Terris David J, Kunda Larisa D, Gonella Marie C
Department of Otolaryngology/Head and Neck Surgery, Medical College of Georgia, Augusta 30812-4060, USA.
J Laryngol Otol. 2002 Sep;116(9):716-21. doi: 10.1258/002221502760238028.
Moderate to severe obstructive sleep apnoea is usually associated with multiple levels of pharyngeal airway collapse, including tongue base obstruction. A new technique has recently been introduced that improves the nocturnal retro-lingual airway. This study was a prospective, non-randomized single-institution evaluation of a recently introduced surgical technique. Nineteen consecutive patients with previously untreated moderate to severe obstructive sleep apnoea underwent tongue suspension using the Respose system and concomitant palatopharyngoplasty (multilevel pharyngeal surgery). The patient demographics and treatment outcomes were prospectively collected and retrospectively analysed. There were 16 men and three women, with a mean (+/-SD) age of 44.9 years (+/- 14.2) and a mean pre-operative apnoea-hypopnoea index (AHI) of 42.8 +/- 24.8. Twelve of the 19 patients (63.2 per cent) have had post-operative polysomnography; eight of these 12 (67 per cent) met the standard criteria for surgical response. Among these eight patients, the AHI improved from 32.4 to 14.4 (p<0.01); the individual scores fell by a mean of 51.7 per cent. The apnoea index improved from 7.4 to 0.9 (p<0.01), with the individual scores falling by a mean of 81.4 per cent. There was anatomic and radiographic evidence of multilevel upper airway enlargement. Notably, the body mass index remained essentially unchanged (31.5 +/- 7.2 to 31.2 +/- 7.6, p>0.5). Subjectively, the mean Epworth sleepiness scale score fell from 11.0 +/- 5.4 to 5.4 +/- 3.8 (p<0.005). Four patients suffered transient velopharyngeal insufficiency, and two patients complained of limited anterior excursion of the tongue. There were no serious, long-term complications. The tongue suspension procedure represents a minimally invasive technique for improving the nocturnal retro-lingual airway in patients with obstructive sleep apnoea. It is easily performed by otolaryngologists, distinguishing it from other established techniques designed to address tongue base obstruction.
中度至重度阻塞性睡眠呼吸暂停通常与包括舌根阻塞在内的多个咽气道塌陷水平相关。最近引入了一种新技术，可改善夜间舌后气道。本研究是对最近引入的一种外科技术进行的前瞻性、非随机单机构评估。19例先前未经治疗的中度至重度阻塞性睡眠呼吸暂停患者连续接受了使用Respose系统的舌悬吊术及同期腭咽成形术（多级咽部手术）。对患者的人口统计学数据和治疗结果进行了前瞻性收集和回顾性分析。患者中有16名男性和3名女性，平均（±标准差）年龄为44.9岁（±14.2），术前平均呼吸暂停低通气指数（AHI）为42.8±24.8。19例患者中有12例（63.2%）术后进行了多导睡眠监测；这12例患者中有8例（67%）符合手术反应的标准。在这8例患者中，AHI从32.4改善至14.4（p<0.01）；个体评分平均下降了51.7%。呼吸暂停指数从7.4改善至0.9（p<0.01），个体评分平均下降了81.4%。有解剖学和影像学证据表明多级上气道扩大。值得注意的是，体重指数基本保持不变（从31.5±7.2降至31.2±7.6，p>0.5）。主观上，Epworth嗜睡量表评分平均从11.0±5.4降至5.4±3.8（p<0.005）。4例患者出现短暂性腭咽闭合不全，2例患者抱怨舌前伸受限。未出现严重的长期并发症。舌悬吊术是一种用于改善阻塞性睡眠呼吸暂停患者夜间舌后气道的微创技术。它易于由耳鼻喉科医生实施，这使其有别于其他旨在解决舌根阻塞的现有技术。
