Zhu Huaming, Yi Hongliang, Guan Jian, Zou Jianyin, Xu Huajun, Liu Yupu
Department of Otolaryngology Head and Neck Surgery，Shanghai Jiao Tong University Affiliated Sixth People's Hospital，Shanghai Key Laboratory of Sleep Disordered Breathing，and Otolaryngological Institute，Shanghai Jiao Tong University，Shanghai，200233，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Feb;35(2):146-151. doi: 10.13201/j.issn.2096-7993.2021.02.012.
The aim of this study is to investigate the effect of smoking on the glucose, lipid metabolism and sleep structure in patients with moderate and severe obstructive sleep apnea （OSA） after operation. A retrospective analysis of 103 adult male patients with moderate to severe OSA who were diagnosed and treated from January 2016 to December 2017. All of them could not tolerate continuous positive pressure ventilation. After evaluation by an otolaryngologist, they underwent modified uvulapalatopharyngoplasty surgery. All participants were grouped according to smoking status（non-smokers, smokers） for analysis. Laboratory-based polysomnographic variables, anthropometric measurements, biochemical indicators, and smoking history, Epworth sleepiness score（ESS） were collected preoperatively and postoperatively. And the difference of each variable preoperatively and postoperatively was demonstrated as delta（Δ, calculated as postoperative value minus preoperative value）. Fifteen patients with preoperative moderate OSA and 88 patients with severe OSA. The overall successful rate of surgery was 55.3%（18.4% cured, 23.3% markedly effective and 13.6% effective）, and there was no statistical difference between the non-smokers and the smokers（59.7% vs 48.9%, =0.276）. After surgery, AHI, mean oxygen saturation, ODI, MAI, TC, FBG, fasting insulin, BMI, ESS, N1 and N3 were significantly improved（<0.05）. The amelioration of glucose or lipid metabolism related traits（including ΔTC, ΔFBG, Δfasting insulin） were not significantly different between smokers and non-smokers. However, as to sleep structure, ΔN3 was significantly higher in non-smoker as compared to smokers（=0.039）. Upper airway surgery is helpful to improve the glucose and lipid metabolism disorder and sleep structure in OSA patients. Postoperative smoking was associated with worse sleep structure, but not glycolipid metabolism. The postoperative improvement of sleep structure in non-smoking OSA patients was better than smokers.
本研究旨在探讨吸烟对中重度阻塞性睡眠呼吸暂停（OSA）患者术后糖脂代谢及睡眠结构的影响。回顾性分析2016年1月至2017年12月期间诊断并接受治疗的103例成年男性中重度OSA患者。他们均无法耐受持续气道正压通气。经耳鼻喉科医生评估后，他们接受了改良悬雍垂腭咽成形术。所有参与者根据吸烟状况（非吸烟者、吸烟者）分组进行分析。术前和术后收集基于实验室的多导睡眠图变量、人体测量指标、生化指标、吸烟史、爱泼华嗜睡量表（ESS）评分。各变量术前和术后的差异用差值（Δ，计算方法为术后值减去术前值）表示。术前有15例中度OSA患者和88例重度OSA患者。手术总体成功率为55.3%（治愈18.4%，显效23.3%，有效13.6%），非吸烟者和吸烟者之间无统计学差异（59.7%对48.9%，P = 0.276）。术后，呼吸暂停低通气指数（AHI）、平均血氧饱和度、氧减指数（ODI）、微觉醒指数（MAI）、总胆固醇（TC）、空腹血糖（FBG）、空腹胰岛素、体重指数（BMI）、ESS评分、N1期和N3期均有显著改善（P < 0.05）。吸烟者和非吸烟者之间糖脂代谢相关指标（包括ΔTC、ΔFBG、Δ空腹胰岛素）的改善无显著差异。然而，在睡眠结构方面，非吸烟者的ΔN3显著高于吸烟者（P = 0.039）。上气道手术有助于改善OSA患者的糖脂代谢紊乱和睡眠结构。术后吸烟与较差的睡眠结构相关，但与糖脂代谢无关。非吸烟OSA患者术后睡眠结构的改善优于吸烟者。
