Robinson Sam, Chia Michael, Carney A Simon, Chawla Sharad, Harris Penelope, Esterman Adrian
Memorial Hospital, North Adelaide, South Australia, Australia.
Otolaryngol Head Neck Surg. 2009 Aug;141(2):257-263. doi: 10.1016/j.otohns.2009.03.022.
To measure long-term quality-of-life (QOL) improvement following contemporary multilevel upper airway reconstruction surgery, compared with continuous positive airway pressure (CPAP) therapy. Secondary aims were to investigate factors determining clinical effectiveness and QOL impact of reported side effects.
Cohort study.
Consecutive, simultaneously treated adult patients with moderate-severe obstructive sleep apnea (OSA) having upper airway surgery (N=77) or CPAP (N=89) therapy were studied by questionnaire. Glasgow Benefit Inventory (GBI), change in snoring status and Epworth Sleepiness Scale (ESS), subjective CPAP compliance, and side effects in both groups were measured at mean+/-SEM 44.12+/-5.78 months (3.68+/-0.48 years) after commencement of therapy.
No significant difference was seen between surgical outcomes for GBI, snoring, or ESS and CPAP controls. Multivariate analysis showed reduction in Respiratory Disturbance Index (RDI) predicted postoperative snoring and ESS, but not GBI outcomes. Snoring control and GBI were related to CPAP compliance (P<0.001). CPAP side effects (reported in 26%) significantly reduced the QOL benefit of treatment, independent of compliance. Surgical complications (occurring in 44%) did not affect QOL treatment benefit.
Patients with poor CPAP compliance and/or significant side effects of CPAP therapy (45% of cases in this series) should be evaluated for contemporary upper airway reconstructive surgery.
与持续气道正压通气（CPAP）治疗相比，评估当代多级上气道重建手术后长期生活质量（QOL）的改善情况。次要目的是研究决定临床疗效的因素以及所报告副作用对生活质量的影响。
队列研究。
通过问卷调查研究连续同时接受治疗的中重度阻塞性睡眠呼吸暂停（OSA）成年患者，其中接受上气道手术的患者有77例，接受CPAP治疗的患者有89例。在治疗开始后平均44.12±5.78个月（3.68±0.48年）时，测量两组患者的格拉斯哥获益量表（GBI）、打鼾状态变化和爱泼沃斯嗜睡量表（ESS）、主观CPAP依从性以及副作用。
GBI、打鼾或ESS的手术结果与CPAP对照组之间未见显著差异。多变量分析显示，呼吸紊乱指数（RDI）降低可预测术后打鼾和ESS，但不能预测GBI结果。打鼾控制和GBI与CPAP依从性相关（P<0.001）。CPAP副作用（报告发生率为26%）显著降低了治疗的生活质量获益，且与依从性无关。手术并发症（发生率为44%）未影响生活质量治疗获益。
对于CPAP依从性差和/或CPAP治疗有显著副作用的患者（本系列病例中的45%），应评估其是否适合当代上气道重建手术。
