上气道解剖与鼻腔通气功能对 OSAHS 诊断及治疗策略的影响研究进展

新阳 黄(承德医学院附属医院，中国)
淑君 张(承德医学院附属医院，中国)

摘要

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是由上气道解剖结构异常与鼻腔通气功能障碍协同引发的常见睡眠呼吸疾病，严重危害患者健康。本综述系统梳理上气道解剖特征（软组织肥大、颌骨发育异常等）与鼻腔通气功能（鼻阻力升高、呼吸模式改变等）参与 OSAHS 发病的核心机制，阐述二者在疾病诊断中的应用价值（含 CT、睡眠内镜、鼻声反射等评估技术），并聚焦解剖与功能导向的个体化治疗策略（单一 / 多平面手术、药物干预、CPAP 辅助治疗等）。最后总结当前研究争议与展望，为 OSAHS 的精准诊疗提供循证依据与实践指导。

关键词

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）；上气道解剖；鼻腔通气功能；诊断评估；个体化治疗

参考

中华医学会呼吸病学分会睡眠呼吸障碍学组。阻塞性睡眠呼吸暂停低通气综合征诊治指南 (2011 年修订版)[J]. 中华结核和呼吸杂志，2012, 35 (1): 9-12.

Hartfield P J, Janczy J, Sharma A, et al. Anatomical determinants of upper airway collapsibility in obstructive sleep apnea: a systematic review and meta-analysis[J]. Sleep Medicine Reviews, 2022, 66: 101682.

Gao F, Li Y R, Xu W, et al. Upper airway morphological changes in obstructive sleep apnoea: effect of age on pharyngeal anatomy[J]. The Journal of Laryngology & Otology, 2020, 134(7): 589-596.

Shrikrishna B H, Deepa G, Anupama S, et al. Anatomical Basis of Obstructive Sleep Apnoea: A Review of Randomized Controlled Trials[J]. Cureus, 2023, 15(9): e44525.

Liu Y L, Lun H M, Hu Q, et al. Dynamic behavior of the oropharynx airway during deep breath in patients with obstructive sleep apnoea hypopnoea syndrome observed by ultrasonography[J]. Scientific Reports, 2025, 15: 5585.

Michels D S, Rodrigues A M S, Nakanishi M, et al. Nasal Involvement in Obstructive Sleep Apnea Syndrome[J]. International Journal of Otolaryngology, 2014, 2014:717419.

Lan M C, Lan M Y, Kuan E C, et al. Nasal Obstruction as a Potential Factor Contributing to Hypoxemia in Obstructive Sleep Apnea[J]. Nature and Science of Sleep, 2021, 13: 55-62.

Lan M C, Lan M Y, Kuan E C, et al. Nasal Obstruction as a Potential Factor Contributing to Hypoxemia in Obstructive Sleep Apnea[J]. Nature and Science of Sleep, 2021, 13: 55-62.

陆汉强，蒋华平，黄秋生。鼻声反射在行鼻腔扩容术 OSAHS 患者鼻功能评估中的应用 [J]. 临床耳鼻咽喉头颈外科杂志，2016, 30 (1): 58-61.

Liu Y L, Lun H M, Hu Q, et al. Dynamic behavior of the oropharynx airway during deep breath in patients with obstructive sleep apnoea hypopnoea syndrome observed by ultrasonography[J]. Scientific Reports, 2025, 15(5585): 1-13.

Shrikrishna B H, Deepa G, Anupama S, et al. Anatomical Basis of Obstructive Sleep Apnoea: A Review of Randomized Controlled Trials[J]. Cureus, 2023, 15(9): e44525.

严小玲，徐亚丽，李敏雄，等。鼻通气功能评估在睡眠呼吸紊乱疾病中的应用价值 [J]. 临床耳鼻咽喉头颈外科杂志，2014, 28 (15): 1125-1128.

中国成人阻塞性睡眠呼吸暂停诊断和外科治疗指南制订工作组，中华医学会耳鼻咽喉头颈外科学分会 (咽喉学组、嗓音学组), 中华耳鼻咽喉头颈外科杂志编辑委员会。成人阻塞性睡眠呼吸暂停诊断和外科治疗指南 (2024)[J]. 中华耳鼻咽喉头颈外科杂志，2025, 60 (7): 716-758.

Georgalas C. The role of the nose in snoring and obstructive sleep apnoea: an update[J]. Eur Arch Otorhinolaryngol, 2011, 268(9):1365-1373.

Park D Y, Cho J H, Jung Y G, et al. Clinical Practice Guideline: Clinical Efficacy of Nasal Surgery in the Treatment of Obstructive Sleep Apnea[J]. Clinical and Experimental Otorhinolaryngology, 2023, 16(3): 201-216.

Sharma S, Wormald J C R, Fishman J M, et al. Rhinological interventions for obstructive sleep apnoea – a systematic review and descriptive meta-analysis[J]. The Journal of Laryngology & Otology, 2019, 133(7): 589-596.

Charakorn N, Hirunwiwatkul P, Chirakalwasan N, et al. The effects of topical nasal steroids on continuous positive airway pressure compliance in patients with obstructive sleep apnea: a systematic review and meta-analysis[J]. Sleep Breath, 2016, 20(4): 1189-1196.

National Center for Biotechnology Information. Upper airway surgery in people unable to tolerate or adhere to CPAP[M]//NBK574316. 2025.

DOI: http://dx.doi.org/10.12345/yzlcyxzz.v9i1.35847