Ramirez S G, Loube D I
Otolaryngology Service, Brooke Army Medical Center, Fort Sam Houston, Tex, USA.
Arch Otolaryngol Head Neck Surg. 1996 Sep;122(9):953-7. doi: 10.1001/archotol.1996.01890210031008.
An inferior sagittal osteotomy with a sliding mandibular osteotomy and hyoid bone suspension, combined with a uvulopalatopharyngoplasty, is advocated in patients with obstructive sleep apnea who fail to tolerate nasal continuous positive airway pressure. Some investigators have suggested that this surgical procedure may be less effective in obese patients.
Preoperative and postoperative nocturnal polysomnograms and lateral cephalometric radiographs were obtained on 12 obese patients with obstructive sleep apnea who underwent these procedures.
The mean +/- SD respiratory disturbance index during sleep decreased 53% +/- 11% after surgical procedures were performed (49 +/- 17 vs 23 +/- 11 events per hour, P < .001). Surgical outcome did not correlate with the body mass index, and 5 (71%) of 7 of the morbidly obese patients (body mass index, > or = 33) had greater than a 50% reduction in the respiratory disturbance index after the surgical procedures were done.
An inferior sagittal osteotomy with a sliding mandibular osteotomy and hyoid bone suspension, combined with a uvulopalatopharyngoplasty, tends to improve obstructive sleep apnea in obese patients.
对于不耐受鼻腔持续气道正压通气的阻塞性睡眠呼吸暂停患者，提倡采用下颌矢状下截骨术联合滑动下颌骨截骨术及舌骨悬吊术，并结合悬雍垂腭咽成形术。一些研究者认为该手术方法对肥胖患者可能效果较差。
对12例接受了上述手术的肥胖阻塞性睡眠呼吸暂停患者进行了术前及术后夜间多导睡眠图检查和头颅侧位X线片检查。
手术后睡眠期间平均±标准差呼吸紊乱指数下降了53%±11%（从每小时49±17次事件降至23±11次事件，P<.001）。手术结果与体重指数无关，7例病态肥胖患者（体重指数≥33）中有5例（71%）在手术后呼吸紊乱指数降低超过50%。
下颌矢状下截骨术联合滑动下颌骨截骨术及舌骨悬吊术，并结合悬雍垂腭咽成形术，往往能改善肥胖患者的阻塞性睡眠呼吸暂停。
