鼻腔扩容手术对阻塞性睡眠呼吸暂停低通气综合征患者睡眠改善作用的回顾性分析

A retrospective analysis of the effect of nasal cavity ventilation expansion techniques on sleep improvement in patients with OSAHS

目的探讨鼻腔扩容手术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的主客观疗效,并分析其可能的影响因素。方法回顾性筛选并收集行鼻腔扩容手术的OSAHS患者共41例。收集患者术前基本临床特征,术前基线主观嗜睡程度(Epworth sleepiness scale,ESS)评分和客观多导睡眠监测(PSG)数据,以及术后半年随访时的ESS评分和PSG数据。分析不同严重程度分组主客观指标的改善情况,以及影响改善率的影响因素。结果鼻腔扩容术后OSAHS患者的ESS评分显著改善(P=0.005),夜间睡眠平均脉搏血氧饱和度(mean pulse oxygen saturation,MSpO2)显著改善(P=0.038)。轻度组呼吸暂停低通气指数(AHI)改善率低于重度组(P=0.025),中等颈围组MSpO2改善量好于高颈围组(P=0.014)。多元有序Logistic回归分析显示BMI增加有使AHI改善率降低风险,具有统计学意义(OR=0.690,95%CI=0.496~0.96,P=0.028);术前AHI增高有使AHI改善率增加的可能,具有统计学意义(OR=1.175,95%CI=1.079~1.279,P<0.001);术前最低脉搏血氧饱和度(lowest pulse oxygen saturation,LSpO2)降低有使AHI改善率降低风险,具有统计学意义(OR=1.222,95%CI=1.023~1.460,P=0.027)。结论鼻腔扩容手术可以改善OSAHS患者主观嗜睡症状,并在一定程度上改善夜间睡眠MSpO2。BMI升高和LSpO2降低是影响AHI改善率的危险因素,而AHI在一定程度上可能是其保护性因素。

OBJECTIVE To investigate the subjective and objective efficacy of Nasal Cavity Ventilation Expansion Techniques(NCVET)in the treatment of patients with OSAHS and t o analyze the possible influencing factors.METHODS Case data of a total of 41 patients with OSHAS undergoing NCVET were screened and collected.Preoperative basic clinical data,baseline Epworth sleepiness scale(ESS)scores and polysomnography(PSG)data were collected,as well as ESS scores and PSG data at the six-month postoperative follow-up.To analyze the improvement of subjective and objective indicators for different severity subgroups and the influencing factors that affect the improvement rate.RESULTS Patients with OSAHS had a significant improvement in ESS scores(P=0.005)and in mean pulse oxygen saturation(MSpO2)during nighttime sleep(P=0.038)after NCVET.The rate of apnea hypopnea index(AHI)improvement was lower in the mild group than in the severe group(P=0.025),and the amount of MSpO2 improvement was better in the moderate neck circumference group than in the high group(P=0.014).Multiple ordered logistic regression analysis showed that an increased BMI had a significant risk of decreasing the rate of AHI improvement(OR=0.690,95%CI=0.496-0.96,P=0.028);an increased preoperative AHI had a significant risk of increasing the rate of AHI improvement(OR=1.175,95%CI=1.079-1.279,P<0.001);and a decreased preoperative lowest pulse oxygen saturation(LSpO2)had a significant risk of reducing the rate of AHI improvement(OR=1.222,95%CI=1.023-1.460,P=0.027).CONCLUSION NCVET improves subjective drowsiness symptoms and to some extent night sleep MSpO2 in patients with OSAHS.Elevated BMI and reduced LSpO2 are risk factors affecting the rate of AHI improvement,and AHI may to some extent be its protective factor.