| ObjectiveObstructive sleep apnea-hypopnea syndrome(OSAHS) is a clinical syndrome of sleep structure disorder characterised by repeated collapse and obstruction of the upper airway during sleep with oxygen desaturation or hypercapnia at the same time. Adverse clinical outcomes associated with OSAHS include: anatomic airway narrowing, the ethnic differences and individual differences with cephalometric indexes, abnormal upper airway neuromotor tone, the decline of the pulinonaiy function residual capacity, obese, the dysfunction of the central ventilation control system, abnormal pulmonary function, metabolic abnormalities. OSAHS disease involves multi-system and multi-organ dysfunction mainly including: the cardiovascular system dysfunction, endocrine system dysfunction, nervous system dysfunction and so on. The disease of nervous system and OSAHS are connected with too many factors. The situation is complicated. There are few research reports related domestically. As an important human sense, Olfactory has a special position in the nervous system. Olfactory disorders have been payed more and more attention to in neuroscience and psychology research. In our study, we want to study the olfactory function and nasal function in OSAHS patients compared with healthy volunteers to investigate the changes of the function of nasal and olfactory sensory in patients, and to explore the related mechanism. MethodHealthy persons were enrolled in this study as control group, patients with OSAHS as observation group. There is difference in olfactory function between male and female. Morbidity rate of male was higher than female. To collect cases easily and decrease this difference, the female patients with OSAHS were excluded.66 patients(male) with OSAHS who complained of daytime sleepiness and snoring in the Otolaryngology-Head and Neck Surgery, the First Central Hospital of Tianjin during the period of January 2014 to January 2015 were included in this study as observation group. Diagnosed OSAHS is based on the diagnostic criteria of OSAHS set by the branch of Otolaryngology-Head and Neck Surgery, Chinese Medical Association. Subjects in observation, ranging in age from 26 to 49, average age(42.4±9.2); Body Mass Index(BMI)22.21-40.3 kg/m2,average BMI(30.9±4.04) kg/m2; Apnea Hyponea Index(AHI)5-109.2 times/h, average AHI(52.1±24.9) times/h; Mean Oxygen Saturation(MSa O2) 78.2%-97%, average MSa O2(88.7±4.9)%; Lowest Oxygen Saturation( LSa O2) 42%-89%, average LSa O2(70.1±10.6)%; were checked for routine screenings of otolaryngology, simply estimated the obstructive site of the upper airway and scored 2-22, average(14.2±3.7) in ESS. Epworth sleepiness scale score was used to evaluate all the subjects daytime sleepiness level.16 healthy volunteers are relatives and friends who accompany OSAHS patients with obtaining the volunteer identity and sign the agreement. For overnight polysomnography(PSG), the apnea hypopnea index(AHI) of all the volunteers are smaller than 5 time/h. Similarly, they are all male whose age is ranging from 28 to 62 years old, and the average age is(42.6 + 10.2); Body mass index(BMI) is about 22.21-40.3 kg/m2, the average of which is(28.6±6.3) kg/m2.Sleep apnea-hypopnea index(AHI) suspended in 1.1 to 4.8 times/h, the average of which is(2.5±1.3) times/h. The mean oxygen saturation(MSa O2) ranges from 78.2% to 97%, the average of which is approximately(96.3±2.0)%.The lowest oxygen saturation(LSa O2) ranges from 42% to 89%, and the mean is(91.1 + 2.9) %. The ESS score is between 1-7 points with the average value of(3.7±1.7).Acoustic rhinometry was used to check the objective nasal ventilation condition. The data is composed of the minimum cross-sectional area(MCA) ?distance of the minimal cross-sectional area to the nostril(DCAN)?the nasal volume from 0 to 5cm and 2 to 5cm(,). And the T&T subjective olfactory function can be used to measure the olfactory threshold(OT) of all the observations.The statistical analysis by SPSS 17.0 was used. The measurement data which had homogeneity of variance and conform to the normal distribution can be denoted by, the homogeneity of variance between two groups can be compared by using two groups of independent sample t test, the heteroscedasticity between groups can be compared by using Wilcoxon rank sum test; general linear model can be used to do ANOVA tests and correlation analysis can be calculated by Pearson, P<0.05 was considered statistically significant. Results1. The general compare between OSAHS group and normal control group is: with regarding to age, there was no statistically significance between OSAHS patients and normal control group(value of t was 0.94, P>0.05), however, the threshold value of BMI, AHI, LSa02, MSa02, ESS of two groups exist significant difference(the values of t were 0.47, 9.7,-7.26,-9.56, 13.59, P<0.01).2. Statistical analysis of OSAHS patients' test results2.1 Patients with OSAHS are categorized by age: 66 patients with OSAHS were divided into group of 17 patients whose age is under 35 years old(25.8%), a group of 42 patients with 36-55 years old(63.6%) and the last group of 7 patients beyond 56 years old(10.6%).2.2 OSAHS patients were classified by body mass index(BMI): in 66 patients with OSAHS, there are 48 cases who are obese people(72.7%), meanwhile, the overweight are 15 cases(22.8%) and the normal are 3 cases(4.5%).2.3 OSAHS patients were classified by AHI index: in 66 patients, the less mild OSAHS patients, that is OSAHS AHI?20, account for 12.1%( 8 cases), in the same time, the proportion of the moderate OSAHS patients with 40?AHI>20 and the severe OSAHS patients with AHI > 40 are respectively 24.2%(16 cases) and 63.6%.2.4 OSAHS patients were classified according to the minimum blood oxygen saturation index: In 66 cases of OSAHS patients with mild hypoxia, there are 3 with cases 90%>LSao2 > 85%(4.5%), 43 cases in patients with moderate hypoxemia 85%>LSao2 >=65%(65.2%), 20 cases in patients with severe hypoxemia with LSao2<65%(30.3%).3.Comparison of nasal function and olfactory function in patients with OSAHS and control group:3.1 OSAHS patients and control group compared in nasal olfactory function: the olfactory threshold(OT) in patients is 1 + 1.04, the control group of olfactory threshold is 0.13 + 1.3.Olfactory control group's Olfactory decreased, the two groups had statistically significant difference(t=2.93.P<0.01).3.2 Result of the comparison of OSAHS patients and the control group of acoustic rhinometry: OSAHS patients' nasal cavity volume V0-5 5 is lower than the control group(t value were-3.14 and-2.23, P<0.05). Two groups have statistically difference; and minimal nasal cross-sectional area from the anterior nares distance(DCan) and minimum nasal cross-sectional area(MCA) between two groups had no statistically significant difference(t=0.69, 0.82, P>0.05, respectively).4?In the results of the nasal ventiltor function in patients with OSAHS and control groups, there were positive correlations between ages?ESS sleepiness scores?AHI, r=0.23,0.33,0.34,P<0.05,and there were negtive correlations between MSa O2?LSa O2, r=-0.36,-0.31,P<0.05.ConclusionThe nasal ventiltor function in patients with OSAHS decreases compared with control groups. Patients with OSAHS are influenced by the decrease of nasal function to sustain normal ventilation resulting in the decrease of sense of smell sensor and the injury in central olfactory cortex resulting in the decrease of subjective olfactory perception. The two factors cause nasal ventiltor function of OSAHS patients decrease to varying degrees. Meanwhile, secondary olfactory cortex can integration sense of smell?gustation?viscera?optesthesia and somatesthesia. Therefore, the preoperative assessment in patients with OSAHS should take the nasal olfaction function into account. |
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