抗反流手术治疗老年食管裂孔疝合并胃食管反流病对阻塞性睡眠呼吸暂停的影响

Effect of anti-reflux surgery on obstructive sleep apnea in elderly patients with hiatal hernia and gastroesophageal reflux disease

目的分析老年食管裂孔疝(HH)合并胃食管反流病(GERD)患者阻塞性睡眠呼吸暂停(OSA)的患病情况,并探索抗反流手术(腹腔镜下食管裂孔疝修补术联合胃底折叠术)治疗老年HH合并GERD对OSA的影响。方法选取2021年1月至2022年6月于徐州医科大学附属医院住院并确诊HH合并GERD的83例老年患者为研究对象,其中6例剔除。根据多导睡眠监测(PSG)结果,将77例患者分为OSA组(n=45)和非OSA组(n=32)。比较手术前后体质量指数(BMI)、呼吸暂停低通气指数(AHI)、氧减指数(ODI)、最长呼吸暂停时间(LAT)、最低血氧饱和度(LSaO_(2))、Epworth嗜睡评分(ESS)、胃食管反流病问卷(GERD-Q)、血清白介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)变化。采用SPSS 25.0统计软件进行数据分析。根据数据类型,分别采用t检验、χ^(2)检验或Fisher确切概率法检验进行组间比较。采用Pearson相关性分析评价OSA组患者术前炎症指标与睡眠参数、手术前后炎症指标差值与睡眠参数差值之间的相关性。结果OSA组患者AHI、ODI、LAT、ESS、血清IL-8、TNF-α水平高于非OSA组,LSaO_(2)低于非OSA组,差异有统计学意义(P<0.05)。OSA组血清TNF-α水平与AHI、ODI、LAT正相关,与LSaO_(2)负相关(r=0.647,0.579,0.477,-0.312;P<0.05);OSA组血清IL-8水平与AHI、ODI正相关,与LSaO_(2)负相关(r=0.422,0.501,-0.330;P<0.05)。与术前相比,OSA组术后AHI、ODI、LAT、ESS、GERD-Q、血清IL-8及TNF-α水平下降,LSaO_(2)升高,差异均有统计学意义(P<0.05)。OSA组手术前后血清TNF-α差值与AHI、ODI、LAT差值呈正相关(r=0.329,0.408,0.529;P<0.05);OSA组手术前后IL-8差值与AHI、ODI、LAT差值呈正相关,与LSaO_(2)差值呈负相关(r=0.343,0.371,0.350,-0.330;P<0.05)。结论老年HH合并GERD患者中,患有OSA较为常见,男女患病比例接近,以轻中度OSA为主。腹腔镜下食管裂孔疝修补术联合胃底折叠术治疗HH合并GERD,能够改善OSA的症状及病情严重程度,并降低炎症反应。

Objective To explore the prevalence of obstructive sleep apnea(OSA)in elderly patients with hiatal hernia(HH)complicated with gastroesophageal reflux disease(GERD),and determine the effect of anti-reflux surgery(laparoscopic hiatal hernia repair combined with fundoplication)on OSA in these elderly patients.Methods A total of 83 elderly patients diagnosed with HH complicated with GERD in our hospital from January 2021 to June 2022 were recruited,6 cases were excluded,and then the 77 cases were divided into OSA group(n=45)and non-OSA group(n=32)according to the results of polysomnography(PSG).The changes in body mass index(BMI),apnea hypopnea index(AHI),oxygen desaturation index(ODI),longest apnea time(LAT),lowest oxygen saturation(LSaO_(2)),Epworth sleepiness score(ESS),and results of gastroesophageal reflux disease questionnaire(GERD-Q),and serum levels of interleukin-8(IL-8)and tumor necrosis factor-α(TNF-α)were compared before and after surgery.SPSS statistics 25.0 was used for data analysis.Based on data type,comparison between groups was performed using student′s t test,Chi-square test or Fisher exact probability test.Pearson correlation analysis was used to evaluate the relationship of preoperative inflammatory indicators with sleep parameters,and the difference between inflammatory indicators and sleep parameters in OSA group before and after surgery.Results AHI,ODI,LAT,ESS score and serum levels of IL-8 and TNF-αwere significantly higher,and LSaO_(2)was obviously lower in the OSA group than the non-OSA group(P<0.05).In the OSA group,the serum TNF-αlevel was positively correlated with AHI,ODI and LAT,and negatively with LSaO_(2)(r=0.647,0.579,0.477,-0.312;P<0.05);the serum IL-8 level was positively correlated with AHI and ODI,and negatively with LSaO_(2)(r=0.422,0.501,-0.330;P<0.05).Compared with pre-operation,the OSA group had notably decreased AHI,ODI,LAT,ESS score,GERD-Q,and serum IL-8 and TNF-αlevels,and increased LSaO_(2)after operation(P<0.05).In the OSA group,the change of serum TNF-αlevel before and after surgery was positively correlated with the changes of AHI,ODI and LAT(r=0.329,0.408,0.529;P<0.05),and the difference of serum IL-8 level before and after surgery was positively correlated with the changes of AHI,ODI and LAT,and negatively with the change of LSaO_(2)(r=0.343,0.371,0.350,-0.330;P<0.05).Conclusion For the elderly with HH complicated with GERD,the presence of OSA is quite common.The male patients have similar proportion as the female,and mainly mild to moderate OSA in severity.Laparoscopic hiatal hernia repair combined with fundoplication alleviates the symptoms of OSA,attenuates the severity,and reduce inflammation in the patients.