전자선단층촬영기를이용한코골이환자의역동적상기도측정

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1 KISEP Rhinology Korean J Otolaryngol 3;46:-5 전자선단층촬영기를이용한코골이환자의역동적상기도측정 예미경 신승헌 김창균 이상흔 이종민 3 최재갑 4 Dynamic Upper Airway Study in Snoring Subjects Using Electron Beam Tomography Mi Kyung Ye, MD, Seung Heon Shin, MD, Chang Gyun Kim, MD, Sang Heun Lee, MD, Jong Min Lee, MD 3 and Jae Kap Choi, DDS 4 Department of Otolaryngology Head and Neck Surgery, College of Medicine, Catholic University of Daegu and Department of Otolaryngology Head and Neck Surgery and 3 Diagnostic Radiology, College of Medicine, Kyungpook National University 4 Department of Oral Medicine, College of Dentistry, Kyungpook National University, Daegu, Korea ABSTRACT Background and ObjectivesThe upper airway caliber shows rhythmic changes according to the respiratory cycle. The dynamic imaging technique is needed to demonstrate nonfixed oropharyngeal obstruction in patients with snoring and/or obstructive sleep apnea. This study was designed with the purpose to determine the level, extent, and dynamics of the oropharyngeal closure from the dynamic view of the oropharynx and to estimate the usefulness of electron beam tomography EBT in the snoring and/or obstructive sleep apnea patients. Materials and MethodThe upper airway was scanned in 8 patients with snoring by using EBT while awake, asleep, pre and post UPPP six patients, and pre and post oral appliance seven patients during at least two full respiratory cycles. ResultsThe oropharyngeal stenosis and collapsibility were increased during sleep, especially in the minimum cross sectional area level. In most cases, the sites of stenosis of wakefulness and sleep did not coincide. The degree of stenosis as well as collapsibility of the oropharynx were reduced after UPPP and oral appliance. ConclusionThe dynamic study during sleep is needed to evaluate sleep induced airway disease. EBT has the potential to provide information quickly and non-invasively on upper airway dynamics and has certain definite advantages over conventional studies. (Korean J Otolaryngol 3;46:-5) KEY WORDSSnoring Sleep Apnea, Obstructive Diagnostic Imaging. -

2 예미경외 Radius cm Cephalic Caudal Minimal CSA Maximal CSA Level of Oropharynx Fig.. Simulated longitudinal diagram of the oropharynx. It was made for the purpose of better depiction of regional oropharyngeal geometry. Dotted linemaximal cross-sectional area, solid lineminimal cross-sectional area. EBT-Multislice flow mode sec.4 sec.8 sec. sec.6 sec. sec.4 sec.8 sec 3. sec 3.6 sec 4. sec 4.4 sec 4.8 sec 5. sec 5.6 sec 6. sec 6.4 sec 6.8 sec 7. sec 7.6 sec Fig.. EBT scans of multi-slice flow mode at a selected level during obstructive sleep apnea. Note total occlusion of the airway. These images of one level were at.4 second intervals and the rest levels of the airway were imaged almost simultaneously.

3 전자선단층촬영기를이용한역동적상기도측정 - Table. The comparison of asleep with awake state in mean values of oropharyngeal minimal cross-sectional areas and minimal volumes and collapsibility indices Awake Asleep Asleep/Awake mcsa mm mvol mm Overall CI % CI of mcsa % CI of Vol % mcsamean value of smallest minimal cross-sectional areas in each patient, mvolmean value of minimal oropharyngeal volume, Overall CImean value of overall average collapsibility indices of the oropharyngx, CI of mcsamean value of the collapsibility indices at smallest minimal cross-sectional areas, CI of Volmean value of the collapsibility indices of volume maximal Volume-minimal Volume/maximal Volume Table. Changes in minimal cross-sectional area and collapsibility index between the awake and asleep state at three oropharyngeal regions High Middle Low Awake Asleep Awake Asleep Awake Asleep mcsa mm CI % High, Middle, Lowthree oropharyngeal regions, mcsaminimal cross-sectional area, CIcollapsibility index.5 Awake, Pre-UPPP.5 Awake, Post-UPPP Radius cm SP BOT Level of oropharynx Asleep, Pre-UPPP Asleep, Post-UPPP Fig. 3. Diagrams showing the results of EBT that scanned before and after UPPP in awake and asleep states. Two vertical lines mean levels of oropharynx determined by review of images of each case. The left line corresponds to the level of distal margin of the soft palate SP, and the right one to the base of tongue BOT. In preoperative results, pharyngeal diameter decreased during sleep compared with awake state through entire length. The obstruction was visible at the region of retropalatal area. The pharyngeal collapsibility increased during sleep, most markedly at the stenotic level. The degree of stenosis was alleviated and the collapsibility of oropharynx was reduced after operation. Korean J Otolaryngol 3;46:-5

4 예미경외 Radius cm Awake SP BOT Level of oropharynx Awake, Oral appliance Asleep Asleep, Oral appliance Fig. 4. Diagrams showing the results of EBT that scanned before and after oral appliance in awake and asleep states. In this case, there were two stenotic sites of retropalatal and retroglossal areas during sleep. The retroglossal stenosis was relieved by wearing an oral appliance, and persisting cephalic stenosis seemed to be needed operation such as UPPP or LAUP. - 3

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