山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (5): 145-151.doi: 10.6040/j.issn.1673-3770.0.2019.586
黄婷,陈金辉综述陶泽璋审校
摘要: 阻塞性睡眠呼吸暂停(OSA)是一种常见的睡眠相关呼吸障碍,若不及时治疗,可导致心血管系统、神经系统等方面的损害。除了选择持续气道正压通气(CPAP)作为治疗方式外,多数OSA患者选择基于解剖阻塞部位进行手术治疗。悬雍垂腭咽成形术(UPPP)是临床最常用的术式之一。结合近期文献从术前评估各种数据中综合分析可能的预测因素,筛选出较明确的预测因素,将有利于构建高效的预测系统,具体化UPPP手术的适应证及禁忌证。
中图分类号:
[1] Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome[J]. Sleep, 1996, 19(2): 156-177. doi:10.1093/sleep/19.2.156. [2] 中国医师协会睡眠医学专业委员会. 成人阻塞性睡眠呼吸暂停多学科诊疗指南[J]. 中华医学杂志, 2018, 98(24): 1902-1914. doi:10.3760/cma.j.issn.0376-2491.2018.24.003. [3] 中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案)[J]. 现代实用医学, 2003, 15(3): 192-195. [4] Fukuda N, Abe T, Katagiri M, et al. Effects of uvulopalatopharyngoplasty on patients with obstructive sleep apnea: the severity of preoperative tonsillar hypertrophy[J]. J Jpn Respir Soc, 1998, 36(1): 34-40. doi:http://dx.doi.org/. [5] Friedman M, Ibrahim H, Joseph NJ. Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment[J]. Laryngoscope, 2004, 114(3): 454-459. doi:10.1097/00005537-200403000-00013. [6] Friedman M, Vidyasagar R, Bliznikas D, et al. Does severity of obstructive sleep apnea/hypopnea syndrome predict uvulopalatopharyngoplasty outcome?[J]. Laryngoscope, 2005, 115(12): 2109-2113. doi:10.1097/01.MLG.0000181505.11902.F7. [7] Braga A, Grechi TH, Eckeli A, et al. Predictors of uvulopalatopharyngoplasty success in the treatment of obstructive sleep apnea syndrome[J]. Sleep Med, 2013, 14(12): 1266-1271. doi:10.1016/j.sleep.2013.08.777. [8] Millman RP, Carlisle CC, Rosenberg C, et al. Simple predictors of uvulopalatopharyngoplasty outcome in the treatment of obstructive sleep apnea[J]. Chest, 2000, 118(4): 1025-1030. doi:10.1378/chest.118.4.1025. [9] Kim SJ, Kim YS, Park JH, et al. Cephalometric predictors of therapeutic response to multilevel surgery in patients with obstructive sleep apnea[J]. J Oral Maxillofac Surg, 2012, 70(6): 1404-1412. doi:10.1016/j.joms.2011.03.016. [10] Li HY, Wang PC, Chen YP, et al. Critical appraisal and meta-analysis of nasal surgery for obstructive sleep apnea[J]. Am J Rhinol Allergy, 2011, 25(1): 45-49. doi:10.2500/ajra.2011.25.3558. [11] Alt JA, DeConde AS, Mace JC, et al. Quality of life in patients with chronic rhinosinusitis and sleep dysfunction undergoing endoscopic sinus surgery: a pilot investigation of comorbid obstructive sleep apnea[J]. JAMA Otolaryngol Head Neck Surg, 2015, 141(10): 873-881. doi:10.1001/jamaoto.2015.1673. [12] Wang MJ, Liu SY, Zhou B, et al. Effect of nasal and sinus surgery in patients with and without obstructive sleep apnea[J]. Acta Otolaryngol, 2019, 139(5): 467-472. doi:10.1080/00016489.2019.1575523. [13] Wu J, Zhao GQ, Li YC, et al. Apnea-hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea: a meta-analysis[J]. Medicine(Baltimore), 2017, 96(5): e6008. doi:10.1097/MD.0000000000006008. [14] Shuaib SW, Undavia S, Lin J, et al. Can functional septorhinoplasty independently treat obstructive sleep apnea?[J]. Plast Reconstr Surg, 2015, 135(6): 1554-1565. doi:10.1097/PRS.0000000000001285. [15] Park CY, Hong JH, Lee JH, et al. Clinical effect of surgical correction for nasal pathology on the treatment of obstructive sleep apnea syndrome[J]. PLoS One, 2014, 9(6): e98765. doi:10.1371/journal.pone.0098765. [16] Friedman M, Tanyeri H, Lim JW, et al. Effect of improved nasal breathing on obstructive sleep apnea[J]. Otolaryngol Head Neck Surg, 2000, 122:71-74. doi: 10.1016/S0194-5998(00)70147-1. [17] Young T, Finn L, Palta M. Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study[J]. Arch Intern Med, 2001, 161(12): 1514-1519. doi:10.1001/archinte.161.12.1514. [18] McNicholas WT, Tarlo S, Cole P, et al. Obstructive apneas during sleep in patients with seasonal allergic rhinitis[J]. Am Rev Respir Dis, 1982, 126(4): 625-628. doi:10.1164/arrd.1982.126.4.625. [19] Sabato R, Guido P, Salerno FG, et al. Airway inflammation in patients affected by obstructive sleep apnea[J]. Arch Monaldi Le Malattie Del Torace, 2006, 65(2): 102-105. doi:10.4081/monaldi.2006.572. [20] Hastan D, Fokkens WJ, Bachert C, et al. Chronic rhinosinusitis in Europe: an underestimated disease. A GA2LEN study[J]. Allergy, 2011, 66(9): 1216-1223. doi:10.1111/j.1398-9995.2011.02646.x. [21] Fibbi A, Ameli F, Brocchetti F, et al. Tongue base suspension and radiofrequency volume reduction: a comparison between 2 techniques for the treatment of sleep-disordered breathing[J]. Am J Otolaryngol, 2009, 30(6): 401-406. doi:10.1016/j.amjoto.2008.08.006. [22] Farrar J, Ryan J, Oliver E, et al. Radiofrequency ablation for the treatment of obstructive sleep apnea: a meta-analysis[J]. Laryngoscope, 2008, 118(10): 1878-1883. doi:10.1097/MLG.0b013e31817d9cc1. [23] Powell NB, Riley RW, Guilleminault C. Radiofrequency tongue base reduction in sleep-disordered breathing: a pilot study[J]. Otolaryngol Head Neck Surg, 1999, 120(5): 656-664. doi:10.1053/hn.1999.v120.a96956. [24] Li KK, Powell NB, Riley RW, et al. Temperature-controlled radiofrequency tongue base reduction for sleep-disordered breathing: Long-term outcomes[J]. Otolaryngol Head Neck Surg, 2002, 127(3): 230-234. doi:10.1067/mhn.2002.126900. [25] Steward DL, Weaver EM, Woodson BT. A comparison of radiofrequency treatment schemes for obstructive sleep apnea syndrome[J]. Otolaryngol Head Neck Surg, 2004, 130(5): 579-585. doi:10.1016/j.otohns.2004.01.012. [26] Koutsourelakis I, Safiruddin F, Ravesloot M, et al. Surgery for obstructive sleep apnea: sleep endoscopy determinants of outcome[J]. Laryngoscope, 2012, 122(11): 2587-2591. doi:10.1002/lary.23462. [27] Steinhart H, Kuhn-Lohmann J, Gewalt K, et al. Upper airway collapsibility in habitual snorers and sleep apneics: evaluation with drug-induced sleep endoscopy[J]. Acta Otolaryngol, 2000, 120(8): 990-994. doi:10.1080/00016480050218753. [28] Gislason T, Lindholm CE, Almqvist M, et al. Uvulopalatopharyngoplasty in the sleep apnea syndrome. Predictors of results[J]. Arch Otolaryngol Head Neck Surg, 1988, 114(1): 45-51. doi:10.1001/archotol.1988.01860130049013. [29] Larsson LH, Carlsson-Nordlander B, Svanborg E. Four-year follow-up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnea syndrome[J]. Laryngoscope, 1994, 104(11 Pt 1): 1362-1368. doi:10.1288/00005537-199411000-00008. [30] Shie DY, Tsou YA, Tai CJ, et al. Impact of obesity on uvulopalatopharyngoplasty success in patients with severe obstructive sleep apnea: a retrospective single-center study in Taiwan[J]. Acta Otolaryngol, 2013, 133(3): 261-269. doi:10.3109/00016489.2012.741328. [31] Janson C, Gislason T, Bengtsson H, et al. Long-term follow-up of patients with obstructive sleep apnea treated with uvulopalatopharyngoplasty[J]. Arch Otolaryngol-Head Neck Surg, 1997, 123(3): 257-262. doi:10.1001/archotol.1997.01900030025003. [32] Choi JH, Cho SH, Kim SN, et al. Predicting outcomes after uvulopalatopharyngoplasty for adult obstructive sleep apnea: a meta-analysis[J]. Otolaryngol Head Neck Surg, 2016, 155(6): 904-913. doi:10.1177/0194599816661481. [33] He M, Yin GP, Zhan SY, et al. Long-term efficacy of uvulopalatopharyngoplasty among adult patients with obstructive sleep apnea: a systematic review and meta-analysis[J]. Otolaryngol Head Neck Surg, 2019, 161(3): 401-411. doi:10.1177/0194599819840356. [34] Dündar