Analysis of the difference of therapeutic effect and predictive factors between postural and non-postural OSA after modified uvulopalatopharyngoplasty
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摘要: 目的 分析影响体位依赖性(positional obstructive sleep apnea, POSA)和非体位依赖性OSA(non-positional OSA，NPOSA)患者悬雍垂腭咽成形术疗效的因素，并探讨二者影响因素之间的差异。方法 回顾性分析2020年11月-2023年11月在浙江大学医学院附属第二医院耳鼻咽喉科接受治疗并追踪随访的101例OSA患者的临床资料，其中45例POSA患者，56例NPOSA患者，均行夜间睡眠呼吸监测及三维计算机断层扫描(3D-CT)评估上气道解剖结构。患者均接受保留悬雍垂的改良腭咽成形术(han-uvulopalatopharyngoplasty, H-UPPP)，术后3个月随访。结果 手术总体有效率为55.45%，接受H-UPPP的POSA手术成功率(30/45，66.7%)高于NPOSA(26/56，46.4%)，2组比较差异有统计学意义(P=0.042)。POSA的H-UPPP疗效与腭咽部气道最小左右径(r=-0.505，P < 0.001)、舌咽部气道最小左右径(mLAT)(r=-0.474，P=0.001)和最小横截面积(r=-0.394，P=0.007)呈负相关。Logistic分析显示，舌咽部mLAT是POSA患者手术疗效的显著预测因子(OR 0.873；95%CI 0.798~0.955，P=0.003)。年龄是NPOSA患者手术疗效的显著预测因子(OR 0.936；95%CI 0.879~0.998，P=0.042)。结论 POSA患者H-UPPP手术疗效高于NPOSA。舌咽部mLAT是影响POSA疗效的重要预测因素。年龄是影响NPOSA疗效的预测因素。
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关键词:
- 体位 /
- 改良悬雍垂腭咽成形术 /
- 阻塞性睡眠呼吸暂停低通气 /
- 治疗结果
Abstract: Objective To analyze the factors influencing the outcome of uvulopalatopharyngoplasty in positional obstructive sleep apnea(POSA) and non-positional OSA(NPOSA) patients, and to explore the differences between the two groups.Methods The data of 101 patients with obstructive sleep apnea who received treatment from November 2020 to November 2023 were retrospectively analyzed. Among them, 45 positional patients(POSA group) and 56 non-positional patients(NPOSA group), who underwent overnight polysomnography were included. The upper airway(UA) anatomy was evaluated by three-dimensional computer tomography(3D-CT). All patients received revised uvulopalatopharyngoplasty with uvula preservation and were followed using polysomnography for at least three months postoperatively.Results The overall effective rate was 55.45%. The surgical success rate in POSA undergoing UPPP was higher than NPOSA(POSA 30/45, 66.7% versus NPOSA 26/56, 46.4%, P=0.042). The H-UPPP effect of POSA was negatively correlated with the minimum lateral airway of the Velopharyngeal airway(r=-0.505, P < 0.001), the minimum lateral airway of the glossopharyngeal airway(r=-0.474, P=0.001) and the minimum cross-sectional area(r=-0.394, P=0.007). Logistic analysis showed that minimal lateral airway of the glossopharynxgeum(mLAT)(OR 0.873; 95%CI 0.798-0.955, P=0.003) was a significant predictor for surgical outcomes among POSA patients. In NPOSA, age(OR 0.936; 95%CI 0.879-0.998, P=0.042) was a significant predictor for surgical outcomes.Conclusion The effect of H-UPPP was higher in POSA than in NPOSA. The width of glossopharyngeal mLAT was an important predictor of POSA efficacy. Age was a predictor of NPOSA efficacy. -
