Research About Pharyngeal Touch Threshold And Mucosal Morphology In Patients With Obstructive Sleep Apnea Hypopnea Syndrom

Objectives:Obstructive sleep apnea hypopnea syndrom(OSAHS)is a common clinical disease,its pathogenesis is complex,previous research shows that peripheral neuropathy of the upper airway is one of the pathogenesis of OSAHS,but the mechanism is not clear.In our research,we tested the touch threshold of the soft palate of patients with OSAHS and normal persons,and we aslo made a study about the pathological morphology of the soft palate mucosa of patients with OSAHS and patients with benign lesions of the amygdala,and compared the results.The objective is to reflect the pathological changes of pharynx in patients with OSAHS,to provide a basis for the further study on the role of the peripheral neuropathy of the upper airway in the occurrence and development of OSAHS.Methods:1.Part Ⅰ : All the specimens were choosed from otolaryngology department of Changhai hospital affiliated with the second military medical university in August 2015 to February 2016.There are 33 patients with OSAHS diagnosed by PSG in the “OSAHS group”,and 33 normal volunteers excluded OSAHS by PSG were recruited as “normal control group”.For all the specimens,the touch threshold were tested at the hand,buccal mucosa and the soft palate mucosa,and we compared the results between the two groups,U Mann-Whitney test was used to analyze the differences between the two groups.The relationship between the touch threshold and AHI was analyzed in OSAHS group.2.Part Ⅱ : All the specimens were choosed from otolaryngology department of Changhai hospital affiliated with the second military medical university in June 2015 to February 2016.There are 18 patients with OSAHS diagnosed by PSG in the “ OSAHS group”.17 patients with benign lesions of the amygdala were selected as the “control group”.Biopsies of the soft palate mucosa were obtained during the surgery,HE staining and Masson staining were performed after paraffin section of the mucosa.The pathological changes of soft palate mucos tissues were observed under light microscope.By using image-pro plus we analyzed the relative cross-sectional area of collagen fibers and the number of inflammatory cells of the soft palate mucosa of the two groups.T test was used to analyze the differences between the two groups.Results:1.Part Ⅰ : There were no significant differences in touch threshold of hand skin between the OSAHS group and normal control group by Mann-Whitney U test,u=468.500,P=0.323(P>0.05).There were no significant differences in touch threshold of buccal mucosa between the OSAHS group and normal control group by Mann-Whitney U test,u=423.500,P=0.113(P>0.05).There were significant differences in touch threshold of the soft palate mucosa between the OSAHS group and normal control group by Mann-Whitney U test,u=333.500,P=0.007(P < 0.05).There were no significant relationship between the touch threshold and AHI in OSAHS group,rs=0.322,P=0.068(P>0.05).2.Part Ⅱ: Compared with control group,the morphological changes of OSAHS group were as follows.The squamous epithelial cells of mucous membrane of the soft palate mucosa were markedly swollen,the shape were irregular,the lamina propria was obviously thickening,a large number of inflammatory cells infiltration,hyperplasia of collagen fiber and fat vacuoles could be observed in submucosal loose connective tissue18/18(100%).There were significant differences in the relative cross-sectional area of collagen fibers of the soft palate mucosa between the OSAHS group and control group(t=7.762,P<0.001).There were significant differences in the number of inflammatory cells of the soft palate mucosa between the OSAHS group and control group(t=159.829,P<0.001).Conclusion:Compared with control group,the touch threshold of soft palate mucosa in OSAHS patients increased significantly,and it means that the soft palate sensory function of OSAHS patients is decreased.Compared with patients with benign lesions of the amygdala,the soft palate mucosa of OSAHS patients showed the morphological alterations as edema,inflammatory cells infiltration and hyperplasia of fibre.The results reflect the lesions of pharyngeal sensory in patients with OSAHS,and it may point out that the occurrence and development of OSAHS were related to the peripheral neuropathy of the upper airway.