Pang Kenny P, Pang Edward B, Pang Kathleen A, Vicini Claudio, Chan Yiong Huak, Rotenberg Brian W
Department of Otorhinolaryngology Head and Neck Surgery, Singapore.
Asia Sleep Center, Singapore.
Laryngoscope. 2018 Feb;128(2):523-527. doi: 10.1002/lary.26759. Epub 2017 Aug 10.
OBJECTIVES/HYPOTHESIS: To evaluate if upper airway surgery reduces blood pressure in patients with obstructive sleep apnea (OSA).
Prospective series.
A prospective series of 112 consecutive OSA patients with hypertension (HTN). All patients were > 18 years old, respiratory disturbance index >5, all levels of apnea-hypopnea index (AHI), with a history of HTN treated with medication for at least 6 months. Surgical procedures included septoplasty, turbinate reduction, palate surgery, and tongue base reduction.
There were 92 men and 20 women, with a mean age of 48.6 years, mean body mass index (BMI) was 27.5 (range, 19.7-34.7). Mean follow-up was 16.1 months. The mean preoperative AHI was 32.6 (range, 1.2-104), with the mean lowest oxygen saturation (LSAT) of 79.9% (range, 52%-93%). The mean adjusted preoperative and postoperative systolic blood pressure (SBP) was reduced from 146 ± 15.3 mm Hg to 122 ± 12.5 mm Hg (P < .001), and diastolic blood pressure (DBP) was reduced from 91 ± 10.2 mm Hg to 76 ± 7.8 mm Hg (P < .001). There was a decrease in overall BMI from 27.5 ± 3.6 to 25.5 ± 3.0 (P < .001); however, based on multivariate analysis, the reduction in SBP and DBP was not affected by this BMI reduction. Fifty-eight patients (51.8%) did not require their antihypertensive after surgery. There was poor correlation noted between HTN with AHI, LSAT, and oxygen duration <90%.
Upper airway surgery does reduce SBP and DBP in patients with OSA.
目的/假设：评估上气道手术是否能降低阻塞性睡眠呼吸暂停（OSA）患者的血压。
前瞻性系列研究。
对112例连续的OSA合并高血压（HTN）患者进行前瞻性系列研究。所有患者年龄均大于18岁，呼吸紊乱指数>5，各种程度的呼吸暂停低通气指数（AHI），有HTN病史且接受药物治疗至少6个月。手术包括鼻中隔成形术、鼻甲切除术、腭部手术和舌根缩小术。
男性92例，女性20例，平均年龄48.6岁，平均体重指数（BMI）为27.5（范围19.7 - 34.7）。平均随访16.1个月。术前平均AHI为32.6（范围1.2 - 104），平均最低氧饱和度（LSAT）为79.9%（范围52% - 93%）。术前和术后经调整的平均收缩压（SBP）从146±15.3 mmHg降至122±12.5 mmHg（P <.001），舒张压（DBP）从91±10.2 mmHg降至76±7.8 mmHg（P <.001）。总体BMI从27.5±3.6降至25.5±3.0（P <.001）；然而，基于多变量分析，SBP和DBP的降低不受BMI降低的影响。58例患者（51.8%）术后无需服用降压药。HTN与AHI、LSAT以及氧饱和度<90%的持续时间之间相关性较差。
上气道手术确实能降低OSA患者的SBP和DBP。
4。《喉镜》，2018年，第128卷，第523 - 527页
