Obstructive Area O1Upper Airway And PGP9.5、NCAM Expression In Soft Palate Of OSAHS Patients

Objective To study airway obstruction position of obstructive sleep apnea hypopneasyndrom (obstructive sleep apnea/hypopnea syndrome, OSAHS) patients and study theobstruction in addition to the anatomical factors involved in the occurrence of OSAHS,whether there is nerve muscle abnormalities involved in the occurrence of OSAHS.Methods1.We choosed100OSAHS patients diagnosed by PSG (Polysomnography,Polysomnography).They were underwent routine physical examination, such as height、weight、neck circumference、 maxillofacial structural abnormality. They wereunderwent specialized examination, such as the nasopharynx、oropharynx,、laryngealpharynx,whether there were anatomical obstruction. They were underwentlaryngofiberscope examination with Muller experiment. They were underwent upperairway CT and the scanning range was from cricoid cartilage to top ofnasopharyngeal.The above examinations could locate obstructed regions occured in theairway.2.Thirty patients with OSAHS were selceted as the experimental group andwhile10patients diagnosed as the simple chronic tonsillitis excluded OSAHS wereselceted as control group. Peripheral nerve distribution in soft palate tissue ofexperimental group and control group was evaluated by HE staining detection.Theexpressions of PGP9.5and NCAM were detected in both groups byimmunohistochemistry method. The level of PGP9.5and NCAM were expressed by theintegrated optical density(IOD) as one kind of semi-quantitative examination,comparing the expression of PGP9.5and NCAM in experimental group and controlgroup could help us to find their difference.Studying the relationship between theexpression of PGP9.5and NCAM in experimental group and AHI could help us to find their relevance.Results1.In routine physical examination,there were80cases with nasal cavitystructure narrow.Nasal septum deviation and chronic hypertrophic rhinitis werecommon.According to Friedman grading,13cases are2°palatal lingual relations.36cases are3°palatal lingual relations.51cases are4°palatal lingual relations. Inlaryngofiberscope examination with Muller experiment,80cases were nasopharyngealstenosis.In oropharyngeal airway obstrucion,there were airway obstructions at isolatedretropalatal regions(fiberoptic pharyngocogy revealing n=32), retropalatal&retroglottal regions simulataneously(fiberoptic pharyngocogy revealing n=66),isolated retroglottal regions (laryngofiberscope examination revealing n=2).In upperairway CT scanning,there were81cases with nasopharyngeal stenosis.In oropharyngealairway obstrucion,there are airway obstruction at isolated retropalatal regions(upperairway CT scanning revealing n=33), retropalatal&retroglottal regionssimulataneously(upper airway CT scanning revealing n=65), isolated retroglottalregions (upper airway CT scanning revealing n=2).2. The peripheral nervedistributions of different tissue levels in soft palate were different.The distribution ofperipheral nerve mainly distributed in the submucosa, glands, blood vessels, and therewas a small amount of distribution around the muscle tissue;○2The expression ofPGP9.5and NCAM in OSAHS patients were significantly higher than the controlgroup,which had statistically difference (P <0.05);○3In OSAHS patients, theexpression of NCAM and PGP9.5were positively correlated to AHI(apnea hypopneaindex),the correction index were0.706and0.636respectively(P=0.01).Conclusion:1.The most likely obstructed region is retropalatal in OSAHS patients.Theretroglottal narrow is also important.There is anatomical narrow of the soft.2. routinephysical examination、fiberoptic pharyngocogy and upper airway CT scanning canlocate the obstructed region.3. There exists the peripheral nerve and nerve reflex in OSAHS patients and non OSAHS.4. The results indicate that nerve abnormalitiesoccurred in the soft palate of OSAHS patients. The more heavier of OSAHS,the moreabnormalities in the soft palate.