Chisholm Edward, Kotecha Bhik
Royal National Throat Nose and Ear Hospital, 330/332 Grays Inn Road, London, WC1X 8DA, UK.
Eur Arch Otorhinolaryngol. 2007 Jan;264(1):51-5. doi: 10.1007/s00405-006-0139-2. Epub 2006 Aug 31.
Continuous positive airway pressure (CPAP) for moderate and severe obstructive sleep apnoea (OSA), albeit effective management, is poorly tolerated. This study looks at the role of laser assisted uvulopalatoplasty (LAUP) in patients with moderate and severe OSA who would not tolerate CPAP. All subjects underwent dynamic sleep nasendoscopy to determine the anatomical level of obstruction and their suitability for the procedure. Twenty subjects were included. Pre-procedure mean apnoea-hypopnea index (AHI) was 47.9 per hour (21.3-101) and mean Epworth sleepiness score 15.6 (4-23). Post operative polysomnography at >or=4 months showed a 73% reduction in AHI to a mean of 12.9 per hour. Two subjects still required CPAP post procedure but both at reduced pressure. Epworth sleepiness questionnaire scores were reduced by a mean of 7.9 points. There was no confounding weight loss. The finding that LAUP offers an effective instrument to reduce the severity of OSA in patients intolerant of CPAP results disagree with the conclusion of the recent Cochrane Collabration review of surgery for OSA. We believe this is due to the careful selection of patients for LAUP based on the anatomical level of obstruction as opposed to random selection.
持续气道正压通气（CPAP）用于治疗中重度阻塞性睡眠呼吸暂停（OSA），尽管是有效的治疗方法，但耐受性较差。本研究探讨了激光辅助悬雍垂腭咽成形术（LAUP）在不耐受CPAP的中重度OSA患者中的作用。所有受试者均接受动态睡眠鼻内镜检查，以确定阻塞的解剖学水平及其是否适合该手术。共纳入20名受试者。术前平均呼吸暂停低通气指数（AHI）为每小时47.9次（21.3 - 101），平均爱泼华嗜睡量表评分15.6分（4 - 23）。术后≥4个月的多导睡眠图显示AHI降低了73%，平均降至每小时12.9次。两名受试者术后仍需要CPAP，但压力均降低。爱泼华嗜睡问卷评分平均降低了7.9分。体重没有因其他因素而减轻。LAUP为不耐受CPAP的患者提供了一种有效降低OSA严重程度的手段，这一发现与Cochrane协作网最近关于OSA手术的综述结论不一致。我们认为这是由于LAUP手术是根据阻塞的解剖学水平仔细选择患者，而不是随机选择。
