不同睡眠分期血氧饱和度差值对悬雍垂腭咽成形术手术预后评估价值

doi:10.6040/j.issn.1673-3770.0.2021.180

摘要/Abstract

摘要： 目的探讨多导睡眠监测数据中不同睡眠分期平均血氧饱和度及最低血氧饱和度差值对改良UPPP手术效果的预测。方法回顾分析117例UPPP手术患者术前及术后一年PSG数据,计算患者术前快速动眼睡眠期(REM)与非快速动眼睡眠期(NREM)平均血氧饱和度差值(ΔAvSaO₂)、最低血氧饱和度差值(ΔLSaO₂)以及术后睡眠呼吸暂停低通气指数(AHI)下降比率(ΔAHI%),对ΔAvSaO₂、ΔLSaO₂和ΔAHI%进行直线相关分析;并以ΔAHI%≥50%为手术有效,绘制二者受试者工作特征曲线,计算截断(Cutoff)值,确定预测手术效果的最佳临界值,并对预测指标进行非条件Logistic回归分析。结果患者术前REM与NREM期平均血氧饱和度差值(ΔAvSaO₂)、最低血氧饱和度差值(ΔLSaO₂)与OSA患者UPPP术后AHI下降比率ΔAHI%均呈负相关,Pearson相关系数分别为r=-0.881和-0.849(P<0.001)。对预测UPPP手术效果指标的ROC曲线分析,ΔAvSaO₂曲线下面积为0.888,95%CI:0.830~0.945(P<0.001),且Cutoff值ΔAvSaO₂=3.25是预测UPPP手术有效的最佳临界值,其敏感性为0.836,特异性为0.804,阳性预测值0.822,阴性预测值0.818;ΔLSaO₂曲线下面积为0.931,95%CI:0.889~0.973(P<0.001),且Cutoff值ΔLSaO₂=8.75是预测UPPP手术有效的最佳临界值,其敏感性为0.836,特异性为0.875,阳性预测值0.879,阴性预测值0.831。经过二元Logistic回归分析,术前具有较小的不同睡眠分期血氧饱和度差值的OSA患者UPPP手术可能更有效,二者联合对UPPP手术有效性预测的准确度为84.6%。结论 OSA患者REM期与NREM期血氧饱和度差值可以作为预测UPPP手术效果的较好指标。

关键词: 阻塞性睡眠呼吸暂停, 睡眠分期, 平均血氧饱和度, 最低血氧饱和度, 改良悬雍垂腭咽成形术

Abstract: Objective The objective of this study was to explore whether the difference in average blood oxygen saturation and lowest oxygen saturation between different sleep stages could predict the effect of uvulopalatopharyngoplasty(UPPP)surgery. Methods Preoperative and postoperative PSG data from 117 patients(113 men and 4 women)with OSA admitted to our hospital between May 2015 and June 2018 were retrospectively analyzed. After computing the average oxygen saturation difference value(ΔAvSaO₂)and the lowest oxygen saturation difference value(ΔLSaO₂)between the REM and NREM sleep stages in preoperative patients, a linear correlation analysis was conducted with the postoperative AHI drop ratio(ΔAHI%). Using ΔAHI %≥50% as an effective operation, we drew the receiver operating characteristic(ROC)curves for ΔAvSaO₂ and ΔLSaO₂.We then calculated the cutoff value to determine the optimal threshold for predicting the operation effect, and also conducted further unconditionallogistic regression analyses on the predictors. Results The preoperative ΔAvSaO₂、ΔLSaO₂ between REM and NREM sleep stages were negatively correlated with ΔAHI% and had Pearson correlation coefficients of r=0.881 and 0.849, respectively(P<0.001), indicating the possibility of that both as the prediction index for the effect of UPPP surgery. The ΔAvSaO₂ area under the curve was 0.888, 95% CI: 0.830-0.945(P<0.001), and ΔAvSaO₂=3.25 was the best threshold for predicting the UPPP surgery effect. Its sensitivity, specificity, positive predictive value, and negative predictive value were 0.836, 0.804, 0.822, and 0.818, respectively. The ΔLSaO₂ area under the curve was 0.931, 95% CI:0.889-0.973(P<0.001), and ΔLSaO₂=8.75 was the best threshold for predicting the UPPP surgery effect. Its sensitivity, specificity, positive predictive value, and negative predictive values were 0.836, 0.875, 0.879, and0.831, respectively. Unconditional logistic regression analysis showed that patients with OSA with smaller preoperative oxygen saturation difference values between REM and NREM sleep stages may have more effective outcomes with UPPP surgery. The prediction accuracy was 84.6% for a combination of both predictors for the UPPP surgery effect. Conclusion The difference in oxygen saturation between REM and NREM in patients with OSA can be used as a good index to predict the outcome of UPPP surgery.

Key words: Obstructive sleep apnea, Sleep stages, Average oxygen saturation, Lowest oxygen saturation, Uvulopalatopharyngoplasty

中图分类号:

R766.9

韩继波,董洁,明伟,王燕,罗志宏. 不同睡眠分期血氧饱和度差值对悬雍垂腭咽成形术手术预后评估价值[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 73-78.

HAN Jibo, DONG Jie, MING Wei, WANG Yan, LUO Zhihong. The utility of different values of average oxygen saturation and minimum oxygen saturation between different sleep stages for predicting the uvulopalatopharyngoplastysurgery effect[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 73-78.

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