A, Gerek M, Ozünlü A, et al. Patient selection and surgical results in obstructive sleep apnea[J]. Eur Arch Otorhinolaryngol, 1997, 254(Suppl 1): S157-S161. doi:10.1007/bf02439750. [35] Li HY, Wang PC, Lee LA, et al. Prediction of uvulopalatopharyngoplasty outcome: anatomy-based staging system versus severity-based staging system[J]. Sleep, 2006, 29(12): 1537-1541. doi:10.1093/sleep/29.12.1537. [36] Xiong YP, Yi HL, Yin SK, et al. Predictors of surgical outcomes of uvulopalatopharyngoplasty for obstructive sleep apnea hypopnea syndrome[J]. Otolaryngol Head Neck Surg, 2011, 145(6): 1049-1054. doi:10.1177/0194599811420811. [37] Bostanci A, Bozkurt S, Turhan M. The relationship between the duration of obstructive respiratory events and outcomes of multilevel upper airway surgery in patients with obstructive sleep apnea[J]. Eur Arch Otorhinolaryngol, 2016, 273(9): 2651-2657. doi:10.1007/s00405-015-3781-8. [38] Kezirian EJ, Weaver EM, Yueh B, et al. Risk factors for serious complication after uvulopalatopharyngoplasty[J]. Arch Otolaryngol Head Neck Surg, 2006, 132(10): 1091-1098. doi:10.1001/archotol.132.10.1091. [39] Suen C, Ryan CM, Mubashir T, et al. Sleep study and oximetry parameters for predicting postoperative complications in patients with Osa[J]. Chest, 2019, 155(4): 855-867. doi:10.1016/j.chest.2018.09.030. [40] Hwang D, Shakir N, Limann B, et al. Association of sleep-disordered breathing with postoperative complications[J]. Chest, 2008, 133(5): 1128-1134. doi: 10.1378/chest.07-1488. [41] Zhang JB, Li YR, Cao X, et al. The combination of anatomy and physiology in predicting the outcomes of velopharyngeal surgery[J]. Laryngoscope, 2014, 124(7): 1718-1723. doi:10.1002/lary.24510. [42] 叶京英, 张俊波. 腭咽部手术治疗阻塞性睡眠呼吸暂停低通气综合征疗效的预测[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(4): 317-320. doi:10.3760/cma.j.issn.1673-0860.2016.04.020. YE Jingying, ZHANG Junbo. Prediction of the efficacy of velopharyngeal surgery for obstructive sleep apnea hypopnea syndrome[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2016, 51(4): 317-320. doi:10.3760/cma.j.issn.1673-0860.2016.04.020. [43] Liu SR, Yi HL, Yin SK, et al. Associated predictors of therapeutic response to uvulopharyngopalatoplasty for severe obstructive sleep apnea hypopnea syndrome[J]. Eur Arch Otorhinolaryngol, 2013, 270(4): 1411-1417. doi:10.1007/s00405-013-2404-5. [44] Zhao D, Li YR, Xian JF, et al. The combination of anatomy and genioglossus activity in predicting the outcomes of velopharyngeal surgery[J]. Otolaryngol Head Neck Surg, 2017, 156(3): 567-574. doi:10.1177/0194599816686537. [45] Osnes T, Rollheim J, Hartmann E. Effect of UPPP with respect to site of pharyngeal obstruction in sleep apnoea: follow-up at 18 months by overnight recording of airway pressure and flow[J]. Clin Otolaryngol Allied Sci, 2002, 27(1): 38-43. doi:10.1046/j.0307-7772.2001.00520.x. [46] 张湘民. 阻塞性睡眠呼吸暂停低通气综合征定位诊断之惑[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 4-7, 17. doi:10.6040/j.issn.1673-3770.0.2017.007. ZHANG Xiangmin. Localization diagnosis of obstructive sleep apnea hypopnea syndrome[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2017, 31(1): 4-7, 17. doi:10.6040/j.issn.1673-3770.0.2017.007. [47] Sher AE, Thorpy MJ, Shprintzen RJ, et al. Predictive value of Müller maneuver in selection of patients for uvulopalatopharyngoplasty[J]. Laryngoscope, 1985, 95(12): 1483-1487. doi:10.1288/00005537-198512000-00009. [48] Petri N, Suadicani P, Wildschiødtz G, et al. Predictive value of Müller maneuver, cephalometry and clinical features for the outcome of uvulopalatopharyngoplasty. Evaluation of predictive factors using discriminant