下轴颈椎矢状位对位作为阻塞性睡眠呼吸暂停严重程度的解剖学相关因素：一项头影测量分析

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中文摘要

背景： 阻塞性睡眠呼吸暂停综合征（OSA）是一种以反复上气道阻塞为特征的重要疾病。颈椎对位和颈椎前凸角度可能影响气道横截面积。本研究旨在探讨OSA患者颈椎前凸角度与疾病严重程度之间的关系。方法：研究纳入30例OSA患者（根据呼吸暂停低通气指数[AHI]分为轻度n=6、中度n=11、重度n=13）和30例以机械性颈痛就诊的非OSA对照者。在颈椎侧位头影测量X线片上采用Cobb法测量C1-C2、C1-C7和C2-C7角度。由于缺乏BMI数据，额外测量软组织和气道参数——C2水平椎前软组织厚度（PST-C2）和C4水平椎前软组织厚度（PST-C4）、后气道间隙（PAS）以及下颌平面-舌骨距离（MP-H）——作为解剖学替代指标。针对每个颈椎角度构建校正年龄和性别的多元线性回归（ANCOVA）模型。结果：与对照组相比，OSA患者的所有颈椎角度均显著减小（C1-C2：25.51 ± 6.47° vs 33.3 ± 4.44°；C1-C7：35.0 ± 11.9° vs 51.2 ± 7.34°；C2-C7：9.19 ± 10.6° vs 19.9 ± 5.05°；所有p < 0.001）。在OSA组内，AHI与C2-C7角度之间存在显著的中度负相关（ρ = -0.522，p = 0.003），而C1-C7角度显示临界关联（ρ = -0.361，p = 0.050），C1-C2未达到显著性（ρ = +0.118，p = 0.534）。校正年龄和性别后，组别（OSA vs. 对照）仍是所有三个颈椎角度的强独立预测因素（所有p < 0.001），而年龄和性别均不是显著预测因素（所有p > 0.34）。OSA组PST-C2显著更高（4.93 ± 1.06 mm vs. 4.30 ± 0.70 mm，p = 0.017），而PST-C4、PAS和MP-H在两组间无显著差异（所有p > 0.05），且这些参数均与C2-C7角度无显著相关性。结论：与 非OSA对照者相比，OSA患者观察到显著的颈椎前凸丢失，其中C2-C7角度在OSA组内与AHI呈显著负相关；校正年龄和性别后，这种关联仍然稳健。补充的软组织和气道测量与颈椎对位或AHI均无显著相关性，提示所观察到的关联不能简单归因于区域软组织厚度或气道狭窄；然而，在没有直接BMI数据的情况下，不能排除全身性肥胖的混杂作用。这些发现提示颈椎姿势与上气道动力学之间可能存在关联；然而，需要更大规模的前瞻性研究来确认其临床实用性。

英文摘要

Background: Obstructive sleep apnea syndrome (OSA) is a significant disorder characterized by recurrent upper airway obstruction. Cervical vertebral alignment and lordosis angles may influence airway cross-sectional area. This study aimed to investigate the relationship between cervical lordosis angles and disease severity in patients with OSA. Methods: The study included 30 patients with OSA (mild n = 6, moderate n = 11, severe n = 13 based on Apnea-Hypopnea Index [AHI]) and 30 non-OSA controls presenting with mechanical neck pain. C1-C2, C1-C7, and C2-C7 angles were measured using the Cobb method on lateral cervical cephalometric radiographs. Additional soft tissue and airway parameters - prevertebral soft-tissue thickness at C2 (PST-C2) and C4 (PST-C4), posterior airway space (PAS), and mandibular plane-hyoid distance (MP-H)- were measured as anatomical surrogates given the unavailability of BMI data. Multiple linear regression (ANCOVA) models adjusting for age and sex were constructed for each cervical angle. Results: All cervical angles were significantly reduced in patients with OSA compared to controls (C1-C2: 25.51 ± 6.47° vs 33.3 ± 4.44°; C1-C7: 35.0 ± 11.9° vs 51.2 ± 7.34°; C2-C7: 9.19 ± 10.6° vs 19.9 ± 5.05°; all p < 0.001). Within the OSA group, a significant moderate negative correlation was found between AHI and the C2-C7 angle (ρ = - 0.522, p = 0.003), while the C1-C7 angle showed a borderline association (ρ = -0.361, p = 0.050) and C1-C2 did not reach significance (ρ = +0.118, p = 0.534). After adjustment for age and sex, group membership (OSA vs. control) remained a strong, independent predictor of all three cervical angles (all p < 0.001), whereas neither age nor sex was a significant predictor (all p > 0.34). PST-C2 was significantly higher in the OSA group (4.93 ± 1.06 mm vs. 4.30 ± 0.70 mm, p = 0.017), whereas PST-C4, PAS, and MP-H did not differ significantly between groups (all p > 0.05), and none of these parameters correlated significantly with the C2-C7 angle. Conclusions: Significant cervical lordosis loss was observed in patients with OSA compared to non-OSA controls, with the C2-C7 angle showing a significant negative correlation with AHI within the OSA group; this association remained robust after adjustment for age and sex. Supplementary soft tissue and airway measurements showed no significant correlation with cervical alignment or AHI, suggesting the observed association is not simply attributable to regional soft-tissue thickness or airway narrowing; however, without direct BMI data, a confounding role of systemic adiposity cannot be excluded. These findings suggest a potential association between cervical posture and upper airway dynamics; however, larger prospective studies are required to confirm clinical utility.