Payne Richard J, Hier Michael P, Kost Karen M, Black Martin J, Zeitouni Anthony G, Frenkiel Saul, Naor Naftaly, Kimoff R John
Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC.
J Otolaryngol. 2005 Oct;34(5):304-11. doi: 10.2310/7070.2005.34502.
To determine the prevalence of obstructive sleep apnea (OSA) in patients with cancer of the oral cavity and oropharynx scheduled for primary surgical resection. To correlate the presence of OSA and the occurrence of postoperative morbidities in this patient population.
This was a prospective study involving 17 patients with malignancies of the oral cavity and oropharynx scheduled for primary surgical resection. Consecutive patients were approached to undergo overnight polysomnography to determine the apnea-hypopnea index (AHI). OSA was defined by an AHI value > or = 20 events per hour. Postoperative morbidities were evaluated in a blinded fashion for the patients completing surgery.
OSA was present in 13 of 17 patients, yielding a striking prevalence of 76% in this patient group. The mean AHI for patients with OSA was 44.7 +/- 3.5 (standard error) events per hour, with a mean nadir oxygen saturation of 88.2 +/- 1.8%, consistent with moderate to severe sleep-disordered breathing. The OSA and non-OSA patients were similar with respect to age and body mass index. The mean size of the primary tumour was 3.3 cm in patients with an AHI < 20 and 3.5 cm in those with an AHI > or = 20 (p = not significant). Overall, postoperative complications, defined as prolonged intensive care unit stay (> 24 hours), need for mechanical ventilation, and cardiopulmonary morbidities, were observed in 67% of OSA and 25% of non-OSA patients.
These findings point to a strong association between OSA and malignancies of the oral cavity and oropharynx. This relationship was independent of the size of the primary malignancy in this patient population with tumours ranging from 1 to 7 cm (p = not significant). When comparing the two groups (AHI < 20 and AHI > or = 20), there was a tendency for the group with OSA to have an increase in postoperative morbidities. Further research is warranted to further evaluate the postoperative morbidities and mortalities associated with OSA in this patient population and to determine the potential roles for preoperative treatment with continuous positive airway pressure and tracheotomy.
确定计划接受初次手术切除的口腔和口咽癌患者中阻塞性睡眠呼吸暂停（OSA）的患病率。探讨该患者群体中OSA的存在与术后并发症发生情况之间的相关性。
这是一项前瞻性研究，纳入了17例计划接受初次手术切除的口腔和口咽恶性肿瘤患者。连续纳入患者并进行夜间多导睡眠监测以确定呼吸暂停低通气指数（AHI）。OSA定义为AHI值≥20次/小时。对完成手术的患者以盲法评估术后并发症。
17例患者中有13例存在OSA，该患者组的患病率高达76%。OSA患者的平均AHI为44.7±3.5（标准误）次/小时，平均最低血氧饱和度为88.2±1.8%，符合中度至重度睡眠呼吸紊乱。OSA患者和非OSA患者在年龄和体重指数方面相似。AHI<20的患者原发肿瘤平均大小为3.3 cm，AHI≥20的患者为3.5 cm（p=无统计学意义）。总体而言，67%的OSA患者和25%的非OSA患者出现了术后并发症，术后并发症定义为重症监护病房停留时间延长（>24小时）、需要机械通气以及心肺并发症。
这些发现表明OSA与口腔和口咽恶性肿瘤之间存在密切关联。在肿瘤大小为1至7 cm的该患者群体中，这种关系与原发恶性肿瘤的大小无关（p=无统计学意义）。比较两组（AHI<20和AHI≥20）时，OSA组术后并发症有增加的趋势。有必要进一步研究以进一步评估该患者群体中与OSA相关的术后并发症和死亡率，并确定持续气道正压通气和气管切开术前治疗的潜在作用。
