Background It is believed that defects in upper airway neuromuscular control play a role in sleep apnea pathogenesis. Currently, there is no simple and non-invasive method for evaluating neuromuscular activity for the purpose of screening in patients with obstructive sleep apnea. This study was designed to assess the validity of chin surface electromyography of routine polysomnography in evaluating the neuromuscular activity of obstructive sleep apnea subjects and probe the neuromuscular contribution in the pathogenesis of the condition. Methods The chin surface electromyography of routine polysomnography during normal breathing and obstructive apnea were quantified in 36 male patients with obstructive sleep apnea. The change of chin surface electromyography from normal breathing to obstructive apnea was expressed as the percent compensated electromyography value, where the percent compensated electromyography value = （normal breath surface electromyography - apnea surface electromyography）/normal breath surface electromyography, and the percent compensated electromyography values among subjects were compared. The relationship between sleep apnea related parameters and the percent compensated electromyography value was examined. Results The percent compensated electromyography value of the subjects varied from 1% to 90% and had a significant positive correlation with apnea hypopnea index （R2=0.382, P 〈0.001）. Conclusions Recording and analyzing chin surface electromyography by routine polysomnography is a valid way of screening the neuromuscular activity in patients with obstructive sleep apnea. The neuromuscular contribution is different among subjects with obstructive sleep apnea.
YIN Guo-ping YE Jing-ying HAN De-rain WANG Xiao-yi ZHANG Yu-huan LI Yan-ru
目的探讨24 h 咽喉 pH 检测在咽喉反流性疾病诊断中的价值。方法选取2006年8月至10月于北京同仁医院就诊由同一医师诊断可疑有反流性咽喉炎患者50例,征得患者同意后以就诊时间为配伍因素,按区组随机排列方法采用半随机分组。第一组25例患者均行24 h 咽喉 pH检测,筛选出阳性患者作为试验组接受奥美拉唑抗酸治疗;第二组25例患者直接给予相同药物及剂量的试验性抗酸治疗作为对照组。服药3个月后进行随访,根据反流症状评分对比治疗前后效果,以主观症状评估总分下降≤4分为治疗无效,>4分为有效。结果行24 h 咽喉 pH 检测的25例患者中有病理性咽喉部反流者17例,阳性率为68.0%(17/25)。24 h 平均总反流次数(35.71±41.70)次(±s,以下同),总反流时间(35.71±33.19)min,总反流指数即每小时反流次数(1.53±1.73)次/h,每次反流平均时间(1.12±0.91)min。抗酸治疗前试验组症状评估总分平均(14.88±4.11)分,对照组总分平均(13.00±4.17)分,组间差异采用 t 检验,无统计学意义(P>0.05)。在抗酸治疗3个月后随访,试验组有效率为82.4%(14/17),对照组失访2例,其余患者治疗有效率为52.2%(12/23)。试验组症状评估总分平均下降(7.47±3.18)分,对照组症状评估总分下降(3.96±4.25)分,总分差值比较,差异有统计学意义(P<0.01)。结论 24 h 咽喉 pH 检测作为诊断咽喉反流性疾病的金标准,可以作为临床中可疑咽喉反流患者的确诊检查手段,并可大大提高抗酸治疗的有效性,值得在临床普遍开展和推广。
