleep studies correlate with DISE epiglottic collapse.

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来源期刊

Sleep and Breathing 医学-呼吸系统

CiteScore

5.20

自引率

4.00%

发文量

222

审稿时长

3-8 weeks

期刊介绍： The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep. Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.