阻塞性睡眠呼吸暂停综合征上游气道结构改变对下游气道塌陷性的影响机制

It is reported that the mechanisms of treating OSAHS by tailing structure of pharynx was that reducing volume of soft tissue, enlarging volume of pharyngeal cavity, aiming to reducing the collapsibility of targets. It is difficult to explain the improvement of this disease by enlarging the volume of the upper airway cavity in some OSAHS. We hypothesize that there are correlation between variation of upper airway resistance, respiratory effort and variation of compensation of upper airway dilator. It is obscure that what is the role of the above factors in the mechanisms of upper airway collapsibility. Based on drug induced sleep endoscopy and measurement of collapsibility of upper airway, first, studying the upper airway resistance, respiratory effort and variation of compensation of upper airway dilator. Its aim is to interpret above factors have a important role in variation of collapsibility of inferior upper airway(retroglossy). Second, by Canine model of OSAHS, we want to find how different sleep stage, negative pressure of airway, tidal volume affect the collapsibility of inferior upper airway. That will give theory base to understand the mechanism of upper airway and to choose key structure that lead to the collapse of upper airway.

以往认为改变咽壁结构治疗阻塞性睡眠呼吸暂停综合征(OSAHS)的机制主要与增大咽腔容积继而减小靶区域的塌陷性有关。但相当数量的患者单纯以气道腔容积变化难以解释病情严重度的改善；说明结构改变治疗OSAHS的机制未被充分认识，在前期研究基础上我们假设：上游气道(软腭后气道)形态变化可能通过咽腔压力分布、呼吸肌/上气道扩张肌代偿功能等因素的改变及其交互作用改善下游气道（舌后气道）塌陷性。为证实该假设，在已建立睡眠电子喉镜及咽腔各气道段塌陷性测量、肌电活性评价技术的基础上，本研究拟：①定量改变上游气道塌陷性，分析气道段阻力、呼吸努力度及扩张肌代偿功能的变化规律，阐明上述因素如何参与下游气道塌陷性改变；②在定量控制上游气道阻力的犬OSAHS模型上，观察不同气道负压和潮气量条件下，上游气道结构改变影响下游气道塌陷性的规律。阐明上述问题将为深入认识OSAHS气道塌陷机制及个体化治疗选择提供理论依据。

本研究旨在阐明不同程度上游气道段阻力、呼吸努力度变化及扩张肌代偿功能对舌后气道(下游气道)塌陷性改变的参与作用及其机制。为认识阻塞性睡眠呼吸暂停低通气综合征患者上气道塌陷机制、为更有选择性地改变气道关键致塌陷结构和个体化治疗选择提供理论依据。完成了诱导睡眠状态下OSAHS患者电子喉镜观察上呼吸道阻塞部位（上游及是否合并下游阻塞）、按VOTE分类系统对参与塌陷的气道结构进行分类、并应用OSAHS患者咽腔阻塞平面下和阻塞平面内压力的不同成功建立了阻塞长度和阻塞高度的测量方法；分析了阻塞高度、阻塞长度等指标与CT形态学评估结果的关系；分析患者基础解剖特征和气道各个阻塞部位的塌陷特点与手术解除腭咽部阻塞的疗效的关系。发现诱导睡眠电子喉镜检查结果，可以进一步区分以往基于解剖和睡眠监测的疗效预测系统无法确定预测疗效的患者的疗效。研究了鼻腔作为咽腔的上游气道，鼻底及相关上游上气道解剖特征与阻塞性睡眠呼吸暂停低通气综合征的相关性。阻塞长度和阻塞高度是OSAHS病人腭咽部手术疗效的独立预测因子，以阻塞长度为1.4cm，阻塞高度为3.2cm为界值做Logisitc回归，发现阻塞长度>1.4cm(OR=0.21; 95%CI, 0.04–0.98; P <0.05)和阻塞高度≥3.2cm (OR= 9.35; 95% CI, 1.79–48.80; P < 0.05)是手术成功的独立预测因子。可用于术前病人的筛选，提高手术疗效。相关研究成果发表SCI收录的期刊论著2篇；核心中文期刊论著：1篇。组织国内睡眠呼吸障碍学习班2期，国际睡眠呼吸障碍疾病学习班1次、参加国际睡眠睡眠学术会议6次。培养本专业方向研究生6名。