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表 1 2组OSA患者的术前临床资料比较
X±S，M(P25，P75) 项目 POSA(n=45) NPOSA(n=56) t/Z P 一般资料 年龄/岁 34(30，44) 40(32，46) -1.412 0.158 BMI/kg/m2 26.80(24.60，28.40) 28.07(25.80，29.33) -2.071 0.038 AHI/次/h 44.00(29.40，54.60) 63.65(50.18，75.52) -4.178 < 0.01 LSpO2/% 78.00(73.5，82.5) 72.00(67.0，78.5) -3.46 0.001 TS90/% 4.07(1.50，16.10) 15.60(3.18，34.05) -2.498 0.013 腭咽部/mm MAP 7.72±2.80 7.27±2.65 0.892 0.375 mLAT 11.70(8.70，16.05) 10.50(7.15，12.50) -2.129 0.033 mCSA 89.00(63.61，125.86) 75.20(45.15，94.38) -2.245 0.025 舌咽部/mm mAP 13.75±4.38 14.12±4.87 -0.439 0.662 mLAT 15.40(9.75，25.25) 15.50(8.83，21.83) -0.799 0.424 mCSA 197.00(120.56，279，60) 187.32(141.10，259.63) -0.083 0.934 AL/mm 85.61±8.91 85.87±8.47 -0.719 0.472 MH/mm 14.04±6.64 15.10±6.44 -3.915 < 0.01 
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表 2 POSA患者手术有效者与无效者术前临床资料比较
X±S，M(P25，P75) 项目 有效(n=30) 无效(n=15) t/Z P 一般资料 年龄/岁 34(31，45) 35(29，43) -0.241 0.809 BMI/kg/m2 26.85(24.02，28.45) 26.12(24.90，28.10) -0.253 0.800 AHI/次/h 44.80±17.85 42.47±19.89 0.398 0.693 LSpO2/% 78.0(72.0，82.3) 78.0(75.0，83.4) -0.458 0.647 TS90/% 4.10(1.50，20.40) 3.40(1.30，13.30) -0.458 0.647 腭咽部/mm MAP 7.69±2.86 7.77±2.78 -0.089 0.929 mLAT 10.55(7.47，12.68) 16.00(13.00，18.90) -3.347 0.001 mCSA 84.30(56.43，114.00) 105.80(87.00，135.30) -1.866 0.062 舌咽部/mm mAP 13.53±4.68 14.19±3.82 -0.472 0.639 mLAT 14.15±6.86 23.57±9.98 -3.719 0.001 mCSA 179.62±82.65 259.87±97.97 -2.886 0.006 AL/mm 82.90(76.88，91.00) 83.50(78.90，95.40) -1.12 0.263 MH/mm 13.59±7.63 13.22±8.03 0.882 0.126
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表 3 NPOSA患者手术有效者与无效者术前临床资料比较
X±S，M(P25，P75) 项目 有效(n=26) 无效(n=30) t/Z P 一般资料 年龄/岁 36.31±8.18 41.96±10.06 -2.282 0.026 BMI/kg/m2 28.40(24.80，29.40) 27.78(26.10，28.91) -0.016 0.987 AHI/次/h 64.80(48.80，70.40) 63.90(57.30，74.06) -0.288 0.774 LSpO2/% 72.69±7.49 70.23±10.39 1.002 0.321 TS90/% 18.00(3.00，32.80) 14.50(3.70，33.90) -0.846 0.397 腭咽部/mm mAP 7.22±2.27 7.24±2.96 -0.033 0.974 mLAT 11.00(7.80，12.50) 10.70(7.10，12.50) -0.107 0.915 mCSA 72.10±35.25 80.33±42.65 -0.77 0.445 舌咽部/mm mAP 14.46±4.77 13.89±4.94 0.441 0.661 mLAT 10.80(8.90，21.90) 17.80(12.30，21.60) -0.411 0.681 mCSA 203.24±78.95 206.72±105.60 -0.136 0.892 AL/mm 83.03±7.66 85.70±8.87 -1.184 0.242 MH/mm 13.49±6.82 15.05±7.85 -0.789 0.434
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