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阻塞性睡眠呼吸暂停低通气综合征患者多维嗓音及发声空气动力学分析

Multidimensional Vocal and Aerodynamic Analysis of Obstructive Sleep Apnea-hypopnea Syndrome

魏梅;杜建群;王晓雨;王桂萍;林鹏;

1:天津市第一中心医院耳鼻咽喉头颈外科

2:天津市耳鼻喉科研究所

3:天津市"十三五"临床重点学科耳鼻咽喉科学

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摘要

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)对患者嗓音的影响。方法应用多维嗓音分析软件分析45例重度OSAHS患者(OSAHS组)与38例正常人(正常组)嗓音基频相关指标、基频微扰相关指标、振幅微扰相关指标、噪声相关指标、扰动相关指标、次谐波成分指标、嗓音不规则性测量、嗓音中断测量8大声学指标间的差异,并分别检测并比较OSAHS组及正常组的发声空气动力学指标。结果 OSAHS组与正常组的基频相关指标、扰动相关指标、次谐波成分指标、嗓音不规则性测量、嗓音中断测量指标差异无统计学意义(均为P>0.05)。基频微扰相关指标、振幅微扰相关指标及噪声相关指标OSAHS组明显高于正常组,其中,OSAHS组的基频微扰百分比、振幅微扰百分比、噪谐比、嗓音紊乱指数分别为1.611%±0.822%、4.124%(3.497%,5.341%)、0.149(0.141,0.165)、0.076(0.056,0.100);而正常组的基频微扰百分比、振幅微扰百分比、噪谐比、嗓音紊乱指数分别为0.471%±0.220%、2.621%(2.160%,2.969%)、0.131(0.114,0.140)、0.057(0.043,0.060)。基频变化系数、振幅微扰、噪谐比的ROC曲线下面积在相应指标类别中最大,可作为诊断OSAHS患者嗓音异常的重要声学指标,其值分别在1.134%、0.318dB、0.141时灵敏性和特异性最高。空气动力学指标中平均气流率、声门下压正常组分别为0.17(0.1225,0.220)L/s、6.199±2.421cmH_2O,OSAHS组分别为0.215(0.17,0.26)L/s、7.850±1.867cmH_2O,正常组明显小于患者组(P<0.05)。正常组声门阻力、发声效率分别为40.1(29.975,61.345)cmH_2O·L(-1)·s(-1)·s(-1)、666.895(537.485,842.058)ppm,OSAHS组分别为29.72(18.528,36.102 5)cmH_2O·L(-1)、666.895(537.485,842.058)ppm,OSAHS组分别为29.72(18.528,36.102 5)cmH_2O·L(-1)·s(-1)·s(-1)、359.96(247.575,531.035)ppm,正常组大于OSAHS组(P<0.05),声门下压为6.005cmH_2O时是检测OSAHS患者灵敏度和特异性较高的空气动力学指标。结论 OSAHS患者声门闭合欠佳,声带振动不规律,嗓音声学分析及发声空气动力学检测可对OSAHS患者的发声功能进行客观评估,是检测OSAHS患者嗓音状况的重要方法。

关键词

阻塞性睡眠呼吸暂停低通气综合征;多维嗓音分析;空气动力学

基金项目(Foundation):

作者

魏梅;杜建群;王晓雨;王桂萍;林鹏;

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