Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
Laryngoscope. 2021 May;131(5):1180-1187. doi: 10.1002/lary.29212. Epub 2020 Oct 28.
OBJECTIVES/HYPOTHESIS: To evaluate associations between sleep surgery and CRP (C-reactive protein) levels in adults with obstructive sleep apnea (OSA).
Meta-analysis.
Two authors independently searched PubMed, Medline, EMBASE, and Cochrane review databases until July 2019. The keywords used were sleep apnea, OSA, sleep apnea syndromes, surgery, C-reactive protein (CRP), and inflammatory markers. The effects of sleep surgery on CRP levels were examined using a random-effects model.
Nine studies with 277 patients were analyzed (mean age: 46.5 years; 92% men; mean sample size: 30.8 patients). The mean change in the apnea-hypopnea index (AHI) after surgery was significantly reduced by -21.1 (95% confidence interval [CI], -28.4 to -13.7) events/hr. Overall, sleep surgery resulted in a significant reduction of CRP levels in patients with OSA (standardized mean difference [SMD] = -0.39, 95% CI, -0.67 to -0.11). Patients with postoperative AHI reduction >20 events/hr achieved a greater reduction in CRP than those with AHI reduction <20 events/hr (SMD: -0.72 vs. -0.14, P for heterogeneity = .007). According to subgroup analysis, differences in the CRP levels after surgery were nonsignificant in the different countries (i.e., United States vs. other countries), CRP types (i.e., CRP vs. high-sensitivity CRP), surgical procedures (i.e., pharyngeal surgery vs. other surgical procedures), and follow-up period (i.e., <6 vs. >6 months).
Sleep surgery for OSA resulted in a significant reduction of CRP levels in adults. The beneficial effect of surgery on CRP levels is greater in patients with large improvement in OSA (i.e., AHI reduction >20 events/hr) after sleep surgery. Laryngoscope, 131:1180-1187, 2021.
目的/假设：评估阻塞性睡眠呼吸暂停（OSA）成人的睡眠手术与 C 反应蛋白（CRP）水平之间的关联。
荟萃分析。
两位作者独立检索 PubMed、Medline、EMBASE 和 Cochrane 评论数据库，检索截至 2019 年 7 月。使用的关键词包括睡眠呼吸暂停、OSA、睡眠呼吸暂停综合征、手术、C 反应蛋白（CRP）和炎症标志物。使用随机效应模型检查睡眠手术对 CRP 水平的影响。
分析了 9 项研究，共 277 例患者（平均年龄：46.5 岁；92%为男性；平均样本量：30.8 例）。手术后呼吸暂停-低通气指数（AHI）的平均变化明显降低了 -21.1（95%置信区间 [CI]，-28.4 至 -13.7）次/小时。总体而言，睡眠手术可显著降低 OSA 患者的 CRP 水平（标准化均数差 [SMD] = -0.39，95%CI，-0.67 至 -0.11）。术后 AHI 降低>20 次/小时的患者比 AHI 降低<20 次/小时的患者（SMD：-0.72 与 -0.14，异质性 P 值 =.007）的 CRP 降低更大。根据亚组分析，手术前后 CRP 水平在不同国家（即美国与其他国家）、CRP 类型（即 CRP 与高敏 CRP）、手术程序（即咽部手术与其他手术程序）以及随访时间（即<6 与>6 个月）之间无显著差异。
睡眠手术治疗 OSA 可显著降低成人的 CRP 水平。在睡眠手术后 OSA （即 AHI 降低>20 次/小时）明显改善的患者中，手术对 CRP 水平的有益影响更大。喉科学，131：1180-1187，2021。
