Does airway surgery lower serum lipid levels in obstructive sleep apnea patients? A retrospective case review.
Does airway surgery lower serum lipid levels in obstructive sleep apnea patients? A retrospective case review.
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DOI：
10.12659/msm.892230
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发表时间：
2014-12-13
期刊：
影响因子：
--
通讯作者：
Wei Y
中科院分区：
文献类型：
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作者：
Li L;Zhan X;Wang N;Pinto JM;Ge X;Wang C;Tian J;Wei Y
阻塞性睡眠呼吸暂停（OSA）与心血管疾病的增加密切相关。手术是治疗OSA的重要方法，但其对OSA患者血脂水平的影响尚不清楚。我们的目的是评估上呼吸道手术对血脂的影响。我们对2012年至2013年在北京一家大型城市学术医院接受手术（鼻腔或悬雍瓣腭咽成形术[UPPP]）的113例OSA成年患者进行了回顾性研究，这些患者术前和术后均有血脂分析。术后血清TC（4.86±0.74 ~ 4.69±0.71）、LP(a)（中位值18.50 ~ 10.90）均显著降低（P分别<0.01、0.01），血清HDL、LDL、TG无明显变化（P均< 0.05）。UPPP患者（n=51）血清TC、HDL、LP(a)均有改善（P分别=0.01、0.01、<0.01）。鼻部患者（n=62）仅血清LP(a)降低（P<0.01）。基线时血脂正常的患者，只有血清LP(a)降低（P<0.01）。与孤立性高甘油三酯血症患者相比，血清HDL、TG、LP(a)均有显著改善（P分别为0.02、0.03、<0.01）。在孤立性高胆固醇血症患者中，血清LP(a)显著降低（P=0.01），血清TC （P=0.06）趋势相似。混合性高脂血症患者血清TC和LDL也降低（P分别为0.02、0.03）。手术可以改善OSA患者的血脂水平，特别是术前血脂异常的患者，可能对代谢和心血管后遗症产生重大益处。前瞻性研究应该检查呼吸道手术对阻塞性睡眠呼吸暂停的潜在代谢影响。
Obstructive sleep apnea (OSA) is tightly linked to increased cardiovascular disease. Surgery is an important method to treat OSA, but its effect on serum lipid levels in OSA patients is unknown. We aimed to evaluate the effect of upper airway surgery on lipid profiles. We performed a retrospective review of 113 adult patients with OSA who underwent surgery (nasal or uvulopalatopharyngoplasty [UPPP]) at a major, urban, academic hospital in Beijing from 2012 to 2013 who had preoperative and postoperative serum lipid profiles. Serum TC (4.86±0.74 to 4.69±0.71) and LP(a) (median 18.50 to 10.90) all decreased significantly post-operatively (P<0.01, 0.01, respectively), with no changes in serum HDL, LDL, or TG (P>0.05, all). For UPPP patients (n=51), serum TC, HDL and LP(a) improved (P=0.01, 0.01,<0.01, respectively). For nasal patients (n=62), only the serum LP(a) decreased (P<0.01). In patients with normal serum lipids at baseline, only serum LP(a) decreased (P<0.01). In contrast, in patients with isolated hypertriglyceridemia, the serum HDL, TG and LP(a) showed significant improvements (P=0.02, 0.03, <0.01, respectively). In patients with isolated hypercholesterolemia, the serum LP(a) decreased significantly (P=0.01), with a similar trend for serum TC (P=0.06). In patients with mixed hyperlipidemia, the serum TC and LDL also decreased (P=0.02, 0.03, respectively). Surgery may improve blood lipid levels in patients with OSA, especially in patients with preoperative dyslipidemia, potentially yielding a major benefit in metabolism and cardiovascular sequelae. Prospective studies should examine this potential metabolic effect of airway surgery for OSA.