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微创外科或 CPAP 治疗对 OSAHS 患者生活质量的影响:一项 2 年回顾性、单中心平行组研究。

Change in Quality of Life of OSAHS Patients with Minimally Invasive Surgery or CPAP Therapy: A 2-year Retrospective, Single-center Parallel-group Study.

机构信息

Department of Occupational Health and Sleep Medicine Center, West China School of Public Health and West China Forth Hospital, Sichuan University, Chengdu, Sichuan, China.

West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.

出版信息

Curr Mol Med. 2020;20(3):231-239. doi: 10.2174/1566524019666191009150734.

Abstract

BACKGROUND

By including untreated obstructive sleep apnea-hypopnea syndrome (OSAHS) patients as the control group, this study explores the influence of minimally invasive surgical treatment and continuous positive airway pressure (CPAP) therapy on OSAHS patients, with the subjective and objective performance. The study also discusses their relationship, determines the effect factor, and provides a simple and practical method for evaluation of clinical efficacy.

METHODS

A total of 90 OSAHS patients, who were diagnosed in the Sleep Disorders Diagnosis and Treatment Center of Sichuan Province from May 2014 to May 2016, were selected for the present study. These patients were divided into three groups: surgery group, CPAP group, and untreated group. These patients were followed up at six months, one year, and two years, respectively. The physiological indicators, clinical symptoms, degree of daytime sleepiness and quality of life were compared among these three groups. The daytime sleepiness and the quality of life before and after minimally invasive surgery and CPAP treatment were evaluated, and the subjective and objective efficacy of surgery and CPAP treatment was explored.

RESULTS

Among these 90 patients, 11 (12.2%) patients had hypertension, while two (2.2%) patients had diabetes. The average AHI score was 50.53±23.39 per hour, and the mean minimum oxygen saturation and mean oxygen saturation was 71.25±14.16% and 90.13±5.90%, respectively. There were statistically significant differences in mouth breathing, morning sore throat and daytime sleepiness in the group having received surgery at 0.5 year and one year. In the CPAP group, there were statistically significant differences in mouth breathing, morning sore throat and daytime sleepiness at 0.5 year, one year and two years. Moreover, there were statistically significant differences in memory loss at one year and two years, and there were statistically significant differences in frequent nocturia at one year. The ESS value in the surgery group decreased at 0.5 year and one year, but increased at two years. The situation was the same in terms of the total points and in each dimension of the SF-36 paramter. The delta values of ESS among the three groups had statistical significance at 0.5 year, one year and two years, in which the CPAP group experienced the most changes, followed by the surgery group and the group received health education.

CONCLUSION

For minimally invasive surgery, CPAP therapy and health education can improve daytime sleepiness and quality of life. CPAP therapy was found to be the most effective, followed by minimally invasive surgery and provision of health education. However, the treatment of OSAHS should be comprehensive.

摘要

背景

本研究通过纳入未经治疗的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者作为对照组,探讨微创外科治疗和持续气道正压通气(CPAP)治疗对 OSAHS 患者的主观和客观表现的影响。本研究还讨论了它们之间的关系,确定了影响因素,并为临床疗效评价提供了一种简单实用的方法。

方法

选择 2014 年 5 月至 2016 年 5 月在四川省睡眠障碍诊断与治疗中心诊断为 OSAHS 的 90 例患者为研究对象,分为手术组、CPAP 组和未治疗组。分别在 6 个月、1 年和 2 年进行随访。比较三组患者的生理指标、临床症状、日间嗜睡程度和生活质量。评价微创术后和 CPAP 治疗前后的日间嗜睡和生活质量,探讨手术和 CPAP 治疗的主观和客观疗效。

结果

90 例患者中,高血压 11 例(12.2%),糖尿病 2 例(2.2%)。平均 AHI 评分 50.53±23.39 次/小时,最低氧饱和度和平均氧饱和度分别为 71.25±14.16%和 90.13±5.90%。术后 0.5 年和 1 年手术组患者张口呼吸、晨起咽痛、日间嗜睡差异有统计学意义;CPAP 组 0.5 年、1 年、2 年张口呼吸、晨起咽痛、日间嗜睡差异有统计学意义;1 年、2 年记忆力丧失、夜间尿频差异有统计学意义。手术组 ESS 值在 0.5 年和 1 年时降低,2 年时升高。SF-36 各维度总分及各维度差值在三组间均有统计学意义,CPAP 组变化最大,其次是手术组和健康教育组。

结论

微创外科、CPAP 治疗和健康教育均可改善日间嗜睡和生活质量。CPAP 治疗效果最明显,其次是微创外科和健康教育。但 OSAHS 的治疗应全面。

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