Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Laryngoscope. 2014 Sep;124 Suppl 4:S1-9. doi: 10.1002/lary.24720. Epub 2014 May 27.
OBJECTIVES/HYPOTHESIS: Healthcare remunerating agencies in North America require patients with obstructive sleep apnea (OSA) to undergo a continuous positive airway pressure (CPAP) trial before funding surgical therapy. The adherence rate of CPAP is problematic. This study's objective was to determine the proportion of surgically favorable patients who failed CPAP who subsequently benefitted from surgical therapy, and to explore consideration of surgical therapy as first-line treatment in this specific OSA subpopulation.
This was a prospective cohort study.
Patients with moderate-severe OSA who had failed a minimum 6-month trial of CPAP were recruited. All had optimal anatomy for surgery and underwent tonsillectomy with palatoplasty ± septoplasty. Outcome measures included apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and Sleep Apnea Quality of Life Index (SAQLI-E), and blood pressure. Patients were followed for 1 year.
By AHI measurement, 85.7% of patients in the entire cohort were successfully treated by surgery. ESS while on CPAP was 13.7 ± 2.9, improving to 4.1 ± 2.5 after surgery. SAQLI-E scores on CPAP were 25.7 ± 5.8, improving to 10.2 ± 3.2 after surgery. Blood pressure remained elevated during CPAP but normalized after surgery. All changes were significant at P < .001.
Surgical intervention improved OSA severity as measured by the ESS, SAQLI-E, and blood pressure. These measures had not improved on CPAP. AHI improved as well. Our results suggest that certain patients with OSA may be managed more effectively with surgery than CPAP, without confounding issues of treatment adherence and with only minor surgical risk.
2 Laryngoscope 124:S1-S9, 2014.
目的/假设：北美医疗保健补偿机构要求阻塞性睡眠呼吸暂停（OSA）患者在获得手术治疗资金前进行持续气道正压通气（CPAP）试验。CPAP 的依从性存在问题。本研究的目的是确定 CPAP 试验失败但随后从手术治疗中获益的手术治疗有利患者的比例，并探讨在特定 OSA 亚群中将手术治疗作为一线治疗的考虑。
这是一项前瞻性队列研究。
招募了 CPAP 最低 6 个月试验失败的中重度 OSA 患者。所有患者均具有最佳手术解剖结构，并接受扁桃体切除术联合悬雍垂-软腭成形术。评估指标包括呼吸暂停低通气指数（AHI）、嗜睡评估量表（ESS）、睡眠呼吸暂停生活质量指数（SAQLI-E）和血压。患者随访 1 年。
根据 AHI 测量，整个队列中有 85.7%的患者通过手术成功治疗。CPAP 时的 ESS 为 13.7 ± 2.9，手术后改善至 4.1 ± 2.5。CPAP 时的 SAQLI-E 评分为 25.7 ± 5.8，手术后改善至 10.2 ± 3.2。CPAP 期间血压仍升高，但手术后恢复正常。所有变化在 P <.001 时均具有统计学意义。
手术干预可改善 ESS、SAQLI-E 和血压测量的 OSA 严重程度。这些措施在 CPAP 上没有改善。AHI 也有所改善。我们的结果表明，某些 OSA 患者可能通过手术治疗比 CPAP 更有效，而不会出现治疗依从性的混杂问题，且只有轻微的手术风险。
2 喉科学 124：S1-S9，2014 年。
