Purpose

There are several surgical treatments for obstructive sleep apnea (OSA) including lateral pharyngoplasty (LP) have yielded promising results, clearly improving symptoms of the disease. However, there are few publications in relation to polysomnographic (PSG) results, and patient selection remains a challenge. There are currently four pathophysiological phenotypes for OSA: anatomical, low arousal threshold, ventilatory instability, and poor muscle response. This study sought to evaluate the PSG results of LP and to verify whether the phenotypic profile is predictive of surgical success.

Methods

This was an observational, retrospective, cross-sectional study that analyzed the PSG results (pre-surgical and at least 6 months after surgery) of patients treated with Cahali’s LP. To assess phenotypes, the following variables of interest (obtained from the pre-operative PSG) were used: apnea–hypopnea index (AHI) during REM sleep (AHIrem), percentage of hypopneas in the AHI, number of central or mixed apneas, and AHIrem and non-REM AHI ratio.

Results

Of 46 patients, it was possible to evaluate the phenotype in 28 patients. There were significant differences in the AHI values, ranging from 37.5 (20.8–49.7) to 10.3 (2.3–33.0) (p < 0.001). The minimum oxyhemoglobin saturation ranged from 78 ± 11 to 83 ± 8 p = 0.008. The time with oxyhemoglobin saturation < 90% ranged from 3.6 min (0.5–9.1) to 0.0 (0.0–1.5) p = 0.031. An AHIrem of < 20 events/h showed a positive correlation with surgical success.

Conclusion

LP is efficient for the treatment of OSA, yielding significant improvement in all respiratory parameters evaluated by PSG. A pre-operative AHIrem of < 20 events/h was associated with surgical success. Other variables of interest for determining the phenotypes were not predictors of surgical success.

中文翻译：

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侧咽成形术：OSA 的多导睡眠图结果和基于表型的分析

目的

有几种针对阻塞性睡眠呼吸暂停 (OSA) 的手术治疗，包括侧咽成形术 (LP) 已经取得了可喜的结果，明显改善了疾病的症状。然而，与多导睡眠图 (PSG) 结果相关的出版物很少，患者选择仍然是一个挑战。OSA 目前有四种病理生理表型：解剖学、低觉醒阈值、通气不稳定和肌肉反应差。本研究旨在评估 LP 的 PSG 结果，并验证表型特征是否可以预测手术成功。

方法

这是一项观察性、回顾性、横断面研究，分析了接受 Cahali LP 治疗的患者的 PSG 结果（术前和术后至少 6 个月）。为了评估表型，使用了以下感兴趣的变量（从术前 PSG 中获得）：REM 睡眠期间的呼吸暂停低通气指数 (AHI) (AHIrem)、AHI 中呼吸不足的百分比、中枢性或混合性呼吸暂停的数量，以及AHIrem 和非 REM AHI 比率。

结果

在 46 名患者中，有可能评估 28 名患者的表型。AHI 值存在显着差异，范围从 37.5 (20.8–49.7) 到 10.3 (2.3–33.0) ( p < 0.001)。最小氧合血红蛋白饱和度范围为 78 ± 11 至 83 ± 8  p = 0.008。氧合血红蛋白饱和度 < 90% 的时间范围为 3.6 分钟 (0.5–9.1) 至 0.0 (0.0–1.5) p = 0.031。< 20 个事件/小时的 AHIrem 显示与手术成功呈正相关。

结论

LP 可有效治疗 OSA，显着改善 PSG 评估的所有呼吸参数。< 20 事件/小时的术前 AHIrem 与手术成功相关。其他用于确定表型的变量并不是手术成功的预测因素。