利用頦下超音波及彈性影像觀察阻塞性睡眠呼吸中止症患者之上呼吸道結構特性

Identifying the Upper Airway Characteristic of Obstructive Sleep Apnea patient with Submental Ultrasound Imaging and Shear Wave Elastography

朱振安(Cheng-An Chu)

指導教授 ： 陳韻之

國立臺灣大學/醫學院/臨床牙醫學研究所/碩士(2019年)

https://doi.org/10.6342/NTU201901937

摘要

研究目的 : 阻塞性睡眠呼吸障礙是指發生在睡眠過程中呼吸道塌陷導致呼吸不 順暢的問題。依文獻回顧所知，舌體的厚度增加以及彈性係數降低，可能會影響 患病的機率。而過去對上呼吸道的研究常以醫學影像例如核磁共振影像、電腦斷 層以及側顱影像觀察上呼吸周邊結構特徵為主，但是受限於輻射曝射、攝影成 本、耗時等缺點，限制其在臨床上的廣泛利用。而使用超音波作為影像工具則無 上述缺點。本篇研究目的，將建立可信賴之頦下彈性超音波，以進行上呼吸道結 構的測量，並分析上呼吸道體積及彈性係數與阻塞性睡眠呼吸中止症之對應關係。
研究方法 : 首先先針對本團隊發展的臨床測量方法，進行信賴度測試。以評估 是否可以作為本臨床研究的檢查工具。本實驗納入共頦下超音波的受試者共 69 人，其中健康受試者為 37 人；阻塞性睡眠呼吸中止症患者 32 人。以頦下彈性超 音波測量矢狀面及冠狀面之舌體厚度以及彈性係數，進行分析與評估。
結果 : 阻塞性睡眠呼吸中止症患者上呼吸道的矢狀面舌體厚度、冠狀面舌體厚 度皆顯著大於健康組(矢狀面舌體厚度 65.38±0.93mm VS 60.99±0.99mm, Odds ratio=1.150, p=0.0045；冠狀面舌體厚度 63.70±0.98mm VS 57.72±0.96mm, Odds ratio=1.205, p=0.0005)，而冠狀面彈性係數平均值則是顯著小於健康組(13.24±0.36 kPa VS 15.87±0.63 kPa, Odds ratio=0.701, p=0.0029)。組內比較部分，患病組之上 呼吸道結構及彈性係數與呼吸中止指數(AHI)皆無顯著差別(p>0.05)。
結論 : 頦下彈性超音波可作為觀察上呼吸道結構特性之理想工具。阻塞性睡眠 呼吸中止症患者表現出較健康組別厚的舌體以及彈性係數較低的舌體剛性。但舌體彈性係數以及厚度並無法作為患病組嚴重程度之評估標準。

關鍵字

阻塞性睡眠呼吸中止症 ； 頦下超音波 ； 彈性超音波 ； 彈性係數 ； 舌頭 ； 上呼吸道

並列摘要

Purpose: Obstructive Sleep Apnea syndrome (OSAs) is a sleep breathing disorders of upper airway collapsing during sleep. It mostly caused by the upper airway structure abnormality. According to the previously studies, volume enlargement and low elasticity of upper airway structure may correlate to the occurrence of OSAs. The medical imaging tools of evaluating upper airway included computed tomography (CT), Magnetic resonance imaging (MRI) and Cephalometric x-ray. However, their application was limited by the drawback such as radiation exposure, high cost and time consuming. Ultrasound imaging may benefit the observation of upper airway. The aim of this study was to establish a reliable submental ultrasound elastography protocol. And identified the upper airway structure characteristic of OSAs patients.
Methods: We used ultrasound as a tool to verified the reliability of clinical submental in our study. Then total sixty-nine adults, with thirty-seven healthy adults and thirty-two OSAs patients, were included for submental ultrasound elastography. The tongue height and tongue elasticity of both sagittal and coronal view were measured to estimate the upper airway characteristic of OSAs patient.
Results: Both Sagittal Tongue Height and Coronal Tongue Height shows significant increase in OSAs patient (Sagittal Tongue Height : 65.38±0.93mm VS 60.99±0.99mm, Odds ratio=1.150, p=0.0045；Coronal Tongue Height 63.70±0.98mm VS 57.72±0.96mm, Odds ratio=1.205, p=0.0005). And the Coronal Tongue Elasticity was lower compared to the healthy group (13.24±0.36 kPa VS 15.87±0.63 kPa, Odds ratio=0.701, p=0.0029). When compared within the OSAs group, Neither Tongue height or Elasticity were correlated to Apnea-Hypopnea Index (AHI) (p>0.05).
Conclusion: Submental ultrasound elastography could be a reliable tool for upper airway structure evaluation. The OSAs patients showed larger Tongue Height and lower Tongue Elasticity when compared to healthy group. But Tongue height and Tongue elasticity could not be the parameter for severity determination in OSAs patients.

並列關鍵字

Obstructive Sleep Apnea ； Submental Ultrasound ； Ultrasound Elastography ； Elasticity ； Tongue ； Upper Airway

參考文獻

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