閉塞性睡眠時無呼吸の閉塞部位

―UPPPの有効群と無効群の相違―

抄録

The purpose of this study was to determine whether the sites of narrowing of the airway of good responders to uvulopalatopharyngoplasty (UPPP) differed from the sites in poor responders. Twenty patients with obstructive sleep apnea syndrome (OSAS) were examined using pressure transducers placed in four different sites, in addition to routine polysomnography and cephalometric analysis. UPPP was then performed in all patients. Twelve patients were good responders and eight patients were poor responders. The good responders had a smaller apnea hypopnea index (All) preoperatively (39.3) than the poor responders (72.0). Preoperative cephalometric analysis revealed that the mean subspinal-nasion-supramental angle (ANB) of the poor responders (4.2°) was larger than the good responders (0.2°). Preoperative airway pressure examination revealed the following: 1) the site of narrowing in the good responders was almost always in the oropharynx; 2) the site of narrowing in poor responders was at the tongue base in half of the patients. For all patients the AHI was correlated with the mean absolute value of the pressure in the hypopharynx (Phyp) and in the esophagus (Pes) during sleep stage 1 and 2 and with the body mass index (BMI). BMI was correlated with Pes during sleep stage 1 and 2. ANB was correlated with the Phyp and Pes during sleep stage 1.
These findings indicate that, due to obesity and mandibular deficiencies, poor responders to UPPP have a higher AHI and tend to have sites of obstruction at the tongue base.