Objective To evaluate the clinical value of localization of upper airway obstructive site with pressure measurements and Friedman staging system in preoperative upper airway reconstructive surgery for obstructive sleep apnea-hypopnea syndrome (OSAHS), and to evaluate the value of Friedman staging system in predicting the upper airway obstructive site. Methods One hundred and three patients with snoring, daytime sleepiness diagnosed as OSAHS by polysomnography were first classified using Friedman staging system, and then examined using whole night recording, including airway continuous pressure measurements (Apnea Graph, AG). AG transducer catheter containing two pressure and two temperature sensors used for obstruction site determination and detection of apnea events during sleep. Obstructive sites were divided into upper (retropalatal region) or lower level (retroglossal region). Using constituent ratio to reflect the obstructive proportion of different levels so as to find the correlation between Friedman staging system and localization of upper airway obstructive site with pressure measurements performed during sleep,and to evaluate the clinical value of Friedman staging system in predicting the severity of OSAHS. Results There was statistically significant difference in the constituent ratio of retroglossal obstruction determined by AG, according to Friedman staging system, Friedman tongue position (FTP) and tonsil size grading ( F =13. 876, 7. 655,10. 207 respectively, P ＜0. 05 ). The constituent ratio of retroglossal obstruction between stage Ⅳ and Ⅰ , Ⅱ, Ⅲ(P＜0.01) was significantly different. With the increasing of Friedman staging,the constituent ratio of retroglossal obstruction had the tendency of increasing. The constituent ratio of retroglossal obstruction between FTP grade 2 and grade 3, grade 4 ( P ＜ 0. 05 ) was significantly different.With the increasing of FTP grading, the constituent ratio of retroglossal obstruction had the tendency of increasing. The constituent ratio of retroglossal obstruction between the Friedman tonsil size grade 4 and gradel, grade 3 ( P ＜ 0. 01 ), grade 2 ( P ＜ 0. 05 ) was significantly different. Conclusions Friedman staging system, in particular the FTP grading, had a correlation with upper airway pressure measurements (AG) in determination of the lower level of upper airway obstructive site, especially the retroglossal region,which could predict the main localization of upper airway obstructive site identified by upper airway pressure measurements during the sleep.%目的 通过比较上气道压力测定法与Friedman气道阻塞临床分型在阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者术前评估判定阻塞平面中的作用,分析Friedman气道阻塞临床分型预测阻塞平面的价值.方法 对103例有打鼾及白天嗜睡已经多道睡眠监测确诊为OSAHS患者进行Friedman气道阻塞临床分型后,同期应用Apnea Graph(AG)行整夜的睡眠监测和上气道压力测定,以下部阻塞层面(主要为舌后区)构成比分析Friedman 气道阻塞临床分型与上气道压力测定所显示上气道阻塞部位的关系.结果 根据Friedman临床分型、舌位高度分级(Friedman tongue position,FTP)、扁桃体分度分组,AG判断的下部阻塞构成比的差异有统计学意义(F值分别为13.876、7.655、10.207,P值均＜0.05).两两比较,下部阻塞构成比在Friedman临床分型的Ⅳ型与Ⅰ、Ⅱ、Ⅲ型之间差异均有统计学意义(P值均＜0.01),且有随着分型级别增高,下部阻塞构成比也有增高的趋势;在FTP分级的2级与3、4级之间差异有统计学意义(P值均＜0.05),也有随着分级增高下部阻塞构成比增高的趋势;在扁桃体分度的4度与1度、2度、3度之间差异均有统计学意义(P值＜0.01或0.05).结论 Friedman临床分型,特别是其中的FTP分级与AG对下部阻塞的判定有相关性趋势,可以作为预测OSAHS患者睡眠时上气道阻塞平面的参考.
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