Friedman分型联合术后早期睡眠脉氧监测对悬雍垂腭咽成形术疗效的预测价值

Predictive values of the combination of Friedman stage and sleep oximetry done early after surgery in predicting the treatment outcomes of uvulopalatopharyngoplasty

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者术前病史及查体等资料,联合术后早期睡眠血氧结果,对悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)疗效的预测价值。方法:选择2013年1月至2016年5月于北京大学第一医院接受UPPP手术治疗且有完整随访资料的患者进行回顾性研究,搜集包括年龄、查体及睡眠监测等资料,所有患者在术后早期(1周)均实施主观疗效评估及整夜脉氧监测,术后长期疗效评估进行至少术后3个月的睡眠监测及视觉模拟量表评估。结果:共纳入61例患者,完成随访后有效者25例(41.0%),无效者36例(59.0%),回归分析发现术后早期≥4%的氧降指数(the oxygen index of≥4%,ODI4)及术前Friedman分型是疗效的独立预测参数(P<0.05),ROC曲线分析术后早期ODI4对疗效的预测效率,发现曲线下面积可达0.822,以15作为界值,敏感性和特异性分别可达0.778和0.760,其中ODI4<15次/h的患者有效率可达70.4%,显著高于ODI4≥15次/h的患者,即17.6%(P<0.05);术前Friedman分型Ⅱ型患者中,ODI4<15次/h的患者,其有效率显著高于ODI4≥15次/h的患者(87.5%vs.25.0%),Ⅲ型患者中亦可得到类似的结果(33.3%vs.6.7%)。结论:通过对UPPP术后早期脉氧监测数据尤其是ODI4的收集,结合术前的Friedman分型,能更好地判断患者潜在的手术疗效。

Objective:To explore the predictive values of the combination of preoperative data,including medical history and physical examination,and results of sleep oximetry performed early after the surgery(one week)in predicting the treatment outcomes of uvulopalatopharyngoplasty(UPPP)in adult patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:All the patients who were diagnosed with OSAHS,underwent UPPP treatment and had complete follow-up data in our institution between Jan 2013 and May 2016 were enrolled in our study.The pre-operative data of these patients,including age,physical examination,and polysomnography(PSG)data,were all exactly collected for analysis.All these patients had received the evaluation of subjective efficacy scale and the sleep oximetry test in early post-operative days(within one week).The long-term efficacy evaluations including PSG and subjective efficacy scale were all finished at least three months after the surgery.Results:In the research 61 patients were finally studied,including 25 responders(41.0%)and 36 non-responders(59.0%).Regression analysis revealed that the pre-operative Friedman stage and early post-operative oxygen desaturation index of≥4%(ODI4)were found to be independently predictive parameters for the UPPP treatment outcomes(P<0.05).The ROC curve analysis was used to estimate the predictive values of ODI4 to the treatment outcomes,and it was calculated with an area under the curve of 0.822.Using the ODI4 of 15 as the cutoff value,the sensitivity and specificity of that calculated were up to 0.778 and 0.760 respectively.The response rate among the patients with an early post-operative ODI4 of<15 was 70.4%,which was significantly higher than that of the patients with an early post-operative ODI4 of≥15,whose response rate was 17.6%(P<0.05).The similar results could also be obtained in the patients with pre-operative Friedman stageⅡ(87.5%vs.25.0%)and Friedman stageⅢ(33.3%vs.6.7%).Conclusion:The combination of early post UPPP operation oximetry parameters,especially ODI4,and pre-operative Friedman stage could be used in better evaluating the potential surgical outcomes of UPPP.