Pontifical Catholic University of Campinas and Campinas State University, Zip Code, Avenida John Boyd Dunlop, Campinas/SP, 13034-685, Brazil.
Sleep Breath. 2023 Jun;27(3):1125-1134. doi: 10.1007/s11325-022-02706-y. Epub 2022 Sep 22.
There are several surgical treatments for obstructive sleep apnea (OSA) including lateral pharyngoplasty (LP) have yielded promising results, clearly improving symptoms of the disease. However, there are few publications in relation to polysomnographic (PSG) results, and patient selection remains a challenge. There are currently four pathophysiological phenotypes for OSA: anatomical, low arousal threshold, ventilatory instability, and poor muscle response. This study sought to evaluate the PSG results of LP and to verify whether the phenotypic profile is predictive of surgical success.
This was an observational, retrospective, cross-sectional study that analyzed the PSG results (pre-surgical and at least 6 months after surgery) of patients treated with Cahali's LP. To assess phenotypes, the following variables of interest (obtained from the pre-operative PSG) were used: apnea-hypopnea index (AHI) during REM sleep (AHIrem), percentage of hypopneas in the AHI, number of central or mixed apneas, and AHIrem and non-REM AHI ratio.
Of 46 patients, it was possible to evaluate the phenotype in 28 patients. There were significant differences in the AHI values, ranging from 37.5 (20.8-49.7) to 10.3 (2.3-33.0) (p < 0.001). The minimum oxyhemoglobin saturation ranged from 78 ± 11 to 83 ± 8 p = 0.008. The time with oxyhemoglobin saturation < 90% ranged from 3.6 min (0.5-9.1) to 0.0 (0.0-1.5) p = 0.031. An AHIrem of < 20 events/h showed a positive correlation with surgical success.
LP is efficient for the treatment of OSA, yielding significant improvement in all respiratory parameters evaluated by PSG. A pre-operative AHIrem of < 20 events/h was associated with surgical success. Other variables of interest for determining the phenotypes were not predictors of surgical success.
阻塞性睡眠呼吸暂停（OSA）的治疗方法有几种，包括 lateral pharyngoplasty（LP）在内的治疗方法已取得了令人鼓舞的结果，明显改善了疾病症状。然而，关于多导睡眠图（PSG）结果的出版物很少，患者选择仍然是一个挑战。目前，OSA 有四种病理生理表型：解剖结构、低觉醒阈值、通气不稳定和肌肉反应差。本研究旨在评估 LP 的 PSG 结果，并验证表型谱是否对手术成功有预测作用。
这是一项观察性、回顾性、横断面研究，分析了接受 Cahali LP 治疗的患者的 PSG 结果（术前和至少术后 6 个月）。为了评估表型，使用了以下感兴趣的变量（从术前 PSG 中获得）：REM 睡眠期间的呼吸暂停-低通气指数（AHIrem）、AHI 中低通气的百分比、中央或混合呼吸暂停的次数，以及 AHIrem 和非 REM AHI 的比值。
在 46 名患者中，有 28 名患者可以评估表型。AHI 值有显著差异，范围从 37.5（20.8-49.7）到 10.3（2.3-33.0）（p < 0.001）。最低氧饱和度范围从 78 ± 11 到 83 ± 8（p = 0.008）。氧饱和度 < 90%的时间范围从 3.6 分钟（0.5-9.1）到 0.0（0.0-1.5）（p = 0.031）。AHIrem < 20 次/小时与手术成功呈正相关。
LP 治疗 OSA 有效，可显著改善 PSG 评估的所有呼吸参数。术前 AHIrem < 20 次/小时与手术成功相关。确定表型的其他感兴趣变量不是手术成功的预测因素。
