Xiao Yang, Han Demin, Zang Hongrui, Wang Danni
a Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Department of Otolaryngology Head and Neck Surgery , Beijing Tongren Hospital, Capital Medical University , Beijing , PR China.
Acta Otolaryngol. 2016 Jun;136(6):626-32. doi: 10.3109/00016489.2016.1143120. Epub 2016 Feb 23.
Conclusion Nasal obstruction can aggravate the psychological status of OSA patients, and nasal surgery should reduce this aggravation. Nasal surgery significantly improved sleep latency and ameliorated several polysomnographic characteristics. Background The aim of this study was to investigate the psychological status of patients with obstructive sleep apnea (OSA) and nasal obstruction and to evaluate the effects of nasal surgery on the psychological symptoms and polysomnographic (PSG) parameters of these patients. Methods The study was designed as a prospective comparative study. This study compared 30 patients (all male) with nasal obstruction and 30 matched patients without nasal obstruction using the Pittsburgh Sleep Quality Index (PSQI) and the Symptom Check List 90 (SCL-90). All of the patients had been previously diagnosed with OSA (apnea hypopnea index [AHI] ≥ 5 events/h) via a whole-night polysomnographic examination. Nasal obstruction was assessed using a visual analogue scale (VAS). The patients with nasal obstruction underwent nasal surgery, and their weight, VAS, nocturnal PSG characteristics, and psychological symptoms at baseline and 3 months after surgery were compared. Results The OSA patients with nasal obstruction suffered from significantly longer sleep latency on the PSQI and higher somatization and anxiety scores on the SCL-90 than the subjects without nasal obstruction (p < 0.05). The nasal obstruction symptoms significantly improved after surgery (VAS decreased from 6.18 ± 1.85 to 1.87 ± 1.76, p < 0.01). The assessments also showed a significant reduction in weight (from 84.60 ± 11.30 kg to 82.27 ± 9.87 kg, p < 0.05) between the pre-operative and post-operative values. Although there was significant reduction in the AHI (from 49.67 ± 19.49/h to 43.07 ± 21.86/h, p < 0.01) and a significant improvement in lowest oxygen saturation (LSpO2, from 73.83 ± 8.49% to 75.97 ± 9.86%, p < 0.05), only 23.3% of patients achieved a response of nasal surgery that met Sher's criteria. Remarkable reductions were observed in the sleep latency scores, daytime dysfunction scores on the PSQI, anxiety and hostility scores, and the number of positive symptoms on the SCL-90 (p < 0.05). There was a strong positive correlation between PSQI total score and some psychosomatic symptoms on the SCL-90, including inter-personal sensitivity, depression, hostility, paranoid ideation, psychoticism, global symptom index, and the number of positive symptoms (r > 0.3, p < 0.05).
结论 鼻塞可加重阻塞性睡眠呼吸暂停（OSA）患者的心理状态，鼻部手术应可减轻这种加重情况。鼻部手术显著改善了入睡潜伏期，并改善了多项多导睡眠图特征。背景 本研究旨在调查合并鼻塞的阻塞性睡眠呼吸暂停（OSA）患者的心理状态，并评估鼻部手术对这些患者心理症状和多导睡眠图（PSG）参数的影响。方法 本研究设计为前瞻性对照研究。本研究使用匹兹堡睡眠质量指数（PSQI）和症状自评量表90（SCL-90）对30例有鼻塞的患者（均为男性）和30例匹配的无鼻塞患者进行了比较。所有患者此前均通过整夜多导睡眠图检查确诊为OSA（呼吸暂停低通气指数[AHI]≥5次/小时）。使用视觉模拟量表（VAS）评估鼻塞情况。对有鼻塞的患者进行鼻部手术，并比较他们术前和术后3个月的体重、VAS、夜间PSG特征和心理症状。结果 与无鼻塞的受试者相比，有鼻塞的OSA患者在PSQI上的入睡潜伏期显著更长，在SCL-90上的躯体化和焦虑评分更高（p<0.05）。术后鼻塞症状显著改善（VAS从6.18±1.85降至1.87±1.76，p<0.01）。评估还显示术前和术后体重显著降低（从84.60±11.30kg降至82.27±9.87kg，p<0.05）。虽然AHI显著降低（从49.67±19.49次/小时降至43.07±21.86次/小时，p<0.01），最低血氧饱和度（LSpO2）显著改善（从73.83±8.49%升至75.97±9.86%，p<0.05），但只有23.3%的患者达到了符合Sher标准的鼻部手术反应。观察到PSQI上的入睡潜伏期评分、日间功能障碍评分、焦虑和敌对评分以及SCL-90上的阳性症状数量显著降低（p<0.05）。PSQI总分与SCL-90上的一些心身症状之间存在强正相关，包括人际敏感性、抑郁、敌对、偏执观念、精神分裂症倾向、总体症状指数和阳性症状数量（r>0.3，p<0.05）。
