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扁桃腺大小和非睡姿依賴性阻塞型睡眠呼吸中止症的相關性

Association between Tonsil Size and Non-Position-Dependent Obstructive Sleep Apnea Syndrome

摘要


背景:部分阻塞性睡眠呼吸中止症患者可藉由非仰睡的睡眠姿勢,有效地改善睡眠呼吸障礙的嚴重程度,目前尚無可用來判斷改變睡姿效果的臨床指標。方法:前瞻性地收集以習慣性打鼾為主訴的門診病患之理學檢查結果,人體測量學(anthropometric)數據及睡眠呼吸生理檢查參數,分析其與睡眠姿勢改變之效果間的相關性。結果:共113名病患確診為阻塞性睡眠呼吸中止症,其中59名患者(52.2%)仰睡時的apnea hypopnea index(AHI)是非仰睡時AHI的2倍或2倍以上,為position-dependent(PD)組,其餘54名(47.8%)non-position-dependent(NPD)組,兩組病患在年齡、AHI、身體質量指數(BMI)均無顯著差異,分析兩組病人與扁桃腺大小等級之相關性則發現兩組之間具有統計學上顯著的差異(chi-square test),p值為0.02。進一步分析扁桃腺大小等級預測NPD組的相關性,則發現扁桃腺大小等級預測NPD組的勝算比(odds ratio)為2.345,95%信賴區間為1.212-4.537(binary logistic regression),p值為0.011,具有統計學上顯著的意義。結論:52.2%的阻塞性睡眠呼吸中止症患者,可藉由非仰睡的睡眠姿勢有效改善睡眠呼吸障礙,而扁桃腺大小等級可提供臨床醫師判斷阻塞性睡眠呼吸中止症患者是否能藉由改變睡眠姿勢而有效改善睡眠呼吸障礙的參考指標。

並列摘要


BACKGROUND: Sleeping in a non-supine position can reduce the number of episodes of apnea and hypopnea per hour (apnea hypopnea index, (AHI)) in some patients with obstructive sleep apnea syndrome (OSAS). According to previous studies, no characteristic upper airway morphology determines the effects of position on obstructive sleep apnea or hypopnea.MATERIALS AND METHODS: The results of a physical examination, anthropometric data, and polysomnographic parameters were prospectively measured in habitual snorers who were referred to our clinic at Cardinal Tien Hospital. The relationship between the morphological features of the upper airway and the effects of position on obstructive sleep apnea or hypopnea were analyzed.RESULTS: In total, 113 patients with OSAS were enrolled. Patients were classified into a position-dependent (PD) group (supine AHI ≥ 2 × non-supine AHI) and a nonposition-dependent (NPD) group. In 52.2% of patients (59 patients), OSAS was position dependent. Age, AHI and body mass index (BMI) did not differ significantly between the two groups. The distribution of tonsil size grade differed significantly between the PD and the NPD groups (p = 0.02, chi-square test). The tonsil size grade was strongly related to the diagnosis of non-position-dependent OSAS patients. (Odds ratio: 2.345, 95% confidence interval: 1.212-4.537, p = 0.011, binary logistic regression).CONCLUSIONS: In this investigation, 52.2% of the 113 patients had positiondependent OSAS. Tonsil size grade can be used as a parameter to determine the effects of sleep position on obstructive sleep apnea or hypopnea.

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