Wang Xiaoting, Zhang Jingyu, Zou Jianyin, Zhou Tianjiao, Zhou Enhui, Shen Li, Yang Siyu, Huang Weijun, Zhu Huaming, Guan Jian, Yi Hongliang, Yin Shankai
Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.
Sleep. 2025 May 12;48(5). doi: 10.1093/sleep/zsaf012.
Multilevel upper airway surgery is effective for some patients with obstructive sleep apnea (OSA), but predicting the response to surgery remains a challenge. The underlying endotypes of OSA include upper airway collapsibility, muscle compensation, loop gain, and the arousal threshold. This study aimed to explore the effect of surgery on polysomnography (PSG)-derived OSA endotypes and establish a surgical response prediction model.
Our study included 54 Chinese patients with OSA who underwent multilevel upper airway surgery. Participants underwent PSG before and after surgery with a median follow-up time of 6.5 months. Using AHIBaseline/AHIpost-surgery ≥ 2 and AHIpost-surgery < 10 events/h as criteria, participants were classified as surgery responders and non-responders. The surgical success rate was 26%. These endotypic traits were derived from a standard PSG data by validated methods.
The surgery altered both anatomical and non-anatomical endotypic traits, including increased Vpassive (baseline vs post-surgery: 51.5 [18.7-84.2] vs 86.8 [67.4-93.7] %Veupnea, p < .001), decreased loop gain (baseline vs post-surgery: 0.7 [0.7-0.8] vs 0.6 [0.5-0.6]; p < .001), and a higher arousal threshold (baseline vs post-surgery: 202.9 [183.7-222.0] vs 160.7 [143.9-177.4] %Veupnea; p < .001). However, it did not significantly affect muscle compensation. Fully adjusted logistic regression analyses indicated that a favorable response to surgery was independently associated with a lower LG (OR [CI 95%], 0.1 [0.0-0.5], p = .032). In patients with improved muscle compensation or a more collapsible airway (lower Vpassive), a lower loop gain was more strongly indicative of success. However, when muscle compensation was lower or collapsibility was less severe (higher Vpassive), a lower loop gain was less predictive of success.
This study demonstrated that multilevel upper airway surgery altered both anatomical and non-anatomical endotypes in Chinese patients with OSA. An endotype based regression model may meaningfully predict surgical success.
多级上气道手术对部分阻塞性睡眠呼吸暂停（OSA）患者有效，但预测手术反应仍是一项挑战。OSA的潜在内型包括上气道可塌陷性、肌肉代偿、环路增益和觉醒阈值。本研究旨在探讨手术对多导睡眠图（PSG）衍生的OSA内型的影响，并建立手术反应预测模型。
我们的研究纳入了54例接受多级上气道手术的中国OSA患者。参与者在手术前后均接受了PSG检查，中位随访时间为6.5个月。以AHI基线/AHI术后≥2且AHI术后<10次/小时为标准，将参与者分为手术反应者和无反应者。手术成功率为26%。这些内型特征通过验证方法从标准PSG数据中得出。
手术改变了解剖学和非解剖学内型特征，包括被动通气增加（基线与术后：51.5[18.7 - 84.2]%与86.8[67.4 - 93.7]%静息通气，p<.001）、环路增益降低（基线与术后：0.7[0.7 - 0.8]与0.6[0.5 - 0.6]；p<.001）以及更高的觉醒阈值（基线与术后：202.9[183.7 - 222.0]%与160.7[143.9 - 177.4]%静息通气；p<.001）。然而，它对肌肉代偿没有显著影响。完全调整的逻辑回归分析表明，对手术的良好反应与较低的LG独立相关（OR[CI 95%]，0.1[0.0 - 0.5]，p =.032）。在肌肉代偿改善或气道更易塌陷（较低的被动通气）的患者中，较低的环路增益更强烈地预示着成功。然而，当肌肉代偿较低或可塌陷性不太严重（较高的被动通气）时，较低的环路增益对成功的预测性较差。
本研究表明，多级上气道手术改变了中国OSA患者的解剖学和非解剖学内型。基于内型的回归模型可能有意义地预测手术成功。
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