Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Department of Otolaryngology-Head & Neck Surgery, University of California, Irvine, Orange, California, USA.
World Neurosurg. 2023 Aug;176:143-148. doi: 10.1016/j.wneu.2023.04.116. Epub 2023 May 4.
There is currently no consensus on the appropriate timing of noninvasive positive pressure ventilation (PPV) resumption in patients with obstructive sleep apnea (OSA) after endoscopic pituitary surgery. We performed a systematic review of the literature to better assess the safety of early PPV use in OSA patients following surgery.
The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases in English were searched using the keywords: "sleep apnea," "CPAP," "endoscopic," "skull base," "transsphenoidal" and "pituitary surgery." Case reports, editorials, reviews, meta-analyses, unpublished and abstract-only articles were all excluded.
Five retrospective studies were identified, comprising 267 patients with OSA who underwent endoscopic endonasal pituitary surgery. The mean age of patients in four studies (n = 198) was 56.3 years (SD = 8.6) and the most common indication for surgery was pituitary adenoma resection. The timing of PPV resumption following surgery was reported in four studies (n = 130), with 29 patients receiving PPV therapy within two weeks. The pooled rate of postoperative cerebrospinal fluid leak associated with PPV resumption was 4.0% (95% CI: 1.3-6.7%) in three studies (n = 27) and there were no reports of pneumocephalus associated with PPV use in the early postoperative period (<2 weeks).
Early resumption of PPV in OSA patients after endoscopic endonasal pituitary surgery appears relatively safe. However, the current literature is limited. Additional studies with more rigorous outcome reporting are warranted to assess the true safety of re-initiating PPV postoperatively in this population.
目前对于内镜垂体手术后阻塞性睡眠呼吸暂停（OSA）患者何时重新开始无创正压通气（PPV）尚无共识。我们对文献进行了系统回顾，以更好地评估 OSA 患者手术后早期使用 PPV 的安全性。
该研究遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。使用“睡眠呼吸暂停”、“CPAP”、“内镜”、“颅底”、“经蝶窦”和“垂体手术”等关键词在英文数据库中进行搜索。排除病例报告、社论、综述、荟萃分析、未发表和仅摘要的文章。
确定了 5 项回顾性研究，共纳入 267 例接受内镜经鼻垂体手术的 OSA 患者。四项研究（n=198）中患者的平均年龄为 56.3 岁（SD=8.6），最常见的手术指征是垂体腺瘤切除术。四项研究（n=130）报告了手术后重新开始 PPV 的时间，29 例患者在术后两周内接受了 PPV 治疗。三项研究（n=27）中与重新开始 PPV 相关的术后脑脊液漏的合并发生率为 4.0%（95%CI：1.3-6.7%），早期（<2 周）手术后没有使用 PPV 导致的气颅报告。
内镜经鼻垂体手术后 OSA 患者早期重新开始使用 PPV 似乎相对安全。然而，目前的文献有限。需要更多具有严格结果报告的研究来评估在该人群中术后重新开始使用 PPV 的真正安全性。
