Chi Jessie Chao-Yun, Chiang Rayleigh Ping-Ying, Chou Tse-Yu, Shu Chih-Hung, Shiao An-Suey, Lin Chia-Mo
Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC.
Eur Arch Otorhinolaryngol. 2015 Feb;272(2):489-96. doi: 10.1007/s00405-014-3253-6. Epub 2014 Sep 12.
Recent studies have shown that lateral pharyngoplasty is an effective procedure to correct obstructive sleep apnea. The objective of the paper was to evaluate factors contributing to obstructive sleep apnea syndrome and identify the different severity categories of obstructive sleep apnea that could benefit from lateral pharyngoplasty. We included 60 patients undergoing uvulopalatopharyngoplasty with or without lateral pharyngoplasty from December 1, 2008 to May 31, 2012. Six who did not complete the post-operative survey were excluded. 54 participants were assigned alternatively to either uvulopalatopharyngoplasty alone (control group, n = 29) or to uvulopalatopharyngoplasty with lateral pharyngoplasty (intervention group, n = 25). The reduction of apnea-hypoxia index in the intervention group (49.3%) was higher than it was in the control group (30.4%), but the average value was not statistically significant (p = 0.088). Only patients with moderate obstructive sleep apnea in the intervention group achieved a significant reduction of apnea-hypoxia index (30.7 vs. 10.8%; p = 0.020). Factors such as body mass index, nadir/mean SpO2, snoring index, Epworth sleepiness scale and periodic limb movement index did not change significantly following lateral pharyngoplasty. To evaluate patients' upper airway anatomy, we employed cephalometry, and found that the retroglossal space played a critical role in severe obstructive sleep apnea. Our study showed that only patients in the moderate category can be benefited from adding lateral pharyngoplasty to uvulopalatopharyngoplasty; however, patients in the mild or severe category did not benefit from adding this procedure. This information is vital when considering surgery for patients with obstructive sleep apnea syndrome. Level of evidence Prospective cohort study, Level II.
近期研究表明，咽外侧壁成形术是矫正阻塞性睡眠呼吸暂停的有效手术。本文的目的是评估导致阻塞性睡眠呼吸暂停综合征的因素，并确定可从咽外侧壁成形术中获益的不同严重程度的阻塞性睡眠呼吸暂停。我们纳入了2008年12月1日至2012年5月31日期间接受了悬雍垂腭咽成形术（伴或不伴咽外侧壁成形术）的60例患者。6例未完成术后调查的患者被排除。54名参与者被交替分配至单纯悬雍垂腭咽成形术组（对照组，n = 29）或悬雍垂腭咽成形术联合咽外侧壁成形术组（干预组，n = 25）。干预组的呼吸暂停 - 低氧指数降低率（49.3%）高于对照组（30.4%），但平均值无统计学意义（p = 0.088）。仅干预组中患有中度阻塞性睡眠呼吸暂停的患者实现了呼吸暂停 - 低氧指数的显著降低（30.7%对10.8%；p = 0.020）。体重指数、最低/平均血氧饱和度、打鼾指数、爱泼华嗜睡量表和周期性肢体运动指数等因素在咽外侧壁成形术后无显著变化。为评估患者的上气道解剖结构，我们采用了头影测量法，发现舌后间隙在重度阻塞性睡眠呼吸暂停中起关键作用。我们的研究表明，只有中度患者可从悬雍垂腭咽成形术联合咽外侧壁成形术中获益；然而，轻度或重度患者并未从增加此手术中获益。在考虑为阻塞性睡眠呼吸暂停综合征患者进行手术时，该信息至关重要。证据级别：前瞻性队列研究，II级。
