Lim Jae Hyun, Park Pona, Wee Jee Hye, Gelera January E, Shrestha Kundan Kumar, Rhee Chae-Seo, Kim Jeong-Whun
Department of Otolaryngology-Head and Neck Surgery, National Police Hospital, Seoul, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Healthcare Research Institute, Seoul National University Hospital, Healthcare System Gangnam Center, Seoul, South Korea.
Eur Arch Otorhinolaryngol. 2018 Apr;275(4):1015-1022. doi: 10.1007/s00405-018-4894-7. Epub 2018 Feb 8.
To identify appropriate success criteria, based on long-term symptoms and incident hypertension, after surgery for obstructive sleep apnea (OSA).
This observational cohort study included 97 adult OSA patients (90 men) who underwent surgical treatment at our tertiary medical center. Subjective symptoms [witnessed sleep apnea and snoring, and Epworth sleepiness scale (ESS) scores] were evaluated through a telephone survey, and incident hypertension was assessed from medical records. The subjects were divided into success and failure groups according to seven different criteria, and data were analyzed to identify the criteria that could significantly differentiate the success from failure groups.
The participants had a mean age of 48.8 ± 11.9 years and a mean preoperative body mass index of 26.5 ± 3.5 kg/m. The mean preoperative and postoperative apnea-hypopnea index (AHI) values were 36.1/h and 19.4/h, respectively. The mean follow-up duration was 77.0 ± 31.1 months. Postoperative witnessed apnea, snoring, and the ESS scores decreased significantly compared to preoperative scores in both the success and failure groups based on most of the seven criteria. Among the seven criteria, success and failure groups based on a postoperative AHI cutoff of 15 or 20/h differed significantly in witnessed apnea, snoring, or ESS scores. Kaplan-Meier survival analysis based on incident hypertension revealed that no criterion could significantly distinguish between the two groups.
Our results suggest that some of the success criteria analyzed may be more useful in differentiating between success and failure groups after surgery, in terms of long-term improvement of subjective OSA-related symptoms.
基于长期症状和新发高血压，确定阻塞性睡眠呼吸暂停（OSA）手术后合适的成功标准。
这项观察性队列研究纳入了97例在我们三级医疗中心接受手术治疗的成年OSA患者（90例男性）。通过电话调查评估主观症状[观察到的睡眠呼吸暂停和打鼾，以及爱泼华嗜睡量表（ESS）评分]，并从病历中评估新发高血压。根据七种不同标准将受试者分为成功组和失败组，并对数据进行分析，以确定能够显著区分成功组和失败组的标准。
参与者的平均年龄为48.8±11.9岁，术前平均体重指数为26.5±3.5kg/m²。术前和术后平均呼吸暂停低通气指数（AHI）值分别为36.1次/小时和19.4次/小时。平均随访时间为77.0±31.1个月。基于七种标准中的大多数，成功组和失败组术后观察到的呼吸暂停、打鼾和ESS评分均较术前显著降低。在这七种标准中，基于术后AHI截断值为15或20次/小时的成功组和失败组在观察到的呼吸暂停、打鼾或ESS评分方面存在显著差异。基于新发高血压的Kaplan-Meier生存分析显示，没有标准能够显著区分两组。
我们的结果表明，就OSA相关主观症状的长期改善而言，分析的一些成功标准可能在区分手术后的成功组和失败组方面更有用。
