Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, South Korea.
J Otolaryngol Head Neck Surg. 2020 Feb 24;49(1):8. doi: 10.1186/s40463-020-00405-w.
The purpose of this study was to determine the therapeutic value of drug-induced sleep endoscopy (DISE) by comparing the outcomes of tongue base surgery based on Muller's maneuver (MM) and those based on DISE in obstructive sleep apnea (OSA) patients.
Ninety-five patients who underwent the tongue base surgery in combination with palatal surgery for OSA at a tertiary referral hospital between March 2012 and March 2019 were enrolled in this retrospective comparative study. Forty-seven patients underwent MM for surgical decision and 48 patients underwent DISE in addition to MM for surgical decision. Surgical success was defined according to the Sher criteria (postoperative apnea-hypopnea index [AHI] < 20/h and ≥ 50% reduction in preoperative AHI), and AHI improvement (%) was defined as (preoperative AHI-postoperative AHI) × 100/preoperative AHI. For comparison between the MM and DISE groups, p-values were calculated using independent or paired t-tests for continuous variables and using chi-square test for categorical variables.
By comparing the results of MM and DISE, consensus on the tongue base level showed insignificant concordance (kappa = 0.017, p = 0.865), whereas that on the oropharynx level showed fair agreement (kappa =0.241, p = 0.005). AHI, supine AHI, rapid eyeball movement (REM) AHI, non-REM AHI, and nadir oxygen saturation were all significantly improved after the tongue base surgery in both groups. The MM group showed a significant improvement in the Epworth sleepiness scale after the tongue base surgery (p = 0.014), whereas the DISE group did not (p = 0.165). However, there was no significant difference in the AHI improvement (MM group = 47.0 ± 32.0, DISE group = 48.3 ± 35.4, p = 0.852) and surgical success (MM group = 42.6%, DISE group = 45.8%, p = 0.748) between the groups. Tonsil grade (p < 0.05) and occlusion at the oropharynx lateral wall (p = 0.031) were significantly related to surgical success in the MM group.
In the judgment of the tongue base surgery, MM and DISE findings showed poor agreement. DISE might affect the surgical decision on the tongue base surgery in OSA patients; however, there was a lack of evidence regarding the superiority of DISE over MM with respect to the surgical outcomes.
本研究旨在通过比较基于 Muller 手法（MM）和基于药物诱导睡眠内镜（DISE）的舌基底手术治疗阻塞性睡眠呼吸暂停（OSA）患者的结果，确定药物诱导睡眠内镜的治疗价值。
本回顾性对照研究纳入了 2012 年 3 月至 2019 年 3 月期间在一家三级转诊医院接受舌基底手术联合腭手术治疗 OSA 的 95 例患者。47 例患者行 MM 用于手术决策，48 例患者在 MM 的基础上行 DISE 用于手术决策。根据 Sher 标准（术后呼吸暂停低通气指数[AHI]<20/h 和术前 AHI 降低≥50%）定义手术成功，AHI 改善率（%）定义为（术前 AHI-术后 AHI）×100/术前 AHI。为了比较 MM 组和 DISE 组，连续变量采用独立或配对 t 检验，分类变量采用卡方检验计算 p 值。
通过比较 MM 和 DISE 的结果，舌基底水平的共识显示一致性无统计学意义（kappa=0.017，p=0.865），而口咽水平的共识显示一致性较好（kappa=0.241，p=0.005）。两组患者舌基底手术后 AHI、仰卧位 AHI、快速眼球运动（REM）AHI、非 REM AHI 和最低血氧饱和度均显著改善。MM 组患者舌基底手术后 Epworth 嗜睡量表评分显著改善（p=0.014），而 DISE 组无显著改善（p=0.165）。然而，两组间 AHI 改善（MM 组=47.0±32.0，DISE 组=48.3±35.4，p=0.852）和手术成功率（MM 组=42.6%，DISE 组=45.8%，p=0.748）无显著差异。MM 组中，扁桃体分级（p<0.05）和口咽侧壁闭塞（p=0.031）与手术成功率显著相关。
在舌基底手术的判断中，MM 和 DISE 的发现一致性较差。DISE 可能影响 OSA 患者舌基底手术的决策，但在手术结果方面，DISE 优于 MM 的证据不足。
