Azbay Sule, Bostanci Asli, Aysun Yasin, Turhan Murat
Department of Otolaryngology, Head and Neck Surgery, Akdeniz University School of Medicine, 07070, Antalya, Turkey.
Eur Arch Otorhinolaryngol. 2016 Sep;273(9):2813-8. doi: 10.1007/s00405-015-3865-5. Epub 2015 Dec 29.
The aim of this study was to evaluate the influence of multilevel upper airway surgery on subsequent continuous positive airway pressure (CPAP) use and tolerance in patients with moderate to severe obstructive sleep apnea (OSA). The study cohort enrolled 67 consecutive patients, who underwent septoplasty plus modified uvulopharyngopalatoplasty (mUPPP) with or without modified tongue base suspension (mTBS) due to CPAP intolerance, and who had residual OSA requiring CPAP therapy [non-responders to surgery, apnea-hypopnea index (AHI) >15 events/h] that had been confirmed by control polysomnography at the sixth month postoperatively. A questionnaire including questions on postoperative CPAP use, problems faced during CPAP use after the surgery, change in OSA symptoms, and satisfaction with the surgery was designed, and filled through interviews. Seventeen (25.4 %) patients had septoplasty plus mUPPP and 50 (74.6 %) had septoplasty plus mUPPP combined with mTBS. Postoperatively, mean AHI (45.00 ± 19.76 vs. 36.60 ± 18.34), Epworth sleepiness scale (ESS) score (18.00 ± 4.45 vs. 13.00 ± 4.72), oxygen desaturation index (ODI) (48.98 ± 16.73 vs. 37.81 ± 17.03), and optimal CPAP level (11.80 ± 1.40 vs. 8.96 ± 1.20) were decreased (p < 0.001 for all parameters). Fifty-nine percent of patients reported that they fairly satisfied with the surgery and 49.2 % reported that their symptoms were completely resolved. While none of the cases could tolerate CPAP before surgery, almost half (47.8 %) of the cases used CPAP without problems postoperatively. Postoperative CPAP users had significantly higher postoperative AHI (p = 0.001), supine AHI (p = 0.009), ESS (p = 0.019), and ODI (p = 0.014), and significantly lower postoperative minimum O2 saturation (p = 0.001) compared with non-users. Multilevel upper airway surgery with less invasive techniques may improve CPAP tolerance in well-selected patients.
本研究的目的是评估多级上气道手术对中重度阻塞性睡眠呼吸暂停（OSA）患者后续持续气道正压通气（CPAP）使用及耐受性的影响。研究队列纳入了67例连续患者，这些患者因CPAP不耐受接受了鼻中隔成形术加改良悬雍垂腭咽成形术（mUPPP），有或没有改良舌根悬吊术（mTBS），且术后6个月经对照多导睡眠图证实存在残余OSA需要CPAP治疗[手术无反应者，呼吸暂停低通气指数（AHI）>15次/小时]。设计了一份问卷，包括关于术后CPAP使用、术后使用CPAP时面临的问题、OSA症状变化以及对手术满意度的问题，并通过访谈填写。17例（25.4%）患者接受了鼻中隔成形术加mUPPP，50例（74.6%）患者接受了鼻中隔成形术加mUPPP联合mTBS。术后，平均AHI（45.00±19.76对36.60±18.34）、爱泼沃斯嗜睡量表（ESS）评分（18.00±4.45对13.00±4.72）、氧饱和度下降指数（ODI）（48.98±16.73对37.81±17.03）和最佳CPAP水平（11.80±1.40对8.96±1.20）均降低（所有参数p<0.001）。59%的患者报告对手术相当满意，49.2%的患者报告症状完全缓解。术前无一例患者能耐受CPAP，而术后近一半（47.8%）的患者使用CPAP无问题。与未使用者相比，术后使用CPAP的患者术后AHI（p = 0.001）、仰卧位AHI（p = 0.009）、ESS（p = 0.019）和ODI（p = 0.014）显著更高，术后最低氧饱和度显著更低（p = 0.001）。采用侵入性较小技术的多级上气道手术可能会提高精心挑选患者的CPAP耐受性。
