Zhang Peng, Ye Jingying, Pan Chuxiong, Sun Nian, Kang Dan
Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Department of Otolaryngology Head and Neck Surgery, Beijing Tsinghua Changgunng Hospital, Beijing, China
Otolaryngol Head Neck Surg. 2015 Jul;153(1):144-9. doi: 10.1177/0194599815576719. Epub 2015 Mar 27.
To measure obstruction length and height using drug-induced sleep endoscopy (DISE) in obstructive sleep apnea (OSA) patients and to evaluate their association with outcomes of velopharyngeal surgery.
Prospective cohort study.
University medical center.
Forty-three consecutive patients with OSA were evaluated by DISE using dexmedetomidine. The 2 new parameters, obstruction length (defined as the distance from the most superior point of the collapse to the most inferior point of the collapse) and obstruction height (the distance from the posterior border of the nasal septum to the most proximal point of the collapse), were measured by both DISE and a pressure transducer catheter method before surgery. All of the patients received velopharyngeal surgery, including revised uvulopalatopharyngoplasty with uvula preservation and transpalatal advancement pharyngoplasty. We followed up with all of the patients using polysomnography at least 3 months after surgery.
Twenty-six (60.5%) patients were responders, and 17 (39.5%) were nonresponders. The mean obstruction length and obstruction height were 1.3 ± 0.5 cm (range, 0.4-2.2 cm) and 3.4 ± 0.9 cm (range, 1.1-5.0 cm), respectively. Nonresponders had a longer obstruction length and a shorter obstruction value. Multivariate logistic regression analysis revealed that obstruction length >1.4 cm (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.04-0.98; P = .048) and obstruction height ≥3.2 cm (OR, 9.35; 95% CI, 1.79-48.80; P = .008) were the only independent predictors of velopharyngeal surgery success.
Accurate measurement of obstruction length and height can be performed with both DISE and a pressure transducer catheter method. The 2 parameters can predict the outcome of velopharyngeal surgery.
使用药物诱导睡眠内镜检查（DISE）测量阻塞性睡眠呼吸暂停（OSA）患者的阻塞长度和高度，并评估它们与腭咽手术结果的相关性。
前瞻性队列研究。
大学医学中心。
连续43例OSA患者接受了使用右美托咪定的DISE评估。在手术前，通过DISE和压力传感器导管法测量了两个新参数，即阻塞长度（定义为从塌陷的最上点到塌陷的最下点的距离）和阻塞高度（从鼻中隔后缘到塌陷的最近端点的距离）。所有患者均接受了腭咽手术，包括保留悬雍垂的改良悬雍垂腭咽成形术和经腭前移咽成形术。我们在术后至少3个月使用多导睡眠图对所有患者进行了随访。
26例（60.5%）患者为反应者，17例（39.5%）为无反应者。平均阻塞长度和阻塞高度分别为1.3±0.5cm（范围0.4 - 2.2cm）和3.4±0.9cm（范围1.1 - 5.0cm）。无反应者的阻塞长度更长，阻塞值更短。多因素逻辑回归分析显示，阻塞长度>1.4cm（比值比[OR]，0.21；95%置信区间[CI]，0.04 - 0.98；P = 0.048）和阻塞高度≥3.2cm（OR，9.35；95%CI，1.79 - 48.80；P = 0.008）是腭咽手术成功的唯一独立预测因素。
DISE和压力传感器导管法均可准确测量阻塞长度和高度。这两个参数可预测腭咽手术的结果。
