Chen Rong-Feng, Nakayama Meiho, Sung Wei-Che, Hung Jeng-Fung, Chu Yih-Min
Department of Otolaryngology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan.
Good Sleep Center & Department of Otolaryngology, Nagoya City University, Nagoya, Japan; Meiho Sleep 11F, 4-chome-6-23 Meieki Nakamura-ku, Aichi 450-002, Japan.
Auris Nasus Larynx. 2022 Apr;49(2):235-239. doi: 10.1016/j.anl.2021.08.001. Epub 2021 Aug 25.
Objective The purpose of this study was to compare surgical outcomes for obstructive sleep apnea (OSA) when the procedure was based on the results of drug-induced sleep endoscopy (DISE) vs. the awake Müller's maneuver (MM). Methods Forty-seven patients with OSA who underwent sleep surgery were included. Patients were divided into 2 groups according to their preoperative upper airway evaluation method. Twenty-five patients received only MM for surgical decision making (MM group), and 22 patients received both MM and DISE (DISE group) for surgical decision making. Results The surgical success rate of the DISE group was higher than that of the MM group (59% vs. 36%), but the difference was not significant (p = 0.118). The differences between pre- and postoperative apnea-hypopnea index (AHI) values in both the MM and DISE group were highly significantly different (p < 0.001). Fifteen patients in the DISE group (68.2%) received multi-level surgery, while in the MM group only 7 patients (28%) received multi-level surgery. Patients with more severe OSA (AHI > 22 or lowest O2 saturation < 81%) had better surgical outcomes when their surgical procedures were based on the findings of DISE, rather than those of MM. Conclusion The results indicate that DISE provides no benefits with respect to surgical outcomes for patients with mild to moderate OSA; however, for patients with more severe OSA surgical procedures based on DISE result in better outcomes.
目的 本研究旨在比较基于药物诱导睡眠内镜检查（DISE）结果与清醒状态下Müller动作（MM）进行手术时，阻塞性睡眠呼吸暂停（OSA）的手术效果。方法 纳入47例行睡眠手术的OSA患者。根据术前上气道评估方法将患者分为2组。25例患者仅通过MM进行手术决策（MM组），22例患者通过MM和DISE两者进行手术决策（DISE组）。结果 DISE组的手术成功率高于MM组（59%对36%），但差异无统计学意义（p = 0.118）。MM组和DISE组术前和术后呼吸暂停低通气指数（AHI）值的差异均具有高度统计学意义（p < 0.001）。DISE组有15例患者（68.2%）接受了多级手术，而MM组只有7例患者（28%）接受了多级手术。当手术基于DISE结果而非MM结果时，OSA更严重（AHI > 22或最低氧饱和度 < 81%）的患者手术效果更好。结论 结果表明，对于轻度至中度OSA患者，DISE在手术效果方面并无益处；然而，对于更严重的OSA患者，基于DISE结果的手术效果更好。
