术前睡眠呼吸紊乱和颅面畸形是口腔癌行皮瓣咽成形术后睡眠呼吸紊乱的危险因素：一项前瞻性病例对照研究。
Preoperative sleep-disordered breathing and craniofacial abnormalities are risk factors for postoperative sleep-disordered breathing in patients undergoing skin-flap oropharyngeal reconstruction surgery for oral cavity cancer: a prospective case-control study.
机构信息
Department of Anesthesiology, Pain and Palliative Care Medicine, Chiba University Hospital, Chiba, Japan.
Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan.
出版信息
Sleep Breath. 2024 May;28(2):797-806. doi: 10.1007/s11325-023-02962-6. Epub 2023 Dec 18.
PURPOSE
After oropharyngeal reconstruction surgery, excessive flap volume within the oral cavity may increase the risk of pharyngeal obstruction during sleep. This prospective observational study aimed to test a hypothesis that the skin-flap oropharyngeal reconstructive surgery increases nocturnal apnea-hypopnea index (nAHI, primary variable) after surgery.
METHODS
Adult patients undergoing oropharyngeal reconstruction surgery participated in this study. The hypothesis was tested by comparing the results of portable type 4 sleep study and craniofacial assessments with lateral head and neck computed tomography scout image before and after surgery. Multiple linear regression analyses were performed to identify predictors for nAHI increase after the surgery.
RESULTS
In 15 patients, a postoperative sleep study was performed at 41 (27, 59) (median (IQR)) days after the surgery. nAHI did not increase after the surgery (mean (95% CI), 13.0 (7.2 to 18.7) to 18.4 (10.2 to 26.6) events.hour, p = 0.277), while apnea index significantly increased after the surgery (p = 0.026). Use of the pedicle flap for the oropharyngeal reconstruction (p = 0.051), small mandible (p = 0.008), longer lower face (0.005), and larger tongue size (p = 0.008) were independent predictors for worsening of nAHI after surgery. Hospital stay was significantly longer in patients with the pedicle flap (n = 8) than in those with the free flap (n = 7) (p = 0.014), and the period of hospital stay was directly associated with increase of nAHI after surgery (r = 0.788, p < 0.001, n = 15).
CONCLUSIONS
Oropharyngeal reconstruction surgery worsens sleep-disordered breathing in some patients with craniofacial and surgical risk factors.
TRIAL REGISTRATION
UMIN Clinical Trial Registry (UMIN000036260, March 22, 2019), https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000036260.
目的
口咽重建手术后，口腔内过多的皮瓣体积可能会增加睡眠时咽阻塞的风险。本前瞻性观察研究旨在检验一个假设，即皮瓣咽重建手术会增加手术后夜间呼吸暂停低通气指数（nAHI，主要变量）。
方法
接受口咽重建手术的成年患者参与了这项研究。通过比较手术前后便携式 4 型睡眠研究和颅面评估与侧头颈部 CT 扫描图像的结果来检验假设。进行多元线性回归分析以确定手术后 nAHI 增加的预测因素。
结果
在 15 名患者中，有 15 名患者在手术后 41（27，59）（中位数（IQR））天进行了术后睡眠研究。手术后 nAHI 没有增加（平均值（95%CI），13.0（7.2 至 18.7）至 18.4（10.2 至 26.6）事件/小时，p = 0.277），但手术后呼吸暂停指数显著增加（p = 0.026）。口咽重建使用蒂瓣（p = 0.051）、小下颌（p = 0.008）、更长的下面部（0.005）和更大的舌体积（p = 0.008）是手术后 nAHI 恶化的独立预测因素。带蒂瓣（n = 8）的患者住院时间明显长于游离瓣（n = 7）（p = 0.014），并且住院时间与手术后 nAHI 的增加直接相关（r = 0.788，p < 0.001，n = 15）。
结论
口咽重建手术会使某些存在颅面和手术危险因素的患者睡眠呼吸紊乱恶化。
试验注册
UMIN 临床研究注册（UMIN000036260，2019 年 3 月 22 日），https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000036260。
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