Study on the structural changes of pharyngeal cavity after bariatric surgery in obese patients with obstructive sleep apnea
-
摘要: 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。
-
关键词:
- 减重手术 /
- 睡眠呼吸暂停, 阻塞性 /
- 咽声反射 /
- 口咽
Abstract: 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.-
Key words:
- bariatric surgery /
- sleep apnea, obstructive /
- acoustic pharyngometry /
- oropharynx
-
-
表 1 术前及术后3、6、12个月各项指标之间的多重比较结果
x±s 指标 术前 3个月 6个月 12个月 F P 形态学指标 BMI 39.35±7.50 33.99±7.361) 30.83±6.621)2) 29.71±5.081)2) 17.39 < 0.01 颈围/cm 43.37±4.35 40.01±3.771) 38.32±3.491) 36.93±4.051)2) 20.96 < 0.01 腰围/cm 119.54±13.55 110.57±13.911) 104.55±12.821)2) 102.86±10.931)2) 14.43 < 0.01 PSG指标 AHIa) 28.45±23.58 14.56±13.271) 11.15±9.551) 8.40±7.961) 15.01 < 0.01 LSaO2 a) 0.76±0.14 0.85±0.091) 0.90±0.071) 0.91±0.111)2) 20.76 < 0.01 咽声反射指标 咽腔容积a)/mL 23.02±4.78 26.17±4.251) 28.40±3.921) 29.17±3.171)2) 19.26 < 0.01 口咽结合处面积/cm2 0.91±0.32 1.04±0.251) 1.11±0.321) 1.15±0.271) 5.40 0.01 声门区面积a)/cm2 0.98±0.30 1.14±0.26 1.24±0.221) 1.24±0.191) 10.16 < 0.01 与术前比较，1)P < 0.01；与术后3个月比较，2)P < 0.01。
注：a)方差不齐，采用Welch检验结果。
下载: 导出CSV
-
[1] Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review[J]. Sleep Med Rev, 2017, 34: 70-81. doi: 10.1016/j.smrv.2016.07.002
[2] Cano-Pumarega I, Barbé F, Esteban A, et al. Sleep Apnea and Hypertension: Are There Sex Differences? The Vitoria Sleep Cohort[J]. Chest, 2017, 152(4): 742-750. doi: 10.1016/j.chest.2017.03.008
[3] Grewal G, Joshi GP. Obesity and Obstructive Sleep Apnea in the Ambulatory Patient[J]. Anesthesiol Clin, 2019, 37(2): 215-224. doi: 10.1016/j.anclin.2019.01.001
[4] Pannain S, Mokhlesi B. Bariatric surgery and its impact on sleep architecture, sleep-disordered breathing, and metabolism[J]. Best Pract Res Clin Endocrinol Metab, 2010, 24(5): 745-761. doi: 10.1016/j.beem.2010.07.007
[5] Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline[J]. J Clin Sleep Med, 2017, 13(3): 479-504. doi: 10.5664/jcsm.6506
[6] Ashrafian H, le Roux CW, Rowland SP, et al. Metabolic surgery and obstructive sleep apnoea: the protective effects of bariatric procedures[J]. Thorax, 2012, 67(5): 442-449. doi: 10.1136/thx.2010.151225
[7] Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis[J]. JAMA, 2004, 292(14): 1724-1737. doi: 10.1001/jama.292.14.1724
[8] Molfenter SM. The Reliability of Oral and Pharyngeal Dimensions Captured with Acoustic Pharyngometry[J]. Dysphagia, 2016, 31(4): 555-559. doi: 10.1007/s00455-016-9713-y
[9] 王勇, 王存川, 朱晒红, 等. 中国肥胖及2型糖尿病外科治疗指南(2019版)[J]. 中国实用外科杂志, 2019, 39(4): 6-11. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201904001.htm
[10] 中国医师协会睡眠医学专业委员会. 成人OSA多学科诊疗指南[J]. 中华医学杂志, 2018, 98(24): 1902-1914. doi: 10.3760/cma.j.issn.0376-2491.2018.24.003
[11] Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline[J]. J Clin Sleep Med, 2017, 13(3): 479-504. doi: 10.5664/jcsm.6506
[12] 荣婷, 马建刚, 赵宇亮, 等. 不同体位咽声反射对OSAHS病情评估的影响及其对OSAHS治疗效果评估的初探[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(2): 118-122, 127. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201902007.htm
[13] Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2008[J]. JAMA, 2010, 303(3): 235-241. doi: 10.1001/jama.2009.2014
[14] Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects[J]. N Engl J Med, 2007, 357(8): 741-752. doi: 10.1056/NEJMoa066254
[15] Santos S, Caramujo C, Silva M, et al. Impact of bariatric surgery on OSAS in obese individuals[J]. Sleep Medicine, 2013, 14(Suppl 1): 273.
[16] Al-Jumaily AM, Ashaat S, Martin B, et al. A pilot study on the biomechanical assessment of obstructive sleep apnea pre and post bariatric surgery[J]. Respir Physiol Neurobiol, 2018, 250: 1-6. doi: 10.1016/j.resp.2018.01.007
[17] Soin D, Kumar PA, Chahal J, et al. Evaluation of obstructive sleep apnea in metabolic syndrome[J]. J Family Med Prim Care, 2019, 8(5): 1580-1586. doi: 10.4103/jfmpc.jfmpc_175_19
[18] Katz SL, Blinder H, Naik T, et al. Does neck circumference predict obstructive sleep apnea in children with obesity?[J]. Sleep Med, 2021, 78: 88-93. doi: 10.1016/j.sleep.2020.12.018
[19] Kamal I. Normal standard curve for acoustic pharyngometry[J]. Otolaryngol Head Neck Surg, 2001, 124(3): 323-330. doi: 10.1067/mhn.2001.113136
[20] Jung DG, Cho HY, Grunstein RR, et al. Predictive value of Kushida index and acoustic pharyngometry for the evaluation of upper airway in subjects with or without obstructive sleep apnea[J]. J Korean Med Sci, 2004, 19(5): 662-667. doi: 10.3346/jkms.2004.19.5.662
[21] Lettieri CJ, Eliasson AH, Greenburg DL. Persistence of obstructive sleep apnea after surgical weight loss[J]. J Clin Sleep Med, 2008, 4(4): 333-338. doi: 10.5664/jcsm.27233
[22] Corda L, Redolfi S, Montemurro LT, et al. Short-and long-term effects of CPAP on upper airway anatomy and collapsibility in OSAH[J]. Sleep Breath, 2009, 13(2): 187-193. doi: 10.1007/s11325-008-0219-1
[23] Sabato R, Guido P, Salerno FG, et al. Airway inflammation in patients affected by obstructive sleep apnea[J]. Monaldi Arch Chest Dis, 2006, 65(2): 102-105.
[24] Stardelova Grivcheva K, Popova Jovanova R, Deriban G, et al. Relationship between Gastroesophageal Refluh Disease(GERD)and Obstructive Sleep Apnea(OSA)in adult population in Macedonia[J]. Physioacta, 2014, 8(1): 1-8.
-
图(1)
表(1)
计量
- 文章访问数: 1018
- PDF下载数: 294
- 施引文献: 0