Farrar Joshua, Ryan James, Oliver Eric, Gillespie M Boyd
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Laryngoscope. 2008 Oct;118(10):1878-83. doi: 10.1097/MLG.0b013e31817d9cc1.
OBJECTIVES/HYPOTHESIS: Recent studies suggest that radiofrequency ablation (RFA) is a treatment option for patients with obstructive sleep apnea (OSA). This study investigates the effectiveness of RFA in treating OSA using a critical literature review and meta-analysis.
Critical literature review and meta-analysis.
Two independent searches of PubMed 1966-present were performed to identify publications pertaining to RFA and OSA. Effectiveness of the procedure was measured by comparing the Epworth Sleepiness Scale (ESS), respiratory disturbance index (RDI), and lowest O2 saturation before and after tissue ablation.
Sixteen studies met the inclusion criteria. The study found a 31% reduction in short-term ESS (odds ratios (OR) 0.69, 95% confidence interval (CI) 0.63-0.75), which was maintained beyond 12 months (OR 0.68, 95% CI 0.43-0.73). Likewise, RFA resulted in a 31% reduction in short term (<12 month) (OR 0.69, 95% CI 0.61-0.77) and 45% reduction (OR 0.55, 95% C.I. 0.45-0.72) in long-term (>24 month) RDI levels. Short-term results of the lowest O2 saturations failed to demonstrate improvement (OR 1.03, 95% CI 0.88-1.20).
RFA seems to be a clinically effective tool that reduces ESS scores and RDI levels in patients with OSA syndrome. The procedure should be considered a valid treatment option for patients who refuse or are unable to tolerate continuous positive airway pressure.
目的/假设:近期研究表明,射频消融术(RFA)是阻塞性睡眠呼吸暂停(OSA)患者的一种治疗选择。本研究通过严谨的文献综述和荟萃分析,探究RFA治疗OSA的有效性。
严谨的文献综述和荟萃分析。
对PubMed 1966年至今的数据进行了两次独立检索,以确定与RFA和OSA相关的出版物。通过比较组织消融前后的爱泼华嗜睡量表(ESS)、呼吸紊乱指数(RDI)和最低氧饱和度来衡量该手术的有效性。
16项研究符合纳入标准。研究发现,短期ESS降低了31%(优势比(OR)0.69,95%置信区间(CI)0.63 - 0.75),且在12个月后仍保持这一效果(OR 0.68,95% CI 0.43 - 0.73)。同样,RFA使短期(<12个月)RDI水平降低了31%(OR 0.69,95% CI 0.61 - 0.77),长期(>24个月)降低了45%(OR 0.55,95% CI 0.45 - 0.72)。最低氧饱和度的短期结果未显示出改善(OR 1.03,95% CI 0.88 - 1.20)。
RFA似乎是一种临床有效的工具,可降低OSA综合征患者的ESS评分和RDI水平。对于拒绝或无法耐受持续气道正压通气的患者,该手术应被视为一种有效的治疗选择。