A Preliminary Study On The Differences Of Upper Airway Stenosis In Adult OSAHS Patients With Different Path Breathing

Objective The purpose of this study is to investigate stenosis in different planes of upper respiratory tract in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)who mainly breathe through nose and mouth respectively,such as(posterior area of soft palate,posterior area of tongue,posterior area of epiglottis).To analyze the differences of the minimum cross-sectional area and the length of upper airway between OSAHS patients who mainly breathe through nose and mouth.And it explores whether there is a correlation between stenosis site and breathing pattern to provide reference for clinical operation.Method 1.Screening the patients with OSAHS from clinic.First,the patients with nasal diseases such as deviation of nasal septum,nasal polyp and lung diseases such as chronic obstructive pulmonary disease were screened out.Then patients with simple pharyngeal stenosis were into groups.All the patients were monitored by polysomnography(PSG)for 7 hours,and OSAHS can be diagnosed if AHI ≥ 5.Meanwhile,by asking the patient’s spouse and checking the air flow intensity of patients through nose and mouth by using cotton swab at the bedside during sleep,the patients in the group were divided into two groups: group A(mainly nasal breathing OSAHS group)and group B(mainly oral breathing OSAHS group).Exclusion criteria:(1)suffering from endocrine system diseases such as hypothyroidism and acromegaly;(2)having throat diseases such as vocal cord paralysis;(3)having received palatopharyngoplasty and other surgical treatment;(4)suffering from nasal diseases such as deviated nasal septum and hypertrophic inferior turbinate;(5)suffering from lung diseases such as asthma and chronic bronchitis;(6)younger than 18 years old.2.Patients with OSAHS tested by PSG are first measured for height and weight,and filled out a sleepiness scale.According to the AHI results,they were divided into mild to moderate(5≤AHI <30)and severe(AHI≥30).Patients with oral and nasal breathing in this study ware divided into 4 groups.Group A1: patients with mild to moderate OSAHS who breathed orally(21 cases);group A2: patients with mild to moderate OSAHS who breathed nasally(8 cases).Group B1: patients with severe OSAHS with oral breathing(32 cases);group B2: patients with severe OSAHS with nasal breathing(17 cases).3.Multi-layer spiral scanner(GE)Light speed VCT is used to examine the patients.The scanning range of upper airway CT is generally from skull base to inferior edge of cricoid cartilage.During the CT scan,the patient is in a supine position and the sides of his head are symmetrically fixed,breathing is stable and keep silence.The upper and lower lips and teeth of the patients with OSAHS who mainly breathe through nose are naturally matched.The mouth of patients with OSAHS who mainly breathe through mouth was slightly open,showing a relaxed posture,and was scanned continuously at the end of the calm breath.And record the relevant data of upper airway parameters.4.The statistical analysis was carried out by using the statistical software of SPSS 26.0.Use independent samples to test and compare the changes of airway measurement parameters between the oral OSAHS group and the nasal OSAH group,and to evaluate whether there is statistical difference between the two groups.The correlation between the parameters of upper airway and AHI was analyzed by regression analysis.Result 1.The minimum cross-sectional area of the posterior area of soft palate and epiglottis in OSAHS group with nasal breathing was larger than that in OSAHS group with oral breathing,(P < 0.05).The difference is statistically significant.The length of left and right posterior palatal diameter and the minimum distance from epiglottis to pharyngeal wall in OSAHS group with nasal breathing were longer than those in OSAHS group with oral breathing,(P < 0.05).The difference is statistically significant.2.Among all OSAHS patients in this study,compared with the mild-moderate OSAHS group,the length of the left and right diameter of the soft palate,the minimum distance from the root of the tongue to the posterior pharyngeal wall,the length of the left and right diameter of the posterior region of the tongue were relatively shorter in the severe OSAHS group,and the distance from the hard palate to the upper edge of the hyoid bone and the length of the soft palate were relatively longer,P <0.05,and the difference is statistically significant.3.There was a linear relationship between AHI and the cross-sectional area of the posterior area of the soft palate,the cross-sectional area of the posterior area of the tongue,the distance from the hard palate to the upper edge of the hyoid bone,and the length of the soft palate in OSAHS group with oral breathing and OSAHS group with nasal breathing,(P < 0.05).Conclusion 1.Multislice spiral CT examination can clearly see the upper airway stenosis and can provide anatomical basis for surgery.2.The minimum cross-sectional area of the posterior soft palate and the length of the left and right diameters of OSAHS group with oral breathing are smaller than those of OSAHS group with nasal breathing.The difference is statistically significant.3.OSAHS patients have strictures in the posterior region of the soft palate and the posterior root of the tongue.Patients with severe OSAHS have more severe stenosis than patients with mild to moderate OSAHS.4.There are differences in the anatomical structure of the upper airway CT scan between the patients with OSAHS and those with OSAHS.The stenosis of the posterior area of the soft palate is more obvious in the patients with OSAHS.It is speculated that a wider surgical scope may be needed in the operation to have a better effect,which could provide guidance for the operation.