药物诱导睡眠内镜检查在预测Friedman II期和III期成人阻塞性睡眠呼吸暂停综合征患者腭咽手术结局中的应用
Application of drug-induced sleep endoscopy in predicting the outcomes of velopharyngeal surgery in adult patients with Friedman stage II and III obstructive sleep apnea syndrome.
作者信息
Cao Xin, Zhou Yingqian, Zhang Junbo, Yin Guoping, Ye Jingying
机构信息
Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China.
出版信息
Front Neurol. 2023 Jan 9;13:1049425. doi: 10.3389/fneur.2022.1049425. eCollection 2022.
OBJECTIVE
This study aimed to evaluate the predictive value of drug-induced sleep endoscopy (DISE) for the outcomes of velopharyngeal surgery in adult patients with Friedman stage II and III obstructive sleep apnea syndrome (OSAS).
METHODS
A total of 39 male OSAS patients with Friedman stage II and III were retrospectively analyzed. Subjects with an apnea-hypopnea index (AHI) > 5 events/h indicated by polysomnography (PSG) and typical symptoms, such as snoring, sleep apnea, and daytime sleepiness, were included in this study. All these patients underwent pre-operative DISE examinations and were treated by velopharyngeal surgery and evaluated by velum, oropharynx, tongue base, and epiglottis (VOTE) scoring system. Clinical, polysomnographic parameters (e.g., hypopnea, apnea, AHI, lowest oxygen saturation, etc.), cephalometric variables, and DISE findings were evaluated. The treatment outcomes were assessed by polysomnography at least 6 months after surgery.
RESULTS
All 39 patients showed complete velopharyngeal airway collapses during pre-operative DISE examinations. After surgery, the AHI was significantly improved from 50.2 ± 21.6 to 19.8 ± 19 events/h ( < 0.05). There were 23 responders (59.0%) and 16 non-responders (41.0%). The glossopharyngeal airway collapse degree (GA-CD) was significantly different between responders and non-responders ( < 0.05). The velopharyngeal airway collapse pattern (VA-CP) and GA-CD were independently predictive of treatment outcomes (both < 0.05). Patients with non-lateral VA-CP and grade II GA-CD (collapse degree > 50%) had a significantly lower surgical success rate than those without ( < 0.05).
CONCLUSION
The VA-CP and GA-CD in DISE examination are valuable for predicting the treatment outcomes of velopharyngeal surgery in patients with Friedman stage II and III OSAS. Patients with lateral VA-CP and grade I GA-CD are appropriate candidates for velopharyngeal surgery.
目的
本研究旨在评估药物诱导睡眠内镜检查（DISE）对Friedman II期和III期阻塞性睡眠呼吸暂停综合征（OSAS）成年患者腭咽手术结局的预测价值。
方法
回顾性分析39例Friedman II期和III期男性OSAS患者。纳入多导睡眠图（PSG）显示呼吸暂停低通气指数（AHI）>5次/小时且有打鼾、睡眠呼吸暂停和日间嗜睡等典型症状的患者。所有这些患者均接受术前DISE检查，并接受腭咽手术治疗，采用腭、口咽、舌根和会厌（VOTE）评分系统进行评估。评估临床、多导睡眠图参数（如低通气、呼吸暂停、AHI、最低血氧饱和度等）、头影测量变量和DISE检查结果。术后至少6个月通过多导睡眠图评估治疗结局。
结果
所有39例患者在术前DISE检查中均显示腭咽气道完全塌陷。术后，AHI从50.2±21.6显著改善至19.8±19次/小时（P<0.05）。有23例反应者（59.0%）和16例无反应者（41.0%）。反应者和无反应者之间的舌咽气道塌陷程度（GA-CD）有显著差异（P<0.05）。腭咽气道塌陷模式（VA-CP）和GA-CD可独立预测治疗结局（均P<0.05）。非侧方VA-CP和II级GA-CD（塌陷程度>50%）的患者手术成功率显著低于无上述情况的患者（P<0.05）。
结论
DISE检查中的VA-CP和GA-CD对预测Friedman II期和III期OSAS患者腭咽手术的治疗结局有重要价值。具有侧方VA-CP和I级GA-CD的患者是腭咽手术的合适候选者。
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