长期体重指数在上气道刺激治疗中的变化趋势：体重指数重要吗？

Long-term trends in body mass index throughout upper airway stimulation treatment: does body mass index matter?

机构信息

Department of Otolaryngology-Head & Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas.

出版信息

J Clin Sleep Med. 2023 Jun 1;19(6):1061-1071. doi: 10.5664/jcsm.10496.

DOI:10.5664/jcsm.10496

PMID:36740926

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10235707/

Abstract

STUDY OBJECTIVES

Upper airway stimulation is a surgical option for patients with obstructive sleep apnea who fail other forms of noninvasive treatment. Current guidelines recommend a baseline body mass index (BMI) below 32 kg/m for eligibility. In this study, we identify trends in BMI before and after upper airway stimulation to characterize the influence of BMI on treatment success.

METHODS

Patients underwent upper airway stimulation implantation between 2016 and 2021. Sleep study data were collected from preoperative and most recent postoperative sleep study. BMI data were collected and compared across the following time points: preoperative sleep study (BMI-1), initial surgeon consultation (BMI-2), surgery (BMI-3), titration polysomnogram (BMI-4), and second postoperative sleep study (BMI-5). Patients were categorized into groups (BMI ≥32 [BMI], 25 ≤ BMI <32 [BMI], BMI <25 [BMI]) based BMI-1, and clinical outcomes were compared.

RESULTS

253 patients were included. The BMI group showed a significant decrease in BMI between BMI-1 and BMI-3 (33.9 vs 32.2; < .001) and a significant increase in BMI between BMI-3 and BMI-5 (32.2 vs 33.0; = .047). Apnea-hypopnea index improvement and treatment success rate were not significantly different between groups. On univariate and multivariable logistic regression, a lower BMI-5 was significantly predictive of treatment success (odds ratio: 0.88; 95% confidence interval: 0.79-0.97; = .016). BMI-5 was also significantly associated with improvement in apnea-hypopnea index ( = .002). Other BMI time points were not associated with measures of treatment success.

CONCLUSIONS

Reduced BMI after upper airway stimulation implantation, as opposed to baseline BMI, predicted treatment success. These findings may guide patient counseling, with implications for long-term adherence and therapy success.

CITATION

Renslo B, Virgen CG, Sawaf T, et al. Long-term trends in body mass index throughout upper airway stimulation treatment: does body mass index matter? . 2023;19(6):1061-1071.

摘要

研究目的

对于其他无创治疗方法失败的阻塞性睡眠呼吸暂停患者，上气道刺激是一种手术选择。目前的指南建议入选患者的基线体重指数（BMI）低于 32kg/m2。在这项研究中，我们确定了上气道刺激治疗前后 BMI 的趋势，以确定 BMI 对上气道刺激治疗成功的影响。

方法

患者在 2016 年至 2021 年间接受了上气道刺激植入术。睡眠研究数据来自术前和最近一次术后睡眠研究。收集 BMI 数据并在以下时间点进行比较：术前睡眠研究（BMI-1）、初次外科医生咨询（BMI-2）、手术（BMI-3）、滴定多导睡眠图（BMI-4）和第二次术后睡眠研究（BMI-5）。根据 BMI-1 将患者分为以下组（BMI≥32[BMI]、25≤BMI<32[BMI]、BMI<25[BMI]），并比较临床结果。

结果

共纳入 253 例患者。BMI 组在 BMI-1 与 BMI-3 之间 BMI 显著下降（33.9 与 32.2；<0.001），在 BMI-3 与 BMI-5 之间 BMI 显著增加（32.2 与 33.0；=0.047）。各组间呼吸暂停低通气指数改善和治疗成功率无显著差异。单因素和多因素逻辑回归分析显示，BMI-5 较低与治疗成功显著相关（优势比：0.88；95%置信区间：0.79-0.97；=0.016）。BMI-5 也与呼吸暂停低通气指数的改善显著相关（=0.002）。其他 BMI 时间点与治疗成功的测量值无关。

结论

上气道刺激植入后 BMI 的降低，而不是基线 BMI，预测了治疗成功。这些发现可能指导患者咨询，对长期依从性和治疗成功具有重要意义。

引文

Renslo B, Virgen CG, Sawaf T, et al. Long-term trends in body mass index throughout upper airway stimulation treatment: does body mass index matter?. 2023;19(6):1061-1071.