体重管理联合悬雍垂腭咽成形术治疗肥胖相关性阻塞性睡眠呼吸暂停低通气综合征的疗效
[Efficacy of weight management combined with uvulopalatopharyngoplasty for obesityrelated obstructive sleep apnea-hypopnea syndrome].
作者信息
Tan Jian, Cui Qianbo, Gu Xiang, Xu Shufang, Xue Sha, Yuan Kun, Chen Wei
机构信息
Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China.
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2020 Nov 30;40(11):1668-1672. doi: 10.12122/j.issn.1673-4254.2020.11.21.
OBJECTIVE
To evaluate the clinical efficacy of weight management combined with pharyngoplasty for treatment of obesity-related obstructive sleep apnea-hypopnea syndrome (OSAHS).
METHODS
Sixty obese patients with OSAHS were randomly assigned into the combined treatment group and control group (=30) and received treatment with uvulopalatopharyngoplasty (UPPP) combined with cognitive-behavioral-psychological intervention for family weight management and uvulopalatopharyngoplasty with conventional management. At 3 and 6 months of the treatment, the patients were examined for changes in body mass index (BMI), neck circumference, waist circumference, Epworth Sleepiness Scale (ESS) scores, apnea-hypopnea index (AHI), the lowest oxygen saturation (LSaO) and the percentage of time with oxygen saturation below 90% (CT90).
RESULTS
After 6 months of treatment, the patients receiving the combined treatment showed significant reductions of BMI, neck circumference and waist circumference as compared with the measurements before treatment and with those in the control group ( < 0.01); these parameters showed no significant changes in the control group ( > 0.05). In the combined treatment group, the ESS score, CT90, AHI, and LSaO at 6 months were all superior to those in the control group ( < 0.01) and differed significantly cross different time points during the treatment, and their improvements were the most obvious after 6 months ( < 0.01). After 6 months of treatment, the combined treatment group had a similar cure rate with the control group (6.6% 7.1%; χ=1.66, > 0.05) but a significantly higher good response (defined as an AHI < 20 h-1 and an AHI reduction by ≥50%) rate (60% 35.7%; χ=8.71, < 0.01) and a higher overall response (a AHI reduction ≥50%) rate (83.3% 53.6%; χ=10.62, < 0.01).
CONCLUSIONS
Weight management combined with uvulopalatopharyngoplasty can produce a good clinical efficacy for treatment of OSAHS with obesity, and the patients should have strengthened continuous family weight management while receiving surgical treatment.
目的
评估体重管理联合咽成形术治疗肥胖相关阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的临床疗效。
方法
将60例肥胖OSAHS患者随机分为联合治疗组和对照组（每组30例），联合治疗组接受悬雍垂腭咽成形术（UPPP）联合认知行为心理干预以进行家庭体重管理，对照组接受悬雍垂腭咽成形术及常规管理。在治疗3个月和6个月时，检查患者体重指数（BMI）、颈围、腰围、爱泼华嗜睡量表（ESS）评分、呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO）及血氧饱和度低于90%的时间百分比（CT90）的变化。
结果
治疗6个月后，联合治疗组患者的BMI、颈围和腰围与治疗前及对照组相比均显著降低（P<0.01）；对照组这些参数无显著变化（P>0.05）。联合治疗组6个月时的ESS评分、CT90、AHI及LSaO均优于对照组（P<0.01），且在治疗过程中不同时间点差异有统计学意义，6个月时改善最明显（P<0.01）。治疗6个月后，联合治疗组的治愈率与对照组相似（6.6%对7.1%；χ²=1.66，P>0.05），但良好反应（定义为AHI<20次/小时且AHI降低≥50%）率显著更高（60%对35.7%；χ²=8.71，P<0.01），总体反应（AHI降低≥50%）率也更高（83.3%对53.6%；χ²=10.62，P<0.01）。
结论
体重管理联合悬雍垂腭咽成形术治疗肥胖型OSAHS可产生良好的临床疗效，患者在接受手术治疗时应加强持续的家庭体重管理。
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