Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan2Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois4Advanced Center for Specialty Care, Department of Otolaryngology, Advocate Illinois Masonic Medical Center, Chicago.
JAMA Otolaryngol Head Neck Surg. 2017 Feb 1;143(2):147-154. doi: 10.1001/jamaoto.2016.3103.
This study adds to the literature on the efficacy and low complication rates associated with minimally invasive, single-stage, multilevel surgery for Asian adults with obstructive sleep apnea (OSA) for whom conservative treatment had failed. Overall, our experience has produced results that make this procedure an option for select patients with snoring and OSA.
To investigate the effectiveness and safety of anatomy-based, minimally invasive, single-stage, multilevel surgery in the treatment of OSA in an Asian population.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective study enrolled 59 consecutive patients with OSA from a tertiary academic medical center who had multilevel obstruction and unsuccessful conservative therapy and then underwent minimally invasive, single-stage, multilevel surgery. The subjective symptoms and objective polysomnographic findings were collected preoperatively and at a minimum of 3 months postoperatively. The Global Patient Assessment questionnaire was used to assess patient satisfaction after minimally invasive, single-stage, multilevel surgery.
Scores on the Epworth Sleepiness Scale and bed partner evaluation of patient's snoring on a visual analog scale (scale of 0-10, with 0 indicating no snoring and 10 indicating the bed partner to leave the room or sleep separately, as assessed by the bed partner). The primary outcomes are a 50% decrease in bed partner's snoring visual analog scale level postoperatively and an improvement of 50% or more in apnea-hypopnea index by an at least 3-month follow-up. Adverse events and patient-reported quality measures were also assessed.
Forty-seven patients (36 men and 11 women; mean [SD], 47.3 [10.9] years) with a minimum 3-month follow-up and complete data were included in the analysis. None of the patients had serious perioperative or postoperative complications. Three months postoperatively, the mean (SD) scores on the Epworth Sleepiness Scale and bed partner evaluation of patient's snoring on the visual analog scale decreased from 11.6 (4.3) to 9.2 (3.1), with a mean (SD) difference of -2.4 (3.7) (95% CI, -3.5 to -1.3), and 9.4 (1.5) to 3.9 (1.9), with a mean (SD) difference of -5.6 (2.0) (95% CI, -6.2 to -5.0), respectively. The mean (SD) apnea-hypopnea index and lowest oxygen saturation changed from 30.5 (18.8) to 26.0 (16.5), with a mean (SD) difference of -4.5 (14.1) (95% CI, -8.6 to -0.3), and 78.2% (9.9%) to 80.8% (8.2%), with a mean (SD) difference of +2.6 (8.7) (95% CI, 0-5.1), respectively. The surgical response rate was 46.8% (22 of 47 patients) (95% CI, 32.5%-61.1%). The success rate by the classic definition was 14.9% (7 of 47 patients) (95% CI, 6.2%-28.3%).
This study reveals the improvement of the 2 relevant clinical outcomes in snoring severity and daytime sleepiness after minimally invasive, single-stage, multilevel surgery for patients with OSA but the limited effects on the polysomnographic parameters. Although the current role of minimally invasive, single-stage, multilevel surgery for Asian adults with OSA remains to be established, it is hoped that ongoing and future studies will solidify their role in the treatment of OSA.
本研究增加了关于微创、单阶段、多水平手术治疗亚洲成年人阻塞性睡眠呼吸暂停（OSA）的疗效和低并发症发生率的文献，这些患者经保守治疗失败。总的来说，我们的经验表明，对于有打鼾和 OSA 的特定患者，该手术是一种选择。
研究基于解剖结构的微创、单阶段、多水平手术治疗亚洲人群 OSA 的有效性和安全性。
设计、地点和参与者：这是一项回顾性研究，共纳入 59 例来自三级学术医疗中心的 OSA 患者，这些患者有多水平阻塞且保守治疗无效，然后接受微创、单阶段、多水平手术。主观症状和客观多导睡眠图检查结果在术前和至少 3 个月后进行收集。使用全球患者评估问卷评估微创、单阶段、多水平手术后患者的满意度。
评估的指标包括：Epworth 嗜睡量表评分和配偶对患者打鼾的视觉模拟量表评分（0-10 分，0 表示无打鼾，10 表示配偶离开房间或分床睡，由配偶评估）。主要结局是术后配偶打鼾视觉模拟量表评分降低 50%，以及在至少 3 个月的随访中，呼吸暂停-低通气指数改善 50%或更多。还评估了不良事件和患者报告的质量指标。
共有 47 例患者（36 名男性和 11 名女性；平均[标准差]年龄为 47.3[10.9]岁）至少随访 3 个月且数据完整，纳入分析。所有患者均无严重围手术期或术后并发症。术后 3 个月，Epworth 嗜睡量表评分和配偶对患者打鼾的视觉模拟量表评分分别从 11.6（4.3）降至 9.2（3.1），平均（标准差）差异为-2.4（3.7）（95%置信区间，-3.5 至-1.3），9.4（1.5）降至 3.9（1.9），平均（标准差）差异为-5.6（2.0）（95%置信区间，-6.2 至-5.0）。平均（标准差）呼吸暂停-低通气指数和最低氧饱和度分别从 30.5（18.8）降至 26.0（16.5），平均（标准差）差异为-4.5（14.1）（95%置信区间，-8.6 至-0.3），78.2%（9.9%）升至 80.8%（8.2%），平均（标准差）差异为+2.6（8.7）（95%置信区间，0-5.1）。手术反应率为 46.8%（22/47 例患者）（95%置信区间，32.5%-61.1%）。经典定义的成功率为 14.9%（7/47 例患者）（95%置信区间，6.2%-28.3%）。
本研究揭示了微创、单阶段、多水平手术治疗 OSA 患者的打鼾严重程度和日间嗜睡的 2 项相关临床结局改善，但对多导睡眠图参数的影响有限。虽然微创、单阶段、多水平手术治疗亚洲成年人 OSA 的当前作用仍有待确定，但希望正在进行和未来的研究将巩固其在 OSA 治疗中的作用。
