体重减轻对肥胖青少年OSAS上呼吸道塌陷因素的影响及机制研究

Obstructive sleep apnea syndrome(OSAS) is the most common sleep disordered breathing disease in children. Adolescents is a critical transition period from childhood to adulthood transition, accompanied by a lot of sleep problems. OSAS is increasing with the prevalence of obesity in adolescents. Both anatomical factors and local neurol muscular tone contribute to upper airway collapsibility. However, the above two factors are different in different individuals, resulting in a different response to treatment. The mechanism of these two factors remain to be studied. In this proposal, We will investigate changes in the local neurol muscular response and anatomacal factors before and after weight loss in the same individual in obese adolescents with and without OSAS and normal weight controls. Furthermore, the correlations between these factors and severity of OSAS will be determined. Differences in volume as well as fat distribution around the upper rairway will be assesed by magnetic resonance image technique and the Amira software system analysis. The pharyngeal critical pressure and the slope of pressure flow relationship will be measured by a continous airway pressure machine providing positive and negative pressure. At the same time, the activity of genioglossus muscle will be recorded. This proposal will provide a theoretical basis to explore the pathogenesis and clinical treatment of OSAS.

阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome, OSAS）是儿童睡眠呼吸障碍中最常见的一类疾病。青少年儿童是儿童期到成人期的过渡的关键阶段，伴有很多睡眠问题，尤其肥胖青少年OSAS的发病率逐年增高。上呼吸道解剖因素和神经因素都参与其中，但不同个体两种因素的影响不同，导致对治疗反应的不同，其机制有待研究。本研究以肥胖青少年OSAS为研究对象，在同一个体上，观察体重减轻前后引起OSAS的上呼吸道局部神经因素和解剖因素的变化，并对各项因素引起OSAS发生的关联性进行评估。应用核磁共振技术及Amira软件系统分析OSAS患者体重减轻前后上呼吸道不同部位的体积以及周围脂肪分布的差异。应用咽部塌陷压力测定技术和颏舌肌肌电电生理学技术评估上呼吸道在不同状态下的神经反应性。为探讨OSAS的发病机制及临床治疗提供理论依据。

阻塞性睡眠呼吸暂停（obstructive sleep apnea, OSA）是儿童睡眠呼吸障碍中常见的一类疾病。青少年儿童是从儿童期到成人期的过渡的关键阶段，这个时期伴有很多睡眠问题，随着肥胖在青少年人群中的逐年增高，OSA在这部分人群中的发病率亦逐年增高。青少年睡眠呼吸暂停的发病中，不仅解剖因素引起的上呼吸道狭窄参与其中，神经反应性异常也在疾病的发生中产生作用。本研究应用咽部塌陷压力测定技术评估上呼吸道在减重前后的神经反应性变化。在上气道激活状态下，肥胖OSA病人组神经反应性明显低于正常两组对照组；在上气道低张状态下，两组肥胖组的神经反应性高于正常体重对照组；减重后均无明显变化。应用核磁共振技术分析患者体重减轻前后上呼吸道不同部位软组织的体积差异，增加了腹部脂肪的测定分析。之后对各项因素引起疾病严重程度的关联性进行评估。结果发现，肥胖OSA病人除了腺样体对疾病发生有意义外，舌体体积和咽侧壁体积均在OSA组增加，减重后，发现舌体体积和咽侧壁体积均减小，而扁桃体腺样体体积不见明显变化。回归分析结果得出，影响AHI的因素除BMI和腺样体外，腹部脂肪体积和软颚后侧壁体积与AHI有直接关系。以上结果说明，青少年OSA的发生，除与扁桃体腺样体肥大有关，肥胖是个更重要的因素，减重将起到非常积极的作用。研究结果为探讨青少年OSA的发病机制及临床预防及治疗提供理论依据。