悬雍垂腭咽成形术与改良射频组织消融术治疗轻中度阻塞性睡眠呼吸暂停的比较：一项随机临床试验。
A Comparison of Uvulopalatopharyngoplasty and Modified Radiofrequency Tissue Ablation in Mild to Moderate Obstructive Sleep Apnea: A Randomized Clinical Trial.
机构信息
Otorhinolaryngology Head and Neck Surgery Department, Occupational Sleep Research Center, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Otorhinolaryngology Head and Neck Surgery Department, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
J Clin Sleep Med. 2017 Sep 15;13(9):1089-1096. doi: 10.5664/jcsm.6730.
STUDY OBJECTIVES
To compare the efficacy of modified radiofrequency tissue ablation (MRFTA) with uvulopalatopharyngoplasty (UPPP) based on both subjective and objective outcome measures in patients with mild to moderate obstructive sleep apnea (OSA).
METHODS
Forty patients with mild to moderate OSA were randomly divided into UPPP and MRFTA groups. Evaluation was made based on the apneahypopnea index (AHI), Sleep Apnea Quality of Life Index (SAQLI) and Epworth Sleepiness Scale (ESS), immediately before the surgery and 6 months postoperatively.
RESULTS
The postoperative AHI scores were improved significantly in both groups, although the postoperative AHI in the UPPP group was significantly lower than in the MRFTA group ( = .02). The difference between success rates for moderate OSA in UPPP and MRFTA was significant (77% versus 30%, = .03) but there was no significant difference between success rates for mild OSA in UPPP and MRFTA groups (70% versus 50%, = .36). Comparing postoperative ESS scores in the 2 groups showed no significant difference ( = .24). The postoperative scores in social interaction, treatment-related symptoms domain, and SAQLI total score were significantly higher in the MRFTA group.
CONCLUSIONS
MRFTA as well as UPPP can greatly improve daytime sleepiness and AHI, especially in patients with mild OSA. MRFTA proved to be more effective than UPPP to enhance quality of life of patients with OSA. Further studies with longer follow-up are required to evaluate long-term safety and efficacy of these procedures.
COMMENTARY
A commentary on this article appears in this issue on page 1023.
CLINICAL TRIAL REGISTRATION
Trial name: Comparison of RFTA (Radio-Frequency-Tissue-Ablation) and UPPP (Uvulopalatopharyngoplasty) in patients with mild to moderate obstructive sleep apnea. URL: http://en.search.irct.ir/view/18617. Registration number: IRCT2014060910160N3.
研究目的
比较改良射频组织消融（MRFTA）与悬雍垂腭咽成形术（UPPP）在治疗轻中度阻塞性睡眠呼吸暂停（OSA）患者的主观和客观疗效。
方法
40 例轻中度 OSA 患者随机分为 UPPP 组和 MRFTA 组。基于呼吸暂停低通气指数（AHI）、睡眠呼吸暂停生活质量指数（SAQLI）和 Epworth 嗜睡量表（ESS）对患者进行评估，在术前和术后 6 个月进行评估。
结果
两组术后 AHI 评分均明显改善，但 UPPP 组术后 AHI 明显低于 MRFTA 组（ =.02）。UPPP 和 MRFTA 治疗中重度 OSA 的成功率差异有统计学意义（77%比 30%， =.03），但 UPPP 和 MRFTA 治疗轻度 OSA 的成功率差异无统计学意义（70%比 50%， =.36）。比较两组术后 ESS 评分，差异无统计学意义（ =.24）。MRFTA 组术后社会交往、治疗相关症状域和 SAQLI 总分评分较高。
结论
MRFTA 和 UPPP 均可显著改善日间嗜睡和 AHI，尤其是轻度 OSA 患者。MRFTA 比 UPPP 更能提高 OSA 患者的生活质量。需要进一步开展长期随访的研究来评估这些手术的长期安全性和疗效。
评论
本文的一篇评论见本期第 1023 页。
临床试验注册
试验名称：比较射频组织消融（RFTA）和悬雍垂腭咽成形术（UPPP）在轻中度阻塞性睡眠呼吸暂停患者中的应用。网址：http://en.search.irct.ir/view/18617。注册号：IRCT2014060910160N3。
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