Article record

阻塞性睡眠呼吸暂停患者对床头抬高反应的DISE与鼻阻力计相关性研究

DISE and Rhinomanometry Correlates of Response to Head-of-Bed Elevation in Obstructive Sleep Apnea.

临床研究鼻科IF 2.3Q2

文献信息

PMID	42703892
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Antonino Maniaci 查看其他 10 位作者 Giannicola Iannella；Stefano Pelucchi；Manuele Casale；Antonio Moffa；Alberto Caranti；Kenny P Pang；Brian W Rotenberg；Ruggero Campisi；Jerome Rene Lechien；Claudio Vicini
作者单位	Department of Medicine and Surgery, University of Enna "Kore,", Enna, Italy. 查看其他 7 条单位信息 Asp 7 Ragusa, Ospedale Maggiore Modica, Ragusa, Italy.；Department of Surgery, University of Mons (UMons), Mons, Belgium.；Organi Di Senso Department, Sapienza University of Rome, Rome, Italy.；Department of Otorhinolaryngology and Audiology, University of Ferrara, Ferrara, Italy.；Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.；Asia Sleep Centre, Singapore, Singapore.；Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.
期刊	The Laryngoscope
SCI 分区	Q2
IF	2.3
研究类型	临床研究 · 临床
所属专科	鼻科

中文摘要

目的： 识别阻塞性睡眠呼吸暂停（OSA）患者对30°床头抬高（HOBE）反应的内镜与鼻阻力计相关性，并探讨上气道（UA）塌陷模式和鼻阻力是否与体位性改善相关。
方法： 我们评估了药物诱导睡眠内镜（DISE）检查结果和鼻阻力计参数与OSA患者对HOBE反应之间的关联。在标准化仰卧位、30° HOBE位和侧卧位进行整夜多导睡眠监测。根据呼吸暂停低通气指数（AHI）的百分比变化评估HOBE反应，并确定其与VOTE塌陷模式和鼻阻力的相关性。
结果： HOBE显著降低AHI，从22.6 ± 5.7降至16.4 ± 4.9次/小时（p < 0.001），侧卧位进一步降低（11.7 ± 4.2，p < 0.001）。OSA患者接受HOBE后AHI改善程度大于对照组（-31.0% vs. -14.0%，p < 0.001）。OSA患者呼气相鼻阻力显著升高（p < 0.001），且与HOBE期间AHI百分比变化强相关（r = 0.912，p < 0.001）。VOTE分析显示OSA患者存在更严重的多平面塌陷；会厌（r = 0.903）和舌根塌陷评分（r = 0.714）与HOBE反应强相关。在调整BMI和性别后，会厌和软腭塌陷评分仍与HOBE反应显著相关，而鼻阻力计相关性减弱且不再具有统计学显著性。
结论： DISE检查结果和呼气相鼻阻力计阻力值可能有助于描述对HOBE的体位反应性，包括UA塌陷模式以及鼻气流阻力。然而，结果应视为假设生成性，需要在更大队列中通过前瞻性数据收集、正式模型开发和外部验证加以确认。

英文摘要

OBJECTIVES: To identify endoscopic and rhinomanometric correlation of response to 30° head-of-bed elevation (HOBE) in patients with obstructive sleep apnea (OSA), and to explore whether upper airway (UA) collapse patterns and nasal resistance are associated with positional improvement.
METHODS: We assessed the associations between drug-induced sleep endoscopy (DISE) findings and rhinomanometric parameters with response to HOBE in OSA patients. Polysomnography was performed overnight in standardized supine, 30° HOBE, and lateral positions. HOBE response was evaluated based on percent change in apnea-hypopnea index (AHI), and correlations with VOTE collapse patterns and nasal resistance were determined.
RESULTS: HOBE significantly reduced AHI from 22.6 ± 5.7 to 16.4 ± 4.9 events/h (p < 0.001), with further lateral position reduction (11.7 ± 4.2, p < 0.001). OSA patients demonstrated greater AHI improvement with HOBE than controls (-31.0% vs. -14.0%, p < 0.001). Expiratory nasal resistance was significantly elevated in OSA patients (p < 0.001) and strongly correlated with percent AHI change during HOBE (r = 0.912, p < 0.001). VOTE analysis revealed more severe multilevel collapse in OSA patients; epiglottic (r = 0.903) and tongue base collapse scores (r = 0.714) were strongly associated with the HOBE response. After adjustment for BMI and sex, epiglottic and velar collapse scores remained significantly associated with HOBE response, whereas rhinomanometric associations were attenuated and no longer statistically significant.
CONCLUSION: DISE findings and expiratory rhinomanometric resistance values may help characterize positional responsivity to HOBE including patterns of UA collapse as well as nasal airflow resistance. However, results should be considered hypothesis-generating and require confirmation in larger cohorts with prospective data collection, formal model development, and external validation.