个体化鼻腔扩容术对阻塞性睡眠呼吸暂停低通气综合征治疗效果的研究分析

doi:10.6040/j.issn.1673-3770.0.2020.258

Abstract

Abstract: Objective To investigate the efficacy of individualized nasal cavity ventilation expansion techniques for obstructive sleep apnea-hypopnea syndrome(OSAHS)patients with nasal obstruction. Methods Between January 2018 and June 2019, 42 adult OSAHS patients with nasal obstruction were selected and treated at the Qilu Hospital of Shandong University(Qingdao). Polysomnogram(PSG),nasal acoustic reflex,resistance examination, and nasal respiration volume were performed before and 3 months after surgery to record the apnea-hypopnea index(AHI), the lowest arterial oxygen saturation(LSaO₂), nasal minimal cross-sectional area(NMCA), nasal cavity volume(NCV), nasal airway resistance(NAR), and nasal total volume(V_T). The nasal obstruction symptom evaluation(NOSE)and Epworth sleepiness scale(ESS)were also administered. Continuous positive airway pressure(CPAP)was performed before surgery; the acceptance of CPAP treatment was recorded using the visual analog scale(VAS). The average effective treatment pressure was assessed using the manual pressure titration, and it was reviewed 3 months after the surgery to analyze the effect of nasal dilatation. Results Three months after the surgery, the scores of NOSE, ESS, and VAS for all the patients were significantly lower than those obtained before the surgery(4.52±1.770 vs. 12.43±2.855; 7.55±2.144 vs. 12.67±2.205; 7.42±1.02 vs. 4.92±1.38, P<0.05). Subjective nasal congestion and somnolence significantly resolved in all the patients. Among the objective indexes, NMCA, NCV, and VT increased significantly, and the average effective pressure of NAR and CPAP decreased significantly(P<0.05). AHI was lower and LSaO₂ was higher in patients with mild and moderate OSAHS after than before the surgery ［Mild: 10.76±2.74 times/h vs. 6.27±2.34 times/h, 76.44±2.63% vs 82.0±2.80%; Moderate: 25.12±5.32 times/h vs. 17.38±6.51 times/h, 70.92±3.17% vs 73.85±3.31%, P<0.05］. Conclusion Individualized nasal dilatation can effectively improve nasal ventilation and the sleep quality of OSAHS patients with nasal congestion symptoms. It is an effective surgical method for the treatment of nasal OSAHS, and it can improve compliance with CPAP treatment. Multifaceted comprehensive treatments are needed for moderate and severe OSAHS cases.

Key words: Sleep apnea, obstructive, Nasal cavity ventilation expansion techniques, Nasal obstruction

CLC Number:

R766.43

WANG Lei, YUAN Ying, YU Xuemin, HAN Yu'e, LI Xiao, LI Long. Clinical evaluation of individualized nasal cavity ventilation expansion techniques for the treatment of obstructive sleep apnea-hypopnea syndrome[J].Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 80-85.

