悬雍垂腭咽成形术可能降低阻塞性睡眠呼吸暂停引起的痴呆发病率：2007-2014 年国家健康保险服务调查。
Uvulopalatopharyngoplasty May Reduce the Incidence of Dementia Caused by Obstructive Sleep Apnea: National Insurance Service Survey 2007-2014.
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University College of Medicine, Seoul, Korea.
Department of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, California.
出版信息
J Clin Sleep Med. 2018 Oct 15;14(10):1749-1755. doi: 10.5664/jcsm.7388.
STUDY OBJECTIVES
Numerous studies have found that obstructive sleep apnea (OSA) causes or exacerbates dementia, including Alzheimer disease and vascular dementia. However, the evidence is often conflicting. Moreover, no study has investigated the effect of surgical treatment for OSA on dementia.
METHODS
This retrospective cohort study analyzed data from the Korea National Health Insurance Corporation. A total of 125,417 participants (age 40 years or older) with a new diagnosis of OSA between 2007 and 2014 were included. The participants were classified into two groups: those who underwent uvulopalatopharyngoplasty (UPPP group, n = 12,664) and those who underwent no surgical treatment (no surgery group, n = 112,753). Propensity score matching by age and sex was used to select the control group of 627,085 participants. Mean follow-up duration was 4.6 ± 2.3 years. The primary endpoint was newly diagnosed Alzheimer dementia, vascular dementia, or other types of dementia.
RESULTS
Compared with the control group, the hazard ratio (HR) and 95% confidence interval of dementia was calculated for patients with OSA. In the no-surgery group, the incidence of Alzheimer disease (HR 1.30 [1.22-1.38]), vascular dementia (HR 1.20 [1.05-1.36]), and other types of dementia (HR 1.35 [1.20-1.54]) was significantly higher than those among the control group. In the UPPP group, the incidence of Alzheimer disease (HR 1.08 [0.80-1.45]), vascular dementia (HR 0.58 [0.30-1.12]), and other types of dementia (HR 1.00 [0.57-1.77]) was similar to control levels.
CONCLUSIONS
Uvulopalatopharyngoplasty may have a preventive effect on dementia in patients with OSA.
研究目的
许多研究发现阻塞性睡眠呼吸暂停（OSA）会导致或加重痴呆症，包括阿尔茨海默病和血管性痴呆症。然而，证据往往存在冲突。此外，尚无研究调查 OSA 的手术治疗对痴呆症的影响。
方法
本回顾性队列研究分析了韩国国家健康保险公司的数据。共纳入 125417 名 2007 年至 2014 年间新诊断为 OSA 的患者（年龄 40 岁或以上）。参与者分为两组：接受悬雍垂腭咽成形术（UPPP 组，n=12664）和未接受手术治疗的组（无手术组，n=112753）。通过年龄和性别进行倾向评分匹配来选择对照组 627085 名参与者。平均随访时间为 4.6±2.3 年。主要终点是新诊断的阿尔茨海默病痴呆、血管性痴呆或其他类型的痴呆。
结果
与对照组相比，计算了 OSA 患者痴呆的风险比（HR）和 95%置信区间。在无手术组中，阿尔茨海默病（HR 1.30[1.22-1.38]）、血管性痴呆（HR 1.20[1.05-1.36]）和其他类型痴呆（HR 1.35[1.20-1.54]）的发生率明显高于对照组。在 UPPP 组中，阿尔茨海默病（HR 1.08[0.80-1.45]）、血管性痴呆（HR 0.58[0.30-1.12]）和其他类型痴呆（HR 1.00[0.57-1.77]）的发生率与对照组相似。
结论
悬雍垂腭咽成形术可能对 OSA 患者的痴呆有预防作用。
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