<br>呼气动态气道塌陷与阻塞性睡眠呼吸暂停严重程度之间的性别差异,European Radiology

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呼气动态气道塌陷与阻塞性睡眠呼吸暂停严重程度之间的性别差异
European Radiology ( IF 4.7 ) Pub Date : 2023-11-14 , DOI: 10.1007/s00330-023-10322-x
Soriul Kim _{1,

2} , Ki Yeol Lee _{3,

4} , Ali Tanweer Siddiquee ₁ , Hyeon Jin Kim ₅ , Hye Ryeong Nam ₁ , Chang Seop Ko ₃ , Nan Hee Kim ₆ , Chol Shin _{1,

7,

8}

Affiliation

目标

睡眠期间吸气对阻塞的上呼吸道产生的重复性不平衡和紧张容易导致呼气中央气道塌陷的发生。此外，男性和女性的上呼吸道结构存在差异，这可能是男女之间阻塞性睡眠呼吸暂停（OSA）患病率存在差异的原因。本研究旨在评估使用胸部多排 CT 测量的呼气动态气管塌陷参数与客观测量的男性和女性 OSA 严重程度之间的关联。

材料和方法

对韩国基因组和流行病学研究中总共 901 名接受胸部 CT 和夜间家庭多导睡眠图检查的参与者进行了横断面分析（女性：46.2%）。根据呼吸暂停低通气指数 (AHI) 的 OSA 严重程度，参与者被分为三组。进行多变量线性回归分析以确定调整心血管相关协变量后中央气道塌陷的影响。

结果

在多变量分析中，涉及面积、直径和周长的呼气管腔结构减少的百分比与 AHI（所有p值 < 0.05）和 OSA 严重程度相关（中度至重度 OSA 与无 OSA 相比： β = 3.30%， p女性中，β = 0.03； β = 2.05%， p = 0.02； β = 1.97%， p = 0.02，而男性中度至重度 OSA 的呼气壁厚度减少比例仅高于无 OSA（ β） = 0.72%， p = 0.003）。此外，患有轻度 OSA 和中度至重度 OSA 的女性比没有 OSA 的男性有更高的呼气性气管塌陷，并且观察到性别的中度影响（交互作用p = 0.007）。

结论

与男性相比，女性呼气动态气管塌陷与 OSA 严重程度独立相关。

临床相关性声明

不同性别的咽部结构和气道固有特征的差异可能会影响男性和女性之间睡眠呼吸暂停易感性的差异。

要点

• 与男性相比，女性呼气动态气管塌陷与 OSA 严重程度独立相关。

• 患有轻度 OSA 的女性比没有 OSA 的男性有更高的呼气性气管塌陷，并且观察到性行为的中度影响。

• 气道的结构差异可能会影响性别之间睡眠呼吸暂停易感性的差异。

"点击查看英文标题和摘要"

Gender differences in association between expiratory dynamic airway collapse and severity of obstructive sleep apnea

Objectives

Repetitive unbalances and tensions generated by inspiratory efforts against an obstructive upper airway during sleep predispose the development of expiratory central airway collapse. In addition, structures of the upper airway between men and women have differences and could be the reasons for differences in obstructive sleep apnea (OSA) prevalence between genders. The present study aimed to evaluate the association between parameters of expiratory dynamic tracheal collapse measured using chest multidetector CT and objectively measured OSA severity between men and women.

Materials and methods

A total of 901 participants who underwent chest CT and overnight in-home polysomnography from the Korean Genome and Epidemiology Study were cross-sectionally analyzed (women: 46.2%). The participants were divided into three groups based on OSA severity by apnea–hypopnea index (AHI). Multivariate linear regression analysis was performed to determine the effects of central airway collapse after adjustment for cardiovascular-related covariates.

Results

In a multivariate analysis, percentages of expiratory lumen structure reductions involving area, diameter, and perimeter were associated with AHI (all p values < 0.05) and with OSA severity (moderate-to-severe OSA than no OSA: β = 3.30%, p = 0.03; β = 2.05%, p = 0.02; β = 1.97%, p = 0.02, respectively) in women, whereas men had only a greater percentage of expiratory wall thickness reduction in moderate-to-severe OSA than no OSA (β = 0.72%, p = 0.003). In addition, women with both mild OSA and moderate-to-severe OSA had higher expiratory tracheal collapse than men without OSA, and a moderate effect of sex was observed (p for interaction = 0.007).

Conclusion

The expiratory dynamic tracheal collapse was independently associated with severity of OSA in women than in men.

Clinical relevance statement

Differences of pharyngeal structures and inherent features of airways by genders may affect the dissimilarities in vulnerability to sleep apnea between men and women.