药物诱导睡眠内镜检查是否会影响手术效果？326 例阻塞性睡眠呼吸暂停患者的多中心研究。
Does drug-induced sleep endoscopy affect surgical outcome? A multicenter study of 326 obstructive sleep apnea patients.
机构信息
Otolaryngology Department, Asia Sleep Centre, Paragon, Singapore.
Otolaryngology Department, Clinica Universidad de Navarra, Pamplona, Spain.
出版信息
Laryngoscope. 2020 Feb;130(2):551-555. doi: 10.1002/lary.27987. Epub 2019 Apr 17.
OBJECTIVES/HYPOTHESIS: Our objective was to determine whether drug-induced sleep apnea (DISE) affects the successfulness of the surgical outcome.
STUDY DESIGN
Prospective, seven-country, nonrandomized trial.
METHODS
There were 326 consecutive obstructive sleep apnea (OSA) patients who had nose, palate, and/or tongue surgery included in the study. DISE was performed in only one group.
RESULTS
There were 170 patients in the DISE group and 156 patients in no-DISE group. The mean preoperative body mass index (BMI) for the DISE group was 27.6 ± 4.6, whereas in the no-DISE group it was 28.1 ± 3.9 (P = .23). The mean preoperative systolic blood pressure (SBP) for the DISE group was 130.4 ± 16.7, whereas in the no-DISE group it was 142.9 ± 15.5 (P < .001). The mean preoperative diastolic blood pressure (DBP) for the DISE group was 81.4 ± 9.7, whereas in the no-DISE group it was 89.1 ± 9.7 (P < .001). The mean preoperative apnea-hypopnea index (AHI) for the DISE group was 32.6 ± 18.8, whereas in the no-DISE group it was 33.7 ± 19.6 (P = .61). The mean postoperative AHI for the DISE group was 15.9 ± 12.6, whereas in the no-DISE group it was 13.2 ± 8.8 (P = .023). The age-, gender-, BMI-adjusted percentage change in AHI for the DISE group was -48.4 ± 31.9, whereas in the no-DISE group it was -59.8 ± 18.6 (P < .001). The age-, gender-, and BMI-adjusted success rate for the DISE group was 66.5%, whereas in the no-DISE group it was 80.8% (P = .004). The age-, gender-, and BMI-adjusted change in SBP for the DISE group was -6.1 ± 8.6, whereas in the no-DISE group it was -13.3 ± 11.1 (P < .001). The age-, gender-, and BMI-adjusted change in DBP in the DISE group was -5.2 ± 12.1, whereas in the no-DISE group it was -12.4 ± 11.7 (P < .001). The mean age- and gender-adjusted change in BMI for the DISE group was -4.6 ± 12.9, whereas in the no-DISE group it was -6.3 ± 18.5 (P = .34). The Cohen effect of BMI on the overall AHI, lowest oxygen saturation, and blood pressure changes was 0.08.
CONCLUSIONS
DISE may not significantly affect surgical success in OSA.
LEVEL OF EVIDENCE
2c Laryngoscope, 130:551-555, 2020.
目的/假设：我们的目的是确定药物诱导的睡眠呼吸暂停（DISE）是否会影响手术结果的成功。
研究设计
前瞻性、七国、非随机试验。
方法
共有 326 例连续的阻塞性睡眠呼吸暂停（OSA）患者纳入本研究，这些患者接受了鼻、腭和/或舌手术。仅在一组中进行 DISE。
结果
DISE 组有 170 例患者，无 DISE 组有 156 例患者。DISE 组的平均术前体重指数（BMI）为 27.6 ± 4.6，而无 DISE 组为 28.1 ± 3.9（P =.23）。DISE 组的平均术前收缩压（SBP）为 130.4 ± 16.7，而无 DISE 组为 142.9 ± 15.5（P <.001）。DISE 组的平均术前舒张压（DBP）为 81.4 ± 9.7，而无 DISE 组为 89.1 ± 9.7（P <.001）。DISE 组的平均术前呼吸暂停低通气指数（AHI）为 32.6 ± 18.8，而无 DISE 组为 33.7 ± 19.6（P =.61）。DISE 组的平均术后 AHI 为 15.9 ± 12.6，而无 DISE 组为 13.2 ± 8.8（P =.023）。DISE 组 AHI 的年龄、性别、BMI 调整后百分比变化为-48.4 ± 31.9，而无 DISE 组为-59.8 ± 18.6（P <.001）。DISE 组的年龄、性别和 BMI 调整后的成功率为 66.5%，而无 DISE 组为 80.8%（P =.004）。DISE 组的 SBP 年龄、性别和 BMI 调整后变化为-6.1 ± 8.6，而无 DISE 组为-13.3 ± 11.1（P <.001）。DISE 组的 DBP 年龄、性别和 BMI 调整后变化为-5.2 ± 12.1，而无 DISE 组为-12.4 ± 11.7（P <.001）。DISE 组的平均年龄和性别调整后 BMI 变化为-4.6 ± 12.9，而无 DISE 组为-6.3 ± 18.5（P =.34）。BMI 对整体 AHI、最低血氧饱和度和血压变化的 Cohen 效应为 0.08。
结论
DISE 可能不会显著影响 OSA 的手术成功率。
证据水平
2c 喉镜，130：551-555，2020 年。
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