References

[1] 韩德民. 关注上呼吸道阻塞性疾病的源头性作用[J].中华耳鼻咽喉头颈外科杂志,2008,43(3):161-162. doi:10.3321/j.issn:1673-0860.2008.03.001. HAN Demin. Pay attention to the source role of upper-airway obstructive disease[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2008,43(3):161-162. doi:10.3321/j.issn:1673-0860.2008.03.001.
[2] 韩德民. 鼻腔扩容技术的临床意义[J].中华耳鼻咽喉头颈外科杂志,2011,46(2):89-90. doi:10.3760/cma.j.issn.1673-0860.2011.02.001. HAN Demin. The importance of nasal cavity ventilation expansion techniques[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery,2011,46(2):89-90. doi:10.3760/cma.j.issn.1673-0860.2011.02.001.
[3] 阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)[J].中华耳鼻咽喉科杂志,2002(6):6-7.
[4] 韩德民.鼻内镜外科学[M].2 版.北京:人民卫生出版社,2012.
[5] Gelardi M, Intiglietta P, Porro G, et al. The role of the nasal valve in patients with obstructive sleep apnea syndrome[J]. Acta Biomed, 2019, 90(2S):15-18. doi:10.23750/abm.v90i2-S.8097.
[6] 王磊,袁英,于学民,等. 鼻中隔连续贯穿缝合技术在鼻中隔偏曲矫正术中的应用[J].山东大学耳鼻喉眼学报,2018,32(3):73-75. doi: 10.6040/j.issn.1673-3770.0.2017.390. WANG Lei, YUAN Ying, YU Xuemin, et al. Efficacy of the continuous suture technique in septoplasty[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(3): 73-75. doi: 10.6040/j.issn.1673-3770.0.2017.390.
[7] 李思, 彭本刚. OSAHS多平面诊断的发展现状[J].临床耳鼻咽喉头颈外科杂志,2015,29(21):1922-1927. doi: 10.13201/j.issn.1001-1781.2015.21.023. LI Si,PENG Bengang. The development of multi-level diagnosis of obstructive sleep apnea hypopnea syndrome[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015, 29(21):1922-1927. doi: 10.13201/j.issn.1001-1781.2015.21.023.
[8] 程晨景,叶京英. 鼻阻力与阻塞性睡眠呼吸暂停低通气综合征[J]. 国际耳鼻咽喉头颈外科杂志,2008, 32(5):269-271. doi:10.3760/cma.j.issn.1673-4106.2008.05.007. CHENG Chenjing,YE Jingying. Nasal resistance and obstructive sleep apnea hypopnea syndrome[J]. International Journal of Otolaryngology-Head and Neck Surgery, 2008, 32(5):269-271. doi:10.3760/cma.j.issn.1673-4106.2008.05.007.
[9] Ishii L, Roxbury C, Godoy A, et al. Does nasal surgery improve OSA in patients with nasal obstruction and OSA? A meta-analysis[J]. Otolaryngol Head Neck Surg, 2015, 153(3): 326-333. doi:10.1177/0194599815594374.
[10] 陈曦,李进让.单独鼻腔手术治疗阻塞性睡眠呼吸暂停低通气综合征疗效的Meta分析[J].临床耳鼻咽喉头颈外科杂志,2015, 29(6):499-504. doi: 10.13201/j.issn.1001-1781.2015.06.006. CHEN Xi, LI Jinrang. Meta analysis of nasal surgery alone for obstructive sleep apnea hypopnea syndrome[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015, 29(06):499-504. doi: 10.13201/j.issn.1001-1781.2015.06.006.
[11] Xiao Y, Han DM, Zang HR, et al. The effectiveness of nasal surgery on psychological symptoms in patients with obstructive sleep apnea and nasal obstruction[J]. Acta Otolaryngol, 2016, 136(6): 626-632. doi:10.3109/00016489.2016.1143120.
[12] Migueis DP, Santos Thuler LC, de Andrade Lemes LN, et al. Systematic review: the influence of nasal obstruction on sleep apnea[J]. Revista Brasileira De Otorrinolaringologia, 2016, 82(2): 223-231. doi:10.1016/j.bjorl.2015.05.018.
[13] 臧洪瑞, 韩德民, 周兵, 等. 鼻腔扩容术的临床疗效观察[J].中国耳鼻咽喉头颈外科,2013, 20(10):537-540. doi: 10.3760/cma.j.issn.1673-4106.2017.05.008. ZANG Hongrui, HAN Demin, ZHOU Bing, et al. Clinical observation with nasal cavity ventilation expansion techniques[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery,2013, 20(10):537-540. doi: 10.3760/cma.j.issn.1673-4106.2017.05.008.
