Millman R P, Carlisle C C, Rosenberg C, Kahn D, McRae R, Kramer N R
Department of Medicine, Brown University School of Medicine, Providence, RI, USA.
Chest. 2000 Oct;118(4):1025-30. doi: 10.1378/chest.118.4.1025.
Our objective was to determine whether baseline polysomnography, cephalometry, and anthropometry data could predict uvulopalatopharyngoplasty (UPPP) success or failure.
We retrospectively reviewed polysomnography, cephalometry, and anthropometry data from patients who underwent UPPP for obstructive sleep apnea (OSA).
A university medical center.
OSA was diagnosed by polysomnography in 46 patients who underwent UPPP surgery for their sleep disorder.
UPPP surgery with/or without tonsillectomy.
The mean patient age was 43 years, and the mean body mass index was 32.5 kg/m(2). The mean presurgical apnea-hypopnea index (AHI) was 45, and the mean baseline nadir oxygen saturation was 81%. Successful surgery was defined as a reduction in AHI to < 10 or to < 20 with a 50% reduction from the patient's baseline AHI. Of the 46 patients, 16 were successfully treated and 30 did not respond to surgical treatment. A mandibular-hyoid distance (MP-H) > 20 mm was found to be significantly (p = 0.05) predictive of failure of UPPP. When stepwise regression analysis was performed utilizing postsurgical AHI as the dependent variable and presurgical AHI, age, body mass index, baseline nadir O(2) saturation, and five cephalometric measurements as independent variables, MP-H distance significantly (r = 0.524; p = 0.01) correlated positively with postsurgical AHI. The distance between the superior point of a line-constructed plane of the sphenoidale (parallel to Frankfort horizontal) and a point at the intersection of the palatal plane perpendicular to the hyoid correlated negatively with postsurgical AHI (r = 0.586; p = 0.05). By creating a logistic model of this data, an MP-H distance < 21 mm, an angle created by point A to the nasion to point B < 3 degrees, and the presence of a baseline AHI < 38 enhanced the predictability of UPPP success.
The presence of a baseline AHI < 38 and an MP-H < or = 20 mm, and the absence of retrognathia are predictors of improvement after UPPP. Based on these findings, we would advocate the continued evaluation of cephalometric measurements and careful consideration of surgical treatment options for OSA.
我们的目的是确定基线多导睡眠图、头影测量和人体测量数据是否能够预测悬雍垂腭咽成形术（UPPP）的成功或失败。
我们回顾性分析了因阻塞性睡眠呼吸暂停（OSA）接受UPPP手术患者的多导睡眠图、头影测量和人体测量数据。
一所大学医学中心。
通过多导睡眠图诊断为OSA的46例患者因睡眠障碍接受了UPPP手术。
行UPPP手术，伴或不伴扁桃体切除术。
患者平均年龄43岁，平均体重指数为32.5kg/m²。术前平均呼吸暂停低通气指数（AHI）为45，基线最低血氧饱和度平均为81%。手术成功定义为AHI降至<10或降至<20且较患者基线AHI降低50%。46例患者中，16例得到成功治疗，30例手术治疗无效。发现下颌舌骨距离（MP-H）>20mm显著（p = 0.05）预示UPPP手术失败。当以术后AHI作为因变量，术前AHI、年龄、体重指数、基线最低血氧饱和度（O₂）以及五项头影测量值作为自变量进行逐步回归分析时，MP-H距离与术后AHI显著正相关（r = 0.524；p = 0.01）。蝶鞍点（平行于法兰克福平面）构建平面的上点与垂直于舌骨的腭平面交点之间的距离与术后AHI呈负相关（r = 0.586；p = 0.05）。通过对这些数据建立逻辑模型，MP-H距离<21mm、A点至鼻根点至B点形成的角度<3°以及基线AHI<38可提高UPPP手术成功的预测性。
基线AHI<38、MP-H≤20mm以及不存在下颌后缩是UPPP术后病情改善的预测指标。基于这些发现，我们主张对头影测量进行持续评估，并认真考虑OSA的手术治疗方案。
