routine 發問時間: 社會與文化語言 · 7 年前

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The risk of developing OSA increases considerably at a higher BMI. If morbidly obese (BMI > 40 kg/m2), the risk of an individual of developing OSA lies between 55% and 90%. Other contributing factors include a large neck circumference (>17 in) and a higher oral mallampati score (denoting an anatomically narrow UA). Neck circumference is a better predictor of OSA than BMI. Even more interestingly, abdominal circumference has proven to be a better predictor of OSA than both neck circumference and BMI.

In OSA, the UA collapses at a critical closing pressure (Pcrit). It is believed that disturbances in the neuromuscular control of the pharyngeal dilatory muscles fail to protect the UA against increasing extra-luminal pressures. The craniofacial variations can predispose toward an anatomically unfavorable UA. Obesity seems to play a large part in increasing the passive mechanical pressures, which contribute to UA obstruction by increasing fat deposition around the soft tissues of the neck and tongue, contributing to an increase in extra-luminal pressures in the pharynx that elevates Pcrit, thereby increasing the chances of airway collapse. Elevated levels of obesity have also been shown to worsen nocturnal hypoxemia in OSA, in part due to an increase in oxygen demand. During apnea, obese patients desaturate at a faster level than lean controls.

Obesity-related reductions in lung volumes (ie, FRC and TLC) also increase passive closing pressures at the pharynx. Heinzer et al demonstrated that a 1.3 L increase in FRC during sleep decreased the apnea/hypopnea index (AHI) from 62.3 events per hour to 31.2 events per hour. In an earlier study by the same authors, higher CPAP pressures were found to be required in order to overcome UA obstruction at reduced lung volumes. It appears that lower lung volumes decrease the caudal traction on the UA during lung inflation, producing lesser longitudinal tension on the pharyngeal walls, especially in the supine position.

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  • 7 年前
    最佳解答

    OSA的發展大大增加在更高的BMI的風險。如果病態肥胖(BMI> 40 kg/m2)中,開發OSA的個人的風險介於55%和90%。其他因素包括:一個大的頸圍(> 17英寸)和較高的口服Mallampati評分(表示一個解剖學狹窄UA)。頸圍是OSA的比BMI更好的預測指標。更有趣的是,腹圍已被證明是OSA的兩個比頸圍與BMI一個更好的預測。

    在OSA中,UA在崩潰的臨界關閉壓(Pcrit)。據認為,在咽拖拉肌肉的神經肌肉控制障礙不能保障UA反對增加額外的管腔壓力。顱面變化可以對易患解剖學不利的UA。肥胖似乎增加了被動的機械壓力,從而通過增加在脖子和舌頭的軟組織脂肪沉積,有助於增加在提升Pcrit咽外腔壓力有助於UA阻塞發揮了很大一部分,從而增加氣道塌陷的機率。肥胖水平升高也被證明惡化夜間低氧血症在OSA的,部分是由於增加了氧的需求。在呼吸暫停,肥胖患者降低飽和度以更快的水平比瘦對照。

    與肥胖有關的減少肺容積(即,FRC和TLC)也增加了被動關閉壓力在咽。 Heinzer等人證實,睡眠時的FRC 1.3 L增高每小時62.3事件減少呼吸暫停/低通氣指數(AHI)為每小時31.2事件。在由同一作者先前的研究中,發現較高的CPAP壓力,被要求以克服梗阻UA在降低肺容量。它似乎降低肺容積減小尾部的牽引力的UA肺膨脹過程中,產生的咽壁的較小的縱向張力,尤其是在仰臥位置。

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