Dong B W, Zhang J B, Xiao S F
Department of Otorhinolaryngology Head and Neck Surgery, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Apr 18;52(2):281-284. doi: 10.19723/j.issn.1671-167X.2020.02.014.
To explore the predictive values of the combination of preoperative data, including medical history and physical examination, and results of sleep oximetry performed early after the surgery (one week) in predicting the treatment outcomes of uvulopalatopharyngoplasty (UPPP) in adult patients with obstructive sleep apnea hypopnea syndrome (OSAHS).
All the patients who were diagnosed with OSAHS, underwent UPPP treatment and had complete follow-up data in our institution between Jan 2013 and May 2016 were enrolled in our study. The pre-operative data of these patients, including age, physical examination, and polysomnography (PSG) data, were all exactly collected for analysis. All these patients had received the evaluation of subjective efficacy scale and the sleep oximetry test in early post-operative days (within one week). The long-term efficacy evaluations including PSG and subjective efficacy scale were all finished at least three months after the surgery.
In the research 61 patients were finally studied, including 25 responders (41.0%) and 36 non-responders (59.0%). Regression analysis revealed that the pre-operative Friedman stage and early post-operative oxygen desaturation index of ≥4% (ODI4) were found to be independently predictive parameters for the UPPP treatment outcomes (P<0.05). The ROC curve analysis was used to estimate the predictive values of ODI4 to the treatment outcomes, and it was calculated with an area under the curve of 0.822. Using the ODI4 of 15 as the cutoff value, the sensitivity and specificity of that calculated were up to 0.778 and 0.760 respectively. The response rate among the patients with an early post-operative ODI4 of <15 was 70.4%, which was significantly higher than that of the patients with an early post-operative ODI4 of ≥15, whose response rate was 17.6% (P<0.05). The similar results could also be obtained in the patients with pre-operative Friedman stage II (87.5% vs.25.0%) and Friedman stage III (33.3% vs. 6.7%).
The combination of early post UPPP operation oximetry parameters, especially ODI4, and pre-operative Friedman stage could be used in better evaluating the potential surgical outcomes of UPPP.
探讨术前数据（包括病史和体格检查）与术后早期（术后1周）进行的睡眠血氧饱和度测定结果相结合，对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）成年患者悬雍垂腭咽成形术（UPPP）治疗效果的预测价值。
选取2013年1月至2016年5月在本机构诊断为OSAHS、接受UPPP治疗且有完整随访数据的所有患者纳入研究。准确收集这些患者的术前数据，包括年龄、体格检查和多导睡眠图（PSG）数据进行分析。所有患者在术后早期（1周内）均接受了主观疗效量表评估和睡眠血氧饱和度测试。包括PSG和主观疗效量表在内的长期疗效评估均在术后至少3个月完成。
本研究最终纳入61例患者，其中25例有效（41.0%），36例无效（59.0%）。回归分析显示，术前Friedman分期和术后早期氧饱和度下降指数≥4%（ODI4）是UPPP治疗效果的独立预测参数（P<0.05）。采用ROC曲线分析评估ODI4对治疗效果的预测价值，计算得出曲线下面积为0.822。以ODI4为15作为截断值，计算得出的敏感度和特异度分别高达0.778和0.760。术后早期ODI4<15的患者有效率为70.4%，显著高于术后早期ODI4≥15的患者，后者有效率为17.6%（P<0.05）。术前Friedman II期（87.5%对25.0%）和Friedman III期（33.3%对6.7%）的患者也得到了类似结果。
UPPP术后早期血氧饱和度测定参数，尤其是ODI4，与术前Friedman分期相结合，可更好地评估UPPP的潜在手术效果。