analysis in 30 sleep apnea patients[J]. Acta Otolaryngol, 1994, 114(5): 565-571. doi:10.3109/00016489409126106. [49] Ritter CT, Trudo FJ, Goldberg AN, et al. Quantitative evaluation of the upper airway during nasopharyngoscopy with the Müller maneuver[J]. Laryngoscope, 1999, 109(6): 954-963. doi:10.1097/00005537-199906000-00022. [50] Gillespie MB, Reddy RP, White DR, et al. A trial of drug-induced sleep endoscopy in the surgical management of sleep-disordered breathing[J]. Laryngoscope, 2013, 123(1): 277-282. doi:10.1002/lary.23506. [51] Eichler C, Sommer JU, Stuck BA, et al. Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea?[J]. Schlaf Atmung, 2013, 17(1): 63-68. doi:10.1007/s11325-012-0647-9. [52] Iwanaga K, Hasegawa K, Shibata N, et al. Endoscopic examination of obstructive sleep apnea syndrome patients during drug-induced sleep[J]. Acta Otolaryngol Suppl, 2003, 550: 36-40. doi: 10.1080/0365523031000055. [53] Soares D, Sinawe H, Folbe AJ, et al. Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery[J]. Laryngoscope, 2012, 122(2): 473-479. doi:10.1002/lary.22474. [54] Koutsourelakis I, Safiruddin F, Ravesloot M, et al. Surgery for obstructive sleep apnea: sleep endoscopy determinants of outcome[J]. Laryngoscope, 2012, 122(11): 2587-2591. doi:10.1002/lary.23462. [55] Meraj TS, Muenz DG, Glazer TA, et al. Does drug-induced sleep endoscopy predict surgical success in transoral robotic multilevel surgery in obstructive sleep apnea?[J]. Laryngoscope, 2017, 127(4): 971-976. doi:10.1002/lary.26255. [56] Lee CH, Mo JH, Seo BS, et al. Mouth opening during sleep may be a critical predictor of surgical outcome after uvulopalatopharyngoplasty for obstructive sleep apnea[J]. J Clin Sleep Med, 2010, 6(2): 157-162. 10.1016/j.pnpbp.2010.02.007. [57] Denolf PL, Vanderveken OM, Marklund ME, et al. The status of cephalometry in the prediction of non-CPAP treatment outcome in obstructive sleep apnea patients[J]. Sleep Med Rev, 2016, 27: 56-73. doi:10.1016/j.smrv.2015.05.009. |
[1] | 李世金,唐昂藏,杨必,王将栏,刘陇黔. 虚拟现实视觉训练对集合不足长期疗效的观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 35-40. |
[2] | 姜雪莲, 张静月, 卫旭东. 基于Meta分析桥接网络药理学的鼻渊通窍颗粒治疗慢性鼻窦炎的疗效评价及潜在机制研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 226-236. |
[3] | 金鑫,施磊,金梦园. 脱细胞真皮基质覆盖鼻腔鼻窦良性肿瘤切除术后术腔的临床疗效观察[J]. 山东大学耳鼻喉眼学报, 2021, 35(5): 17-22. |
[4] | 马亦飞,喻国冻,鲜志芃,何星辰,顾萍,陈自力. 嗓音训练应用于声带息肉术后的效果评价[J]. 山东大学耳鼻喉眼学报, 2021, 35(3): 54-58. |
[5] | 林小燕,李静,马志祺,李依琳,高馨怡,李勇. 益生菌治疗变应性鼻炎的临床疗效及抗变态反应作用Meta分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(3): 70-80. |
[6] | 周恩,肖禹,肖旭平. 等离子射频消融技术在早期声门型喉癌治疗中的应用进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 9-15. |
[7] | 林育珊,卢标清. 从心脾论治突发性耳聋的疗效观察[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 6-11. |
[8] | 刘宇鹏,吴文瑾,何景春,郑贵亮,张青,杨军. 迷路后径路前庭神经切断术治疗难治性梅尼埃病75例[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 46-50. |
[9] | 陈海兵, 卫亚楠, 许晓泉, 陈曦. 基于XGBoost人工智能结合CT构建甲状腺癌颈部淋巴结转移预测模型[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 40-45. |
[10] | 田雨鑫,王菁菁,王慧,吴雅琴,时海波,陈正侬. 医源性面瘫的手术治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 20-24. |
[11] | 郑永波, 赵宇, 娄麟, 宋瑶, 董怡君, 任建君, 王晶, 许洋, 雷蕾. 静脉源性搏动性耳鸣手术治疗的疗效分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 26-31. |
[12] | 张俊军,刘海莉,刘加福,秦小奉,杜洪明,王厚慧. 糖皮质激素不同给药方式治疗突发性聋的临床疗效及安全性研究[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 52-55. |
[13] | 丁剑,刘艺鸣. 前庭康复对老年良性阵发性位置性眩晕患者后遗头晕的疗效[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 64-68. |
[14] | 周庆,刘雄光,吴昌林,叶小武. 耳内镜下耳屏软骨环-软骨膜修补术治疗鼓膜穿孔40例[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 69-72. |
[15] | 孟立新,李健,韦善文. 鼓膜微管置入术治疗中耳不张76例临床分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 61-65. |
|