Hattori C, Nishimura T, Shibata N, Akita Y, Kawakatsu K, Hayakawa M, Nishimura Y, Hattori H, Suzuki K, Yagisawa M
Second Department of Otolaryngology, Fujita Health University, Nagoya.
Nihon Jibiinkoka Gakkai Kaiho. 2000 Dec;103(12):1284-91. doi: 10.3950/jibiinkoka.103.1284.
Uvulopalatopharyngoplasty (UPPP) and nasal CPAP are used for the treatment of obstructive sleep apnea syndrome (OSAS) in different institutions. Although OSAS results from an abnormality in the soft-palate, almost no reports have been made on the selection of UPPP or nasal CPAP procedures according to the type of abnormality. The most probable reason for this is that a comparison of treatment methods in individuals cases is difficult. We performed CPAP titration before and after operations, and compared the treatment methods, and evaluated the medical therapy.
A sleep polygraph was performed on the first night, and cases diagnosed as OSAS received CPAP titration on the second night. The blocked region was identified by endoscopic examination. The results of the operation were evaluated after 1-2 months, and apnea hypopnea index (AHI) improvements of less than 50% received a second CPAP titration.
The operation results were poor for cases where endoscopic examination showed full-circumference palatal type, and good for soft palate and tonsillar type abnormalities. When endoscopic examinations were performed in conjunction with nasal CPAP, the treatment was observed to act on the soft palate and expand the air way in all cases. Nasal CPAP was effective in cases with full-circumference palatal abnormalities because in these cases, the pressure was caused by inflamma. Combined medical treatments were effective in cases where CPAP alone was ineffective because the pressure was too high.
悬雍垂腭咽成形术（UPPP）和鼻持续气道正压通气（CPAP）在不同机构用于治疗阻塞性睡眠呼吸暂停综合征（OSAS）。尽管OSAS是由软腭异常引起的，但几乎没有关于根据异常类型选择UPPP或鼻CPAP手术的报道。最可能的原因是在个体病例中比较治疗方法很困难。我们在手术前后进行了CPAP滴定，比较了治疗方法，并评估了药物治疗效果。
第一晚进行睡眠多导监测，诊断为OSAS的病例在第二晚接受CPAP滴定。通过内镜检查确定阻塞区域。术后1 - 2个月评估手术结果，呼吸暂停低通气指数（AHI）改善小于50%的患者接受第二次CPAP滴定。
内镜检查显示全周腭型的病例手术效果差，软腭和扁桃体型异常的病例手术效果好。当结合鼻CPAP进行内镜检查时，观察到治疗对所有病例的软腭均有作用并扩大了气道。鼻CPAP对全周腭异常的病例有效，因为在这些病例中，压力是由炎症引起的。联合药物治疗对单独使用CPAP无效（因为压力过高）的病例有效。
