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[改良悬雍垂腭咽成形术后体位性与非体位性阻塞性睡眠呼吸暂停的治疗效果差异及预测因素分析]

[Analysis of the difference of therapeutic effect and predictive factors between postural and non-postural OSA after modified uvulopalatopharyngoplasty].

作者信息

Zhang Ying, Zhao Di

机构信息

Department of Otorhinolaryngology,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou,310000,China.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Aug;38(8):703-709. doi: 10.13201/j.issn.2096-7993.2024.08.006.

Abstract

To analyze the factors influencing the outcome of uvulopalatopharyngoplasty in positional obstructive sleep apnea(POSA) and non-positional OSA(NPOSA) patients, and to explore the differences between the two groups. The data of 101 patients with obstructive sleep apnea who received treatment from November 2020 to November 2023 were retrospectively analyzed. Among them, 45 positional patients(POSA group) and 56 non-positional patients(NPOSA group), who underwent overnight polysomnography were included. The upper airway(UA) anatomy was evaluated by three-dimensional computer tomography(3D-CT). All patients received revised uvulopalatopharyngoplasty with uvula preservation and were followed using polysomnography for at least three months postoperatively. The overall effective rate was 55.45%. The surgical success rate in POSA undergoing UPPP was higher than NPOSA(POSA 30/45, 66.7% versus NPOSA 26/56, 46.4%, =0.042). The H-UPPP effect of POSA was negatively correlated with the minimum lateral airway of the Velopharyngeal airway(=-0.505, <0.001), the minimum lateral airway of the glossopharyngeal airway(=-0.474, =0.001) and the minimum cross-sectional area(=-0.394, =0.007). Logistic analysis showed that minimal lateral airway of the glossopharynxgeum(mLAT)( 0.873; 95% 0.798-0.955, =0.003) was a significant predictor for surgical outcomes among POSA patients. In NPOSA, age( 0.936; 95% 0.879-0.998, =0.042) was a significant predictor for surgical outcomes. The effect of H-UPPP was higher in POSA than in NPOSA. The width of glossopharyngeal mLAT was an important predictor of POSA efficacy. Age was a predictor of NPOSA efficacy.

摘要

分析影响体位性阻塞性睡眠呼吸暂停(POSA)和非体位性阻塞性睡眠呼吸暂停(NPOSA)患者悬雍垂腭咽成形术治疗效果的因素,并探讨两组之间的差异。回顾性分析2020年11月至2023年11月接受治疗的101例阻塞性睡眠呼吸暂停患者的数据。其中,纳入45例体位性患者(POSA组)和56例非体位性患者(NPOSA组),均接受了整夜多导睡眠监测。通过三维计算机断层扫描(3D-CT)评估上气道(UA)解剖结构。所有患者均接受保留悬雍垂的改良悬雍垂腭咽成形术,并在术后至少三个月使用多导睡眠监测进行随访。总有效率为55.45%。接受悬雍垂腭咽成形术的POSA患者手术成功率高于NPOSA患者(POSA组30/45,66.7%;NPOSA组26/56,46.4%,=0.042)。POSA患者的改良悬雍垂腭咽成形术效果与腭咽气道最小外侧气道(=-0.505,<0.001)、舌咽气道最小外侧气道(=-0.474,=0.001)和最小横截面积(=-0.394,=0.007)呈负相关。Logistic分析显示,舌咽最小外侧气道(mLAT)(0.873;95% 0.798 - 0.955,=0.003)是POSA患者手术效果的重要预测指标。在NPOSA患者中,年龄(0.936;95% 0.879 - 0.998 =0.042)是手术效果的重要预测指标。改良悬雍垂腭咽成形术在POSA患者中的效果高于NPOSA患者。舌咽mLAT宽度是POSA疗效的重要预测指标。年龄是NPOSA疗效的预测指标。

相似文献

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本文引用的文献

1
[Effect of mouth breathing on upper airway structure in patients with obstructive sleep apnea].[口呼吸对阻塞性睡眠呼吸暂停患者上气道结构的影响]
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Jul;37(7):529-534. doi: 10.13201/j.issn.2096-7993.2023.07.005.
3
Uvulopalatopharyngoplasty.悬雍垂腭咽成形术。
Oral Maxillofac Surg Clin North Am. 2021 May;33(2):295-303. doi: 10.1016/j.coms.2021.01.001. Epub 2021 Feb 10.

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