[14] 周明辉, 赵玉林, 张玉杰, 等. 个体化鼻腔扩容术治疗OSAHS的疗效分析[J].临床耳鼻咽喉头颈外科杂志,2018, 32(12):941-943,948. doi: 10.13201/j.issn.1001-1781.2018.12.014. ZHOU Minghui, ZHAO Yulin, ZHANG Yujie, et al. Clinical analysis of individualized nasal cavity ventilation expansion techniques for treatment of OSAHS patients[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(12):941-943,948. doi: 10.13201/j.issn.1001-1781.2018.12.014.
[15] Dicus Brookes CC, Boyd SB. Controversies in obstructive sleep apnea surgery[J]. Sleep Med Clin, 2018, 13(4): 559-569. doi:10.1016/j.jsmc.2018.07.005.
[16] 修世国,于丹丹,王伊梦,等.同期行改良悬雍垂腭咽成形术和鼻中隔成形术治疗阻塞性睡眠呼吸暂停低通气综合征的可行性[J].中华耳鼻咽喉头颈外科杂志,2017, 52(8):592-596. doi:10.3760/cma.j.issn.1673-0860.2017.08.007. XIU Shiguo, YU Dandan, WANG Yimeng, et al. Feasibility of single-staged Han-uvulopalatopharyngoplasty with septoplasty in adults with obstructive sleep apnea-hypopnea syndrome[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(8):592-596. doi:10.3760/cma.j.issn.1673-0860.2017.08.007.
[17] 杨洋, 韩跃峰. 阻塞性睡眠呼吸暂停低通气综合征的综合治疗[J].国际耳鼻咽喉头颈外科杂志,2017, 41(5):282-284. doi: 10.3760/cma.j.issn.1673-4106.2017.05.008. YANG Yang, HAN Yuefeng. Comprehensive treatment of obstructive sleep apnea hypopnea syndrome[J].International Journal of Otolaryngology-Head and Neck Surgery,2017, 41(5):282-284. doi: 10.3760/cma.j.issn.1673-4106.2017.05.008.
[18] 段祥强, 郑宏良. OSAHS发病机制与治疗方式选择的探讨[J].临床耳鼻咽喉头颈外科杂志,2017, 31(17):1376-1380. doi:10.13201/j.issn.1001-1781.2017.17.022. DUAN Xiangqiang, ZHENG Hongliang. Obstructive sleep apnea hypopnea syndrome study on pathogenesis and prognosis[J] Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2017, 31(17):1376-1380. doi:10.13201/j.issn.1001-1781.2017.17.022.
[19] 彭易坤. 鼻腔扩容术在OSAHS治疗中的应用及临床疗效评估[J].山东大学耳鼻喉眼学报,2017, 31(1):13-17. doi:10.6040/j.issn.1673-3770.0.2016.511. PENG Yikun. Application of nasal cavity expansion surgery in the treatment of OSAHS and its clinical efficacy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2017, 31(1):13-17. doi:10.6040/j.issn.1673-3770.0.2016.511.
[20] Camacho M, Riaz M, Capasso R, et al. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment pressures: a systematic review and meta-analysis[J]. Sleep, 2015, 38(2): 279-286. doi:10.5665/sleep.4414.
[21] 李彦如,韩德民,叶京英.上气道阻塞定位诊断的价值[J]. 国际耳鼻咽喉头颈外科杂志,2006(5):289-293. doi:10.3760/cma.j.issn.1673-4106.2006.05.003. LI Yanru, HAN Demin, YE Jingying. The value of location diagnosis of upper airway obstruction[J]. International Journal of Otolaryngology-Head and Neck Surgery, 2006(5):289-293. doi:10.3760/cma.j.issn.1673-4106.2006.05.003.
[22] Li HY, Lo YL, Wang CJ, et al. Dynamic drug-induced sleep computed tomography in adults with obstructive sleep apnea[J]. Sci Rep, 2016, 6: 35849. doi:10.1038/srep35849.
[23] Zaghi S, Holty JE, Certal V, et al. Maxillomandibular advancement for treatment of obstructive sleep apnea: a meta-analysis[J]. JAMA Otolaryngol Head Neck Surg, 2016, 142(1): 58-66. doi:10.1001/jamaoto.2015.2678.
[24] Friedman M, Tanyeri H, Lim JW, et al. Effect of improved nasal breathing on obstructive sleep apnea[J]. Otolaryngol - Head Neck Surg, 2000, 122(1): 71-74. doi:10.1016/S0194-5998(00)70147-1.

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Clinical evaluation of individualized nasal cavity ventilation expansion techniques for the treatment of obstructive sleep apnea-hypopnea syndrome

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