成人阻塞性睡眠呼吸暂停的外科治疗进展与展望

Advances and prospects in surgical treatment of adult obstructive sleep apnea

阻塞性睡眠呼吸暂停(OSA)严重影响睡眠,危害身体健康。成人OSA病因复杂,除有导致上气道狭窄的解剖因素,还有神经肌肉调控功能下降、内分泌紊乱、代谢障碍以及遗传等因素。外科手术是治疗OSA的重要方法之一,应该选择合适的适应证及治疗方案,才可望获得理想的疗效。OSA外科手术的主要目的是扩大上气道,解除狭窄,防止或减轻睡眠时因上气道肌肉松弛塌陷导致气道狭窄或阻塞。手术按照解剖部位分有鼻腔、鼻咽、腭咽、舌咽、喉咽各平面手术,以及骨性结构手术、减重手术及神经电刺激装置植入术等。外科手术的方式方法很多,但如何提高疗效,减少不良反应,让患者持久获益,仍然是医学界研究的重要课题。以下拟结合相关文献及笔者多年的临床经验,探讨成人OSA外科治疗的进展和展望。

Sleep apnea hypopnea syndrome(OSA)severely affects sleep and jeopardizes overall health.The eti-ology of adult OSA is complex,involving anatomical factors causing upper airway narrowing,as well as factors such as neuro-muscular control dysfunction,endocrine disorders,metabolic disturbances,and genetic predisposition.Surgical intervention is an important treatment modality for OSA,but appropriate patient selection and treatment strategies are cru-cial for achieving desirable outcomes.The primary goal of surgical treatment for OSA is to enlarge the upper airway,re-lieve narrowing,and prevent or alleviate airway obstruction caused by relaxation and collapse of upper airway muscles dur-ing sleep.Surgical procedures include nasal,nasopharyngeal,oropharyngeal,tongue base,hypopharyngeal plane surger-ies,as well as skeletal structural procedures,weight reduction surgeries,and implantation of neurostimulation devices.Although various surgical techniques are available,improving efficacy,minimizing adverse reactions,and ensuring long-term benefits for patients remain significant challenges in the medical field.In this review,based on relevant literature and the author's clinical experience,we discuss the advances and prospects in surgical treatment of adult OSA.