减重手术对肥胖合并睡眠呼吸暂停患者的咽腔结构改变研究

Study on the structural changes of pharyngeal cavity after bariatric surgery in obese patients with obstructive sleep apnea

目的:研究减重手术是否以及如何改变肥胖合并阻塞性睡眠呼吸暂停(OSA)患者的咽腔结构。方法:招募42例行腹腔镜下袖状胃切除术的患者,在术前以及术后3、6、12个月评估形态学指标(BMI、颈围和腰围)、PSG指标和咽声反射指标。结果:包括形态学、咽腔结构和OSA严重程度在内的所有指标在手术后均发生了显著变化,其中,BMI、颈围、腰围和AHI值显著降低(P<0.001),而咽腔容积、咽体积、口咽结合处面积、声门面积和LSaO2显著增加(P<0.001)。多重比较结果显示,BMI、颈围和腰围在6个月前显著下降,6~12个月时变化不显著;AHI和LSaO2的降低主要发生在0~3个月,3个月与6个月、6个月与12个月之间差异无统计学意义;术后口咽结合处面积在0~3个月内显著增加,而咽腔容积和声门区面积在术后6、12个月显著增加。结论:减重手术可以显著降低体重,减少颈部脂肪堆积;扩大咽腔容积和横截面积,改善上气道阻塞情况,可以在一定程度上减轻肥胖合并OSA患者的睡眠呼吸暂停症状。

Objective: To study whether and how bariatric surgery changes the structure of the pharyngeal cavity in obese patients with obstructive sleep apnea(OSA). Methods: Forty-two patients who underwent laparoscopic sleeve gastrectomy were recruited. Morphological indicators(BMI, neck and waist circumference), PSG and acoustic pharyngometry indicators were evaluated pre-operatively and 3, 6, and 12 months post-operatively. Results: All indicators including morphology, pharyngeal cavity structure and OSA severity changed significantly after surgery. Among them, BMI, neck circumference, waist circumference and AHI value were significantly reduced(P<0.001), while pharyngeal cavity volume, pharynx volume, oropharyngeal junction area, glottis area and LSaO2 increased significantly(P<0.001). The results of multiple comparisons showed that BMI, neck and waist circumference decreased significantly in the first 6 months, and no further decline occurred during 6 to 12 months postoperatively. The decrease in AHI and LSaO2 mainly occurred within the first 3 months postoperatively, while there was no statistically significant difference in these two indicatiors between 3 months vs. 6 months, 6 months vs. 12 months postoperatively. The area of the oropharyngeal junction increased significantly within 0 to 3 months after surgery, while the volume of the pharyngeal cavity and the area of the glottis increased at 6 months and 12 months after surgery. Conclusion: Bariatric surgery can significantly reduce body weight and reduce fat accumulation in the neck. It can also enlarge the volume and cross-sectional area of the pharyngeal cavity, and improve upper airway obstruction, therefore reduce the symptoms of sleep apnea in obese patients with OSA to a certain extent.