阻塞性睡眠呼吸暂停低通气综合征手术的主观和客观疗效分析

Investigation of outcomes of surgical treatment for patients with obstructive sleep apnea hypopnea syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者主观和客观评价相关性,评价手术的主观和客观疗效。方法 41例OSAHS患者,根据阻塞部位采用单一或联合手术,术前和术后6个月分别做多道睡眠图(PSG)监测、OSAHS疾病特异性生活质量量表——魁北克睡眠问卷简体中文版和Epworth嗜睡量表评价。评价术前及术后改变的主观和客观评价指标相关性,术后主观和客观评价指标的变化。结果术前主观和客观评价指标的相关系数在-0.442～0.413,6个有统计学意义(P均<0.05);术后主观和客观评价指标变化值的相关系数在-0.478～0.442,11个有统计学意义(P均<0.05)。术后主观和客观评价指标都得到明显改善(P均<0.001)。结论 OSAHS主观和客观评价指标相关性较差,临床疗效分析应该用PSG监测及OSAHS疾病特异性生活质量量表共同完成;手术明显改善PSG监测参数和生活质量,是治疗OSAHS的有效手段。

OBJECTIVE To investigate the relationship of polysomnography（PSG）indexes and daytime sleepiness,OSAHS specific quality of life before surgery and to study the subjective and objective evaluation of the outcome after surgical treatment for patients with obstructive sleep apnea hypopnea syndrome（OSAHS）.METHODS A single or a combined surgical treatment was performed on 41 OSAHS patients based on obstructive sites.The data of PSG,Epworth sleepiness scale（ESS） and OSAHS specific quality of life-Quebec sleep questionnaire（QSQ） before surgery and 6 months after surgery were recorded.Correlations between PSG indexes and subjective measures before surgery and correlations between changes in PSG indexes and subjective measures after surgery were examined.The outcome of the surgery was evaluated with PSG indexes,ESS and QSQ.RESULTS Correlations between PSG indexes and subjective measures before surgery ranged from-0.442 to 0.413,and 6 associations had statistically significance（P0.05）.Correlations between changes in PSG indexes and subjective measures ranged from-0.478 to 0.442,and 11 associations had statistically significance（P0.05）.Both PSG indexes and quality of life improved significantly after surgery（P0.001）.CONCLUSION PSG indexes are not consistently associated with daytime sleepiness and OSAHS-related quality of life.Clinical outcomes should be evaluated with physiological and subjective measures.Surgical treatment can greatly reduce PSG indexes,improve the quality of life and it is proved to be an effective therapy.