Husman Tiffany, Bhat Amrita, Durr Megan L, Chang Jolie L
Department of Otolaryngology-Head and Neck Surgery University of California San Francisco San Francisco California USA.
Department of Veterans Affairs Medical Center Surgery Service San Francisco California USA.
OTO Open. 2025 Mar 26;9(1):e70093. doi: 10.1002/oto2.70093. eCollection 2025 Jan-Mar.
To identify predictors of patient decision to pursue sleep apnea surgery following initial consultation with a sleep surgeon.
Retrospective cohort analysis.
Outpatient tertiary care academic center.
A retrospective review of patients with obstructive sleep apnea (OSA) diagnosis, BMI < 35 kg/m², and prior positive airway pressure (PAP) trial who were evaluated at a sleep surgery clinic. Patients who completed drug-induced sleep endoscopy (DISE) and/or surgery were compared to those who did not within at least 4 months of consultation. Surveys on OSA-related symptoms and decisional conflict were completed prior to the consultation for PAP alternatives.
Among 437 patients, 321 did not undergo DISE/surgery, whereas 116 completed DISE/surgery within an average of 16.8 months of consultation. Patients who underwent DISE/surgery had a significantly higher Epworth sleepiness scale score (10.1 ± 4.9 vs 8.5 ± 5.1, = .006) and insomnia severity index (15.6 ± 5.5 vs 14.3 ± 5.8, = .037) as well as significantly lower decisional conflict scale (DCS) scores (27.9 ± 21.8 vs 38.2 ± 24.9, < .001). Multivariate analysis revealed that lower preconsultation DCS score (OR = 0.97, 95% CI [0.97, 0.99], < .001) and lower BMI (OR = 0.91, 95% CI [0.85, 0.99], = .019) were independently significant predictors of pursuing DISE/surgery.
Decisional conflict prior to consultation is significantly associated with completion of DISE/surgery. Those with higher decisional conflict are less likely to proceed with DISE/surgery after consultation on PAP alternatives. Effective interventions that improve patient understanding of OSA and enhance support in decision-making are needed.
确定患者在初次咨询睡眠外科医生后决定进行睡眠呼吸暂停手术的预测因素。
回顾性队列分析。
门诊三级医疗学术中心。
对在睡眠外科诊所接受评估的阻塞性睡眠呼吸暂停（OSA）诊断患者、BMI < 35 kg/m²且先前进行过持续气道正压通气（PAP）试验的患者进行回顾性研究。将完成药物诱导睡眠内镜检查（DISE）和/或手术的患者与在咨询后至少4个月内未进行该检查和/或手术的患者进行比较。在咨询PAP替代方案之前，完成了关于OSA相关症状和决策冲突的调查。
在437例患者中，321例未接受DISE/手术，而116例在平均咨询16.8个月内完成了DISE/手术。接受DISE/手术的患者的爱泼华嗜睡量表评分显著更高（10.1±4.9 vs 8.5±5.1，P = 0.006），失眠严重程度指数也更高（15.6±5.5 vs 14.3±5.8，P = 0.037），而决策冲突量表（DCS）评分显著更低（27.9±21.8 vs 38.2±24.9，P < 0.001）。多变量分析显示，咨询前较低的DCS评分（OR = 0.97，95%CI [0.97, 0.99]，P < 0.001）和较低的BMI（OR = 0.91，95%CI [0.85, 0.99]，P = 0.019）是进行DISE/手术的独立显著预测因素。
咨询前的决策冲突与DISE/手术的完成显著相关。决策冲突较高的患者在咨询PAP替代方案后进行DISE/手术的可能性较小。需要有效的干预措施来提高患者对OSA的理解并加强决策支持。
