药物诱导睡眠内镜下腭咽塌陷模式的种族差异
Race-Based Differences in Velopharyngeal Collapse Patterns During Drug-Induced Sleep Endoscopy.
文献信息
| PMID | 42813727 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Katherine P Gouldman |
| 作者单位 | Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA. |
| 期刊 | Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 探讨药物诱导睡眠内镜（DISE）检查中上气道塌陷模式的种族差异，并评估这些差异对黑人阻塞性睡眠呼吸暂停（OSA）患者舌下神经刺激（HGNS）治疗资格差异的潜在影响。
研究设计： 回顾性队列研究。
研究场所： 学术性三级医疗中心。
方法： 纳入接受DISE检查的成年OSA患者。操作采用标准化丙泊酚方案，并使用腭、口咽、舌根、会厌（VOTE）分类进行评分。分析自我认同为黑人或白人的患者。采用t检验和卡方分析比较人口学、人体测量学及多导睡眠图数据。在调整协变量后，采用逻辑回归分析确定种族是否与前后向（AP）腭塌陷独立相关。
结果： 共分析90例患者（黑人：n=20；白人：n=70）。两组在年龄、性别、体重指数、呼吸暂停低通气指数和颈围方面相似。黑人患者中AP塌陷的发生率显著低于白人患者（40% vs 71%，P=.02）。在调整年龄、性别、体重指数、颈围和咽部开放压力的多变量模型中，黑人种族仍与AP塌陷独立负相关（比值比0.09，95% CI [0.02-0.40]，P<.01）。
结论： 黑人患者在白人患者中相比，DISE检查中表现出AP腭塌陷的可能性显著更低，这可能限制其接受HGNS治疗的资格。这些发现提示，上气道生理学的种族差异可能导致OSA手术治疗机会的差异，并强调需要针对非AP塌陷表型的治疗方法。
英文摘要
OBJECTIVE: To investigate race-based differences in upper-airway collapse patterns during drug-induced sleep endoscopy (DISE) and assess their potential contribution to disparities in hypoglossal nerve stimulation (HGNS) eligibility among black patients with obstructive sleep apnea (OSA).
STUDY DESIGN: Retrospective cohort study.
SETTING: Academic tertiary care center.
METHODS: Adult patients with OSA who underwent DISE were included. Procedures were performed using a standardized propofol protocol and scored using the Velum, Oropharynx, Tongue base, Epiglottis (VOTE) classification. Patients self-identifying as black or white were analyzed. Demographic, anthropometric, and polysomnographic data were compared using t tests and chi-squared analyses. Logistic regression was performed to determine whether race was independently associated with anterior-posterior (AP) velum collapse after adjusting for covariates.
RESULTS: Ninety patients were analyzed (black: n = 20; white: n = 70). Groups were similar in age, sex, body mass index, apnea-hypopnea index, and neck circumference. AP collapse was significantly less common among black than white patients (40% vs 71%, P = .02). In multivariable modeling adjusting for age, sex, body mass index, neck circumference, and pharyngeal opening pressure, black race remained an independently negatively associated with AP collapse (odds ratio 0.09, 95% CI [0.02-0.40], P < .01).
CONCLUSION: Black patients were significantly less likely than white patients to exhibit AP velum collapse on DISE, potentially limiting eligibility for HGNS therapy. These findings suggest that racial differences in upper-airway physiology may contribute to disparities in access to surgical treatment for OSA and underscore the need for therapies addressing non-AP collapse phenotypes.