基于CT三维重建的鼻腔结构参数对OSAHS患者夜间低氧血症的预测效能

Predictive efficacy of nasal structural parameters based on CT three-dimensional reconstruction for nocturnal hypoxemia in patients with obstructive sleep apnea-hypopnea syndrome

摘要:

目的 分析鼻腔解剖结构与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者夜间低氧血症的关系，为低氧风险分层提供影像学参考，并为鼻腔扩容手术相关研究提供形态学基础。方法 连续纳入150例 OSAHS患者，其中合并夜间低氧血症者75例（低氧血症组）、未合并夜间低氧血症者75例（非低氧血症组）。经鼻窦CT三维重建测量鼻腔总容积、最狭窄处截面积、鼻中隔偏曲角度和下鼻甲最大厚度，同步行多导睡眠监测，记录呼吸暂停低通气指数（AHI）、氧减指数（ODI）及最低血氧饱和度（minSpO₂）。采用Spearman相关分析评价鼻腔结构参数与睡眠监测指标的相关性；以是否合并夜间低氧血症为结局，绘制受试者工作特征（ROC）曲线，评价各鼻腔结构参数对夜间低氧血症的预测效能。结果 低氧血症组体质指数（BMI）、AHI、ODI、鼻中隔偏曲角度和下鼻甲最大厚度均高于非低氧血症组，鼻腔总容积和最狭窄处截面积更低（P均<0.001）。Spearman相关分析显示，鼻腔总容积、最狭窄处截面积与minSpO₂呈正相关、与ODI呈负相关，鼻中隔偏曲角度和下鼻甲最大厚度则相反（P均<0.05）。4个鼻腔参数对夜间低氧血症的判别能力为中等，曲线下面积（AUC）为0.679~0.770(P均<0.001)。结论 鼻腔结构参数与OSAHS患者夜间低氧血症的关联密切，基于CT三维参数的定量评估可为OSAHS患者个体化治疗提供关键解剖学依据。

Abstract:

Objective To investigate the association between nasal anatomical structure and nocturnal hypoxemia in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and to provide radiological reference for hypoxemia risk stratification and a morphological basis for further research on nasal cavity expansion surgery. Methods A total of 150 patients with OSAHS were consecutively enrolled, including 75 with nocturnal hypoxemia (hypoxemia group) and 75 without (non-hypoxemia group). Total nasal cavity volume, minimal cross-sectional area, nasal septum deviation angle, and maximum inferior turbinate thickness were measured by three-dimensional reconstruction of paranasal sinus CT. Simultaneously, polysomnography was performed to record the apnea-hypopnea index (AHI), oxygen desaturation index (ODI) and the minimum oxygen saturation (minSpO₂). Spearman correlation analysis was used to assess the correlations between nasal structure parameters and sleep monitoring indices. Receiver operating characteristic (ROC) curves were constructed using the presence or absence of nocturnal hypoxemia as the outcome to assess the predictive performance of each nasal parameter. Results Compared to the non-hypoxemia group, the hypoxemia group had significantly higher body mass index (BMI), AHI, ODI, deviated septum angle, and maximum inferior turbinate thickness, while the total nasal cavity volume and the minimal cross-sectional area were lower (all P<0.001). Spearman correlation analysis showed that the total nasal cavity volume and the minimal cross-sectional area were positively correlated with minSpO₂ and negatively correlated with ODI, whereas the septum deviation angle and the maximum inferior turbinate thickness were the opposite (all P<0.05). The discriminatory ability of the four nasal parameters for nocturnal hypoxemia was moderate (area under the curve ranging from 0.679 to 0.770, all P<0.001). Conclusions The nasal structural parameters are closely associated with nocturnal hypoxemia in OSAHS patients. Quantitative assessment based on CT three-dimensional parameters can provide critical anatomical evidence for individualized treatment of OSAHS.