Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2022, Vol. 36 ›› Issue (4): 73-78.doi: 10.6040/j.issn.1673-3770.0.2021.180

Previous Articles    

The utility of different values of average oxygen saturation and minimum oxygen saturation between different sleep stages for predicting the uvulopalatopharyngoplastysurgery effect

HAN Jibo, DONG Jie, MING Wei, WANG Yan, LUO Zhihong   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
  • Published:2022-07-11

PDF (PC)

77

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

CLC Number: 

  • R766.9
[1] 陈雄, 孔维佳. 努力提高OSAHS外科手术技术[J]. 临床耳鼻咽喉头颈外科杂志, 2015,29(6): 495-498. doi:10.13201/j.issn.1001-1781.2015.06.005. CHEN Xiong, KONG Weijia. Improving the surgical technology in treatment of OSAHS[J]. J Clin Otorhinolaryngol Head Neck Surg, 2015,29(6): 495-498. doi:10.13201/j.issn.1001-1781.2015.06.005.
[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] 黄婷, 陈金辉, 陶泽璋. 悬雍垂腭咽成形术疗效术前预测因素分析[J]. 山东大学耳鼻喉眼学报, 2020,34(5): 145-151. doi: 10.6040/j.issn.1673-3770.0.2019.586. HUANG Ting, CHEN Jinhui, TAO Zezhang. Analysis of the preoperative predictive factors of Uvulopalatopharyngoplasty[J]. J OtolaryngolOphthalmol Shandong Univ, 2020, 34(5): 145-151. doi: 10.6040/j.issn.1673-3770.0.2019.586.
[4] Cori JM, O'Donoghue FJ, Jordan AS. Sleeping tongue: current perspectives of genioglossus control in healthy individuals and patients with obstructive sleep apnea[J]. Nat Sci Sleep, 2018, 10: 169-179. doi:10.2147/NSS.S143296.
[5] Kim R, Dedhia RC, Kapur VK. Does surgery for obstructive sleep apnea provide value?[J]. J Clin Sleep Med, 2015, 11(5): 509-510. doi:10.5664/jcsm.4688.
[6] Lee HM, Kim HY, Suh JD, et al. Uvulopalatopharyngoplasty reduces the incidence of cardiovascular complications caused by obstructive sleep apnea: results from the national insurance service survey 2007-2014[J]. Sleep Med, 2018, 45: 11-16. doi:10.1016/j.sleep.2017.12.019.
[7] 肖水芳, 张俊波. 重新认识OSAHS外科手术治疗的有效率[J]. 临床耳鼻咽喉头颈外科杂志, 2015,29(6): 492-494. doi:10.13201/j.issn.1001-1781.2015.06.004. XIAO Shuifang, ZHANG Junbo. Redefine the efficacy of surgical treatments for obstructive sleep apnea hypopnea syndrome[J]. J Clin Otorhinolaryngol Head Neck Surg, 2015,29(6): 492-494. doi:10.13201/j.issn.1001-1781.2015.06.004.
[8] Rosvall BR, Chin CJ. Is uvulopalatopharyngoplasty effective in obstructive sleep apnea?[J]. Laryngoscope, 2017, 127(10): 2201-2202. doi:10.1002/lary.26631.
[9] 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.
[10] Friedman M, Vidyasagar R, Bliznikas D, et al. Does severity of obstructive sleep apnea/hypopnea syndrome predict uvulopalatopharyngoplastyoutcome?[J]. Laryngoscope, 2005, 115(12): 2109-2113. doi:10.1097/01.MLG.0000181505.11902.F7.
[11] Siddiqui F, Walters AS, Goldstein D, et al. Half of patients with obstructive sleep apnea have a higher NREM AHI than REM AHI[J]. Sleep Med, 2006, 7(3): 281-285. doi:10.1016/j.sleep.2005.10.006.
[12] Eun YG, Kwon KH, Shin SY, et al. Multilevel surgery in patients with rapid eye movement-related obstructive sleep apnea[J]. Otolaryngol Head Neck Surg, 2009, 140(4): 536-541. doi:10.1016/j.otohns.2009.01.006.
[13] 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.
[14] Kim SH, Yang CJ, Baek JT, et al. Does rapid eye movement sleep aggravate obstructive sleep apnea?[J]. Clin Exp Otorhinolaryngol, 2019, 12(2): 190-195. doi:10.21053/ceo.2018.00934.
[15] Oliven R, Cohen G, Somri M, et al. Relationship between the activity of the genioglossus, other peri-pharyngeal muscles and flow mechanics during wakefulness and sleep in patients with OSA and healthy subjects[J]. Respir Physiol Neurobiol, 2020, 274: 103362. doi:10.1016/j.resp.2019.103362.
[16] 赵迪, 李彦如, 曲玥,等. 颏舌肌活性对阻塞性睡眠呼吸暂停低通气综合征患者腭咽部手术疗效的影响[J]. 中华耳鼻咽喉头颈外科杂志, 2019,54(6):421-426. doi: 10.3760/cma.j.issn.1673-0860.2019.06.005. ZHAO Di, LI Yanru, QU Yue, et al. The effect of genioglossus activity to velopharyngeal surgery in patient with obstructive sleep apnea hypopnea syndrome[J]. Chin J Otorhinolaryngol Head Neck Surg,2019,54(6):421-426. doi: 10.3760/cma.j.issn.1673-0860.2019.06.005.
[1] JIN Xiaoxue, HAN Yingying, GUO Ruixiang, NI Shoujie, ZOU Juanjuan, WANG Yan, LI Yanzhong. Correlation between allergy factors and maxillofacial malformation in children with tonsil and adenoid hypertrophy in denture replacement period [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 45-50.
[2] HAN YingyingOverview,LI YanzhongGuidance. Obstructive sleep apnea hypopnea syndrome and subclinical arteriosclerosis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 126-132.
[3] SHI Xiaoli, MU Hong. Multidisciplinary diagnosis and treatment of a child with severe obstructive sleep apnea syndrome complicated by pulmonary hypertension [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 116-119.
[4] JI Di, DENG Anchun. Meta-analysis of the effect of surgery for obstructive sleep apnea hypopnea syndrome on blood pressure [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 92-98.
