Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC.
Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
J Chin Med Assoc. 2022 Jun 1;85(6):672-678. doi: 10.1097/JCMA.0000000000000737. Epub 2022 Jun 10.
Obstructive sleep apnea (OSA) is characterized by partial or complete airway blockage during sleep. Nocturnal nasal obstruction usually leads to mouth breathing while sleeping, which worsens sleep apnea by aggravating tongue base and lateral pharyngeal wall collapse. The pathogenesis of OSA is multifactorial, and the precipitating factors vary significantly among individuals. Although continuous positive airway pressure (CPAP) is considered the first-line therapy for OSA, its adherence rate remains a challenge. Oral appliances are more suitable for simple snorers or patients with mild OSA. Maxillomandibular advancement (MMA) is highly effective for treating those with mandibular retrognathia and moderate-to-severe OSA. Intrapharyngeal surgeries yield favorable outcomes in patients with large tonsils and low tongue resting position (Friedman Stage I); however, their efficacy declines with time. Each therapy has its own strength and weakness; thus, the principle of multimodality treatment should be adopted. Nasal surgery plays an indispensable role in the holistic care for OSA. In addition to alleviating nasal congestion, nasal surgery significantly reduces snoring intensity and daytime sleepiness, which improves the quality of life of patients with OSA. Although it significantly reduces the respiratory disturbance index, its effect on the apnea-hypopnea index remains controversial. A combination of nasal surgery and multilevel pharyngeal surgery may result in better prognosis. Nasal surgery can significantly reduce the therapeutic pressure and improve the CPAP compliance of patients undergoing CPAP therapy. In conclusion, multimodality treatment and holistic care for OSA should involve nasal surgery for optimizing treatment outcomes.
阻塞性睡眠呼吸暂停（OSA）的特征是睡眠期间部分或完全气道阻塞。夜间鼻阻塞通常导致睡眠时张口呼吸，通过加重舌基底和咽侧壁塌陷，使睡眠呼吸暂停恶化。OSA 的发病机制是多因素的，诱发因素在个体之间差异很大。虽然持续气道正压通气（CPAP）被认为是 OSA 的一线治疗方法，但它的依从性仍然是一个挑战。口腔矫治器更适合单纯打鼾或轻度 OSA 患者。上颌骨下颌骨前伸（MMA）对于治疗下颌后缩和中重度 OSA 非常有效。咽内手术在扁桃体大、舌休息位低（Friedman Ⅰ期）的患者中取得了良好的效果；然而，随着时间的推移，其疗效下降。每种治疗方法都有其自身的优缺点；因此，应采用多模式治疗原则。鼻手术在 OSA 的整体治疗中起着不可或缺的作用。除了缓解鼻塞外，鼻手术还显著降低了打鼾的强度和白天嗜睡程度，提高了 OSA 患者的生活质量。尽管它显著降低了呼吸紊乱指数，但对呼吸暂停低通气指数的影响仍存在争议。鼻手术和多平面咽手术的联合可能会产生更好的预后。鼻手术可以显著降低 CPAP 治疗患者的治疗压力，提高 CPAP 依从性。总之，OSA 的多模式治疗和整体护理应包括鼻手术，以优化治疗效果。
