Predicting Surgical Response Using Tensiometry in OSA Patients after Genioglossus Advancement with Uvulopalatopharyngoplasty
Predicting Surgical Response Using Tensiometry in OSA Patients after Genioglossus Advancement with Uvulopalatopharyngoplasty
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DOI：
10.1177/0194599815625210
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发表时间：
2016-03
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影响因子：
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通讯作者：
J. Barrera;G. Dion
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文献类型：
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作者：
J. Barrera;G. Dion
目的探讨颏舌肌张力在多节段阻塞性睡眠呼吸暂停（OSA）手术治疗睡眠呼吸障碍患者颏舌肌前移中的作用。研究设计前瞻性研究。设置学术实践。对象和方法23例患者接受颏舌肌前移和悬雍垂腭咽成形术治疗OSA。受试者接受术前和术后多导睡眠描记术、头影测量和主观评估问卷。18例受试者完成了研究。测量下颌骨的张力和颏结节的双皮质宽度，并确定手术反应。结果呼吸暂停低通气指数（AHI）改善15例（83.3%）。11名受试者被归类为应答者，7名被归类为无应答者（61.1%成功），与无应答者相比，应答者表现出平均Δ AHI的统计学显著降低：28.3 ± 26.2 vs 2.0 ± 22.0起事件/小时（95%置信区间，1.8-50.8; P = 0.037）。埃普沃思嗜睡量表从13.2 ± 4.5改善至7.6 ± 3.4（P = .002）。应答者和非应答者之间的体重指数、颈围、整体张力或下颌宽度没有显著差异。然而，有反应者（53.9 ± 6.38 g/mm）和无反应者（65.4 ± 11.2 g/mm; 95%置信区间，0.92-22.1; P = 0.036）之间的张力：宽度比存在显著差异。结论本文描述了一种新的方法来确定在推进过程中施加到颏舌肌上的力及其与术后结果的相关性。张力：宽度比可能是OSA患者术后成功和Δ AHI改善的指标。
Objective To evaluate the role of tension on the genioglossus muscle in the performance of genioglossus advancement on sleep-disordered breathing in patients undergoing multilevel obstructive sleep apnea (OSA) surgery. Study Design Prospective study. Setting Academic practice. Subjects and Methods Twenty-three subjects underwent genioglossus advancement with uvulopalatopharyngoplasty for OSA. Subjects underwent pre- and postoperative polysomnography, cephalometry, and subjective assessment questionnaires. Eighteen subjects completed the study. The tension force of the mandible and the bicortical width of the genial tubercle were measured and surgical response determined. Results Improvement in apnea-hypopnea index (AHI) was seen in 15 of 18 subjects (83.3%). Eleven subjects were classified as responders and 7 as nonresponders (61.1% success), with responders exhibiting a statistically significant reduction in mean delta AHI as compared with nonresponders: 28.3 ± 26.2 versus 2.0 ± 22.0 events per hour (95% confidence interval, 1.8-50.8; P = .037). The Epworth Sleepiness Scale improved from 13.2 ± 4.5 to 7.6 ± 3.4 (P = .002). There was no significant difference in body mass index, neck circumference, overall tension, or mandibular width between responders and nonresponders. However, there was a significant difference in the tension:width ratio between responders (53.9 ± 6.38 g/mm) and nonresponders (65.4 ± 11.2 g/mm; 95% confidence interval, 0.92-22.1; P = .036). Conclusion This article describes a novel approach to determine the force applied to the genioglossus during advancement and its correlation to postoperative outcomes. The tension:width ratio may be an indicator for postoperative success and delta AHI improvement in OSA patients.