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Clarifying the link between sleep disordered breathing and tracheal collapse: a retrospective analysis

机译：澄清睡眠呼吸障碍与气管塌陷之间的联系：回顾性分析

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Background Symptoms of acquired tracheobronchomalacia (TBM) include wheezing, shortness of breath, and chronic cough, and can negatively affect quality of life. Successful treatment of TBM requires identification of the disorder and of contributing factors. Acquired TBM is generally associated with a number of conditions, including asthma, chronic obstructive pulmonary disease (COPD), and gastroesophageal reflux. Although a possible relationship with obstructive sleep apnea (OSA) has been observed, data illuminating such an interaction are sparse. Methods In the present study, we analyzed the percent tracheal collapse (as measured on dynamic chest CT) and detailed sleep reports of 200 patients that had been seen at National Jewish Health, half of which had been diagnosed with OSA and half which did not have OSA. Results Tracheal collapse ranged from 0 to 99% closure in the population examined, with most subjects experiencing at least 75% collapse. OSA did not relate significantly to the presence or severity of tracheobronchomalacia in this population. Sleep disordered breathing (SDB) did show a strong association with TBM ( p ?0.03). Conclusions Tracheobronchomalacia may develop as a result of increased negative intrathoracic pressure created during attempts at inhalation against a closed or partially closed supraglottic area in patients experiencing apneic or hypopneic events, which contributes to excessive dilation of the trachea. Over time, increased airway compliance develops, manifesting as tracheal collapse during exhalation. Examining TBM in the context of SDB may provide a reasonable point at which to begin treatment, especially as treatment of sleep apnea and SDB (surgical or continuous positive airway pressure) has been shown to improve associated TBM.
机译：背景技术获得性气管支气管软化症（TBM）的症状包括喘息，呼吸急促和慢性咳嗽，并且可能对生活质量产生负面影响。要成功治疗TBM，就必须确定疾病和影响因素。获得性TBM通常与多种疾病相关，包括哮喘，慢性阻塞性肺疾病（COPD）和胃食管反流。尽管已经观察到与阻塞性睡眠呼吸暂停（OSA）的可能关系，但阐明这种相互作用的数据很少。方法在本研究中，我们分析了200名在美国国家犹太健康中心就诊的患者的气管塌陷百分比（通过动态胸部CT测量）和详细的睡眠报告，其中一半被诊断为OSA，另一半没有被诊断为OSA。 OSA。结果在所检查的人群中，气管塌陷的范围为0％至99％，大多数受试者的塌陷程度至少为75％。 OSA与该人群中气管支气管软化症的存在或严重程度无明显关系。睡眠呼吸障碍（SDB）确实与TBM密切相关（p <？0.03）。结论气管支气管软化可能是由于在呼吸暂停或呼吸不足的患者中尝试吸入封闭或部分封闭的声门上区域时产生的负胸内压力而导致的，从而导致气管过度扩张。随着时间的流逝，呼吸道顺应性逐渐增强，表现为呼气时气管塌陷。在SDB的背景下检查TBM可能会为开始治疗提供一个合理的时机，特别是因为睡眠呼吸暂停和SDB（外科或持续气道正压通气）的治疗已显示可改善相关的TBM。

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