Effects of orofacial myofunctional therapy on postoperative outcomes of upper airway surgery for adults with severe obstructive sleep apnea
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摘要: 目的 探讨口面肌功能训练对成人重度阻塞性睡眠呼吸暂停(OSA)患者上气道手术临床疗效的影响。方法 纳入2020年6月—2021年9月于深圳市第二人民医院行上气道手术的OSA患者48例，随机分为联合组(21例)和单纯手术组(27例)，联合组在上气道手术后1个月开始行口面肌功能训练，单纯手术组不进行口咽肌功能训练，通过对比分析2组有效率，术后6个月的呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、鼾声事件及Epworth嗜睡量表评分等情况。结果 联合组术后6个月AHI、LSaO2、鼾声事件、总鼾声时间占比分别为(14.77±9.15)次/h、(81.19±6.52)%、(172.43±73.67)次、(13.16±6.02)%、单纯手术组术后6个月AHI、LSaO2、鼾声事件、总鼾声时间占比为(23.87±10.60)次/h、(80.78±4.88)%、(235.81±83.23)次、(17.58±5.94)%，两组患者术后6个月较术前比较，AHI、鼾声事件、总鼾声时间占比明显下降，LSaO2明显提高，差异均有统计学意义(P< 0.05)，但联合组术后6个月AHI、鼾声事件、总鼾声时间占比改善较单纯手术组明显，差异均有统计学意义(P< 0.05)。结论 口面肌功能训练可以提高成人重度OSA上气道手术术后临床疗效。Abstract: Objective To investigate the effect of orofacial myofunctional therapy on the clinical efficacy of upper airway surgery for adults with severe obstructive sleep apnea(OSA).Methods A total of 48 patients with OSA who underwent upper airway surgery in the Shenzhen Second People's Hospital from June 2020 to September 2021 were included in this study. These patients were randomly divided into the combination group(21 cases) and the surgery group(27 cases). The effective rate, AHI, minimum blood oxygen saturation, snoring events and Epworth sleepiness scale scores at 6 months after operation were compared and analyzed between the two groups.Results The proportions of AHI, LSaO2, snoring events, and total snoring time in the combined group at 6 months after operation were(14.77±9.15) times/h, (81.19±6.52)%, (172.43±73.67) times, and(13.16±6.02)%. The proportion of AHI, LSaO2, snoring events, and total snoring time in surgical group at 6 months after operation was(23.87±10.6) times/h, (80.78±4.88)%, (235.81±83.23) times, (17.58±5.94)%. Compared with preoperative 6 months after operation, the proportion of AHI, snoring events, and total snoring time was significantly decreased, and LSaO2was significantly increased, and the differences were statistically significant(P< 0.05). The time of snoring and the proportion of snoring to time were significantly improved compared with those in the simple operation group, and the differences were statistically significant(P< 0.05).Conclusion This study verified that orofacial myofunctional therapy can improve the clinical efficacy after upper airway surgery for adults with severe obstructive sleep apnea.
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Key words:
- obstructive sleep apnea /
- orofacial myofunctional therapy /
- surgery
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表 1 术前两组临床资料比较
特征 单纯手术组(n=27) 联合组(n=21) t/χ2 P值 年龄/岁 35.81± 8.96 36.76± 7.89 -0.382 0.704 BMI/(kg·m-2) 26.49± 2.29 26.71± 2.29 -0.323 0.510 颈围/cm 40.30± 2.61 40.10± 2.67 -0.262 0.794 AHI/(次·h-1) 49.16± 13.25 48.11± 17.71 0.233 0.817 LSaO2/% 70.30± 8.79 70.14± 8.75 0.798 0.952 鼾声事件 371.30± 153.12 386.57± 147.45 -0.348 0.729 总鼾声时间占比 28.94± 7.49 30.37± 8.55 -0.615 0.541 Friedman分级 0.135 0.935 Ⅰ 2 2 Ⅱ 18 13 Ⅲ 7 6 手术平面 0.717 0.397 腭咽 6 3 腭咽+鼻腔 1 1 腭咽+舌根 7 4 腭咽+舌根+鼻腔 13 13 
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表 2 两组间术前及术后6个月睡眠呼吸监测指标比较
组别 例数 时间 AHI LSaO2 鼾声事件 总鼾声时间占比 联合组 21 术前 48.11±17.71 70.14±8.75 386.57±147.45 30.37±8.55 术后6个月 14.77±9.151)3) 81.19±6.521) 172.43±73.671)3) 13.16±6.021)2) 单纯手术组 27 术前 49.16±13.25 70.30±8.79 371.30±153.12 28.94±7.49 术后6个月 23.87±10.61) 80.78±4.881) 235.81±83.231) 17.58±5.941) 与术前比较，1)P < 0.01；与单纯手术组术后6个月比较，2)P < 0.05，3)P < 0.01。
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表 3 两组患者疗效比较
组别 例数 痊愈 显效 有效 无效 总有效率/% χ2 P值 联合组 21 2(9.5) 11(52.4) 5(23.8) 3(14.3) 85.7 0.488 0.485 单纯手术组 27 0(0) 12(44.4) 9(33.3) 6(23.5) 77.8
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