Department of Head and Neck Surgery, Kaiser Permanente, East Bay, Oakland, California, U.S.A.
Division of Research, Kaiser Permanente Northern California, Oakland, California, U.S.A.
Laryngoscope. 2023 May;133(5):1262-1270. doi: 10.1002/lary.30590. Epub 2023 Feb 2.
To identify clinical and demographic characteristics of adults with obstructive sleep apnea (OSA) undergoing soft tissue and orthognathic sleep surgery, assess temporal trends in surgery type and proportion of women undergoing surgery, and provide clinical perspective before wide-spread implementation of hypoglossal nerve stimulation (HGNS).
In a retrospective cohort study, adults diagnosed with OSA from 2009 to 2016 were identified in a large integrated healthcare system. Characteristics between cohort members who did and did not undergo sleep surgeries were compared. Multivariable logistic regression models examined associations of different characteristics with whether surgery was performed.
Of 172,216 adults with OSA, 2,262 (1.3%) underwent sleep surgery during 2009-2017. The most common sleep surgery was palate surgery (56.9%), which decreased proportionately over time. In multivariable analysis, older age and obesity were associated with lower odds of undergoing surgery. Those who underwent tonsillectomy and adenoidectomy were more likely to have larger tonsils and not require additional surgery, whereas tongue reduction recipients were more likely to have severe OSA and require multiple surgery types. The proportion of women undergoing surgery increased over time (p < 0.001 from trend test).
Clinical and demographic characteristics associated with soft tissue and orthognathic sleep surgery were identified in a large adult cohort prior to widespread implementation of HGNS. An increase in sleep surgery among women and a decrease in palate surgery over time were observed. The findings provide clinical perspective on sleep surgery performed prior to implementation of HGNS and may inform future studies examining its associations with patient characteristics.
3 Laryngoscope, 133:1262-1270, 2023.
确定行软组织和正颌睡眠手术的阻塞性睡眠呼吸暂停（OSA）成年患者的临床和人口统计学特征，评估手术类型和行手术女性比例的时间趋势，并在广泛应用舌下神经刺激（HGNS）之前提供临床视角。
在一项回顾性队列研究中，在一个大型综合医疗保健系统中确定了 2009 年至 2016 年被诊断为 OSA 的成年人。比较了行睡眠手术和未行睡眠手术的队列成员之间的特征。多变量逻辑回归模型检验了不同特征与是否行手术之间的关联。
在 172216 名患有 OSA 的成年人中，2262 名（1.3%）在 2009-2017 年期间行睡眠手术。最常见的睡眠手术是腭部手术（56.9%），其比例随时间呈比例下降。多变量分析显示，年龄较大和肥胖与手术可能性降低相关。行扁桃体切除术和腺样体切除术的患者更有可能有较大的扁桃体且无需额外手术，而行舌缩小术的患者更有可能患有严重的 OSA 并需要多种手术类型。行手术的女性比例随时间增加（趋势检验 p<0.001）。
在广泛应用 HGNS 之前，在一个大型成年队列中确定了与软组织和正颌睡眠手术相关的临床和人口统计学特征。观察到女性睡眠手术的比例增加和腭部手术随时间减少。这些发现为在实施 HGNS 之前进行的睡眠手术提供了临床视角，并可能为未来研究其与患者特征的关联提供信息。
Laryngoscope, 133:1262-1270, 2023.