[5] Obstructive sleep apnea(OSA)is a common sleep-related respiratory disorder. If left untreated, it can lead to cardiovascular and nervous system damage. In addition to continuous positive airway pressure(CPAP), most OSA patients have surgical treatment based on the anatomical obstruction. Uvulopalatopharyngoplasty(UPPP)is the most common procedure performed. This paper reviews the current research on the preoperative evaluation of UPPP, summarizes possible predictors, and screens out more specific predictive factors. The aim is to construct a more efficient predictive system, specify the indications and contraindications of UPPP surgery.. Analysis of the preoperative predictive factors of Uvulopalatopharyngoplasty [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 145-151.
[6] Obstructive sleep apnea(OSA)is a chronic disease that is prevalent worldwide. The morbidity of OSA has increased year by year. The primary characteristic of OSA is repeated upper airway collapse, which causes recurrent apnea, hypopnea, and frequent decline of the oxyhemoglobin saturation. This leads to sleep fragmentation and sleep structure disorder. Patients with OSA usually suffer from daytime sleepiness and inattention. Long-term sleep fragmentation and micro-arousal state are related to many chronic diseases, such as hypertension, myocardial infarction, Type 2 diabetes and Alzheimer's disease. Moreover, OSA is also closely related to tumors. With increases in the degree of OSA and hypoxemia, the incidence and mortality of related tumors have also gone up. Such tumors include lung, breast, nasopharyngeal, prostate and central nervous system cancers. To provide a reference for OSA and tumor-related research and clinical practice and develop ideas around further treatment research that could be conducted, this article reviews the profile of OSA and the statistical evidence, moreover, the molecular mechanism and treatment of OSA related to tumors will be discussed.. Correlation between obstructive sleep apnea and tumors [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 152-156.
[7] Obstructive sleep apnea syndrome(OSAS)and laryngopharyngeal reflux disease(LPRD)are two common diseases in otolaryngology. In recent years, with the increasing incidence, these diseases have affected the health of more and more people. As research on these two diseases continues to expand, the correlation between them has captured the attention of a number of scholars. In this study, we reviewed the recently published literature on the two diseases, concluding that there is a correlation between them. We have also elaborated on the factors and mechanisms of their mutual influence, analyzed the existing treatment methods of OSAS and LPRD, and provided new ideas for further refinement of the diagnosis and treatment.. Advances in the study of obstructive sleep apnea syndrome and laryngopharyngeal reflux diseaseWANG Hongyan, WANG SanchunOverview TENG Bo, GE Min Guidance Department of Otolaryngology Head & Neck Surgery, the Second Hospital of Jilin University, Changchun 130022, Jilin, ChinaAbstract: [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 134-138.
[8] LI Xiao, YUAN Ying, LI Yanzhong, WANG Yan, YANG Ke, SUN Yongqiang, YU Xuemin, WANG Ning, WANG Lei. Effects of anxiety and depression on nocturnal blood pressure fluctuation in patients with obstructive sleep apnea hypopnea syndrome [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(6): 68-71.
[9] Zhaokun WU,Xinhua ZHU. Can adenotonsillectomy adequately cure children with obstructive sleep apnea syndrome [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 148-152.
[10] SONG Fan, HUANG Weijun, XU Huajun, GUAN Jian, YI Hongliang. Relationship between carotid elasticity and oxidative stress in patients with obstructive sleep apnea syndrome [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 99-104.
[11] JI Di, CHEN Xiang, YU Lin. Soft palate surgeries with hyoid bone suspension for obstructive sleep apnea hypopnea syndrome with glossoptosis: a meta-analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 124-130.
[12] YAN Zhigang, ZHANG Huihui, YU Dan, LIU Yan, WEN Lianji, WANG Di. Diagnosis and treatment of cognitive deficits in adult patients with obstructive sleep apnea hypopnea syndrome [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 155-161.
[13] Min YIN,Lei CHENG. Comments and opinions on the nomenclature of snoring disease [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 19-22.
[14] HU An, XING Yanli, CHEN Xiaoping, XUE Xiaocheng, ZHANG Yi, XU Weihua. Treatment of coexisting obstructive sleep apnea and laryngopharyngeal reflux disease and analysis of its characteristic reflux symptom index and reflux finding score [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 86-89.
[15] LIU Dawei, ZHANG Yu, LI Chenglin, CHEN Xiumei, SONG Xicheng. Use of enhanced recovery after surgery in children with obstructive sleep apnea syndrome during the perioperative period [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 19-22.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Website Copyright: Editorial Office of Journal of Otolaryngology and Ophthalmology of Shandong University
Address: No.27 Shanda South Road, Jinan, Shandong, China. Post code: 250100 Tel: +86-0531-88366912 Email: ebhxb@sdu.edu.cn Supported by Beijing Magtech Co.Ltd