Surgery for obstructive sleep apnoea.
Surgery for obstructive sleep apnoea.
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DOI：
10.1002/14651858.cd001004
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发表时间：
1998-01
期刊：
影响因子：
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通讯作者：
S. Sundaram;S. Bridgman;J. Lim;T. Lasserson
中科院分区：
文献类型：
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作者：
S. Sundaram;S. Bridgman;J. Lim;T. Lasserson
阻塞性睡眠呼吸暂停/低通气综合征（OSAHS）是睡眠期间气流周期性减少或停止。该综合征与大声打鼾、睡眠中断和观察到的呼吸暂停有关。阻塞性睡眠呼吸暂停/低通气综合征的手术旨在缓解日间嗜睡症状，改善生活质量，并减少多导睡眠图记录的睡眠呼吸暂停体征。本综述的目的是评估任何类型的手术治疗成人阻塞性睡眠呼吸暂停/低通气综合征的症状的效果。检索策略我们检索了科克伦航空集团专业注册和参考文献列表。我们联系了该领域的专家、研究传播机构和其他科克伦审查小组。截至2005年7月，这些数据均为当前数据。选择标准：比较阻塞性睡眠呼吸暂停/低通气综合征的任何手术干预与其他手术或非手术干预或无干预的随机试验。数据收集和分析两名评审员评估了可能相关研究的电子文献检索结果。提取符合入选标准的研究的特征和数据，并输入RevMan 4.2。主要结果在2005年更新的这篇综述中，8项质量不一的研究（412名受试者）符合纳入标准。来自7项研究的数据有资格在审查中进行评估。无法合并数据。悬雍垂腭咽成形术（UPPP）与保守治疗（一项试验）：一项未经验证的症状评分显示，在12个月的随访期内存在间歇性显著差异。未报告多导睡眠图（PSG）结局的差异。激光辅助悬雍垂腭成形术（LAUP）与保守治疗/安慰剂（两项试验）：一项研究招募了混合人群，无法获得该试验的单独数据。在另一项研究中，未报告埃普沃思评分或生活质量的显著差异。据报道，在呼吸暂停低通气指数（AHI）和打鼾频率和强度方面，LAUP有显著差异。UPPP与口腔矫治器（OA）（一项试验）：OA治疗的AHI显著低于UPPP。生活质量无显著差异。UPPP与侧咽成形术（侧咽成形术）（1项试验）：埃普沃思评分无显著差异，但报告了侧咽成形术的AHI降低幅度更大。舌前移（下颌骨截骨术）+ PPP与舌悬吊+ PPP（一项试验）：两组的症状均显著减轻，但两种手术类型之间无显著差异。所有手术技术报告的并发症包括鼻返流、疼痛和出血。这些情况并没有长期持续下去。另一项研究评估了四种不同技术的效果。未获得组间比较的数据。多节段温控射频组织消融（TCRFTA）与假安慰剂和CPAP（1项试验）相比：与假安慰剂相比，TCRFTA的主要和次要结局均有所改善，但与CPAP相比，症状改善无差异。医师结论：目前有少量的试验评估不同的手术技术与非活性和活性对照治疗。综述中收集的研究没有提供证据支持在睡眠呼吸暂停/呼吸不足综合征中使用手术，因为尚未证明总体显著获益。被招募到研究中的参与者具有混合水平的AHI，但在测量时往往患有中度白天嗜睡。短期结果不太可能始终确定合适的手术候选人。需要对手术矫正上呼吸道阻塞的患者进行长期随访。这将有助于确定手术是否是一种治疗性干预，或者睡眠呼吸暂停的体征和症状是否有重新出现的趋势，促使患者寻求进一步的睡眠呼吸暂停治疗。
BACKGROUND Obstructive sleep apnoea/hypopnoea syndrome(OSAHS) is the periodic reduction or cessation of airflow during sleep. The syndrome is associated with loud snoring, disrupted sleep and observed apnoeas. Surgery for obstructive sleep apnoea/hypopnoea syndrome aims to alleviate symptoms of daytime sleepiness, improve quality of life, and reduce the signs of sleep apnoea recorded by polysomnography. OBJECTIVES The objective of this review was to assess the effects of any type of surgery for the treatment of the symptoms of obstructive sleep apnoea/hypopnoea syndrome in adults. SEARCH STRATEGY We searched the Cochrane Airways Group Specialised Register and reference lists of articles. We contacted experts in the field, research dissemination bodies and other Cochrane Review Groups. Searches were current as of July 2005. SELECTION CRITERIA Randomised trials comparing any surgical intervention for obstructive sleep apnoea/hypopnoea syndrome with other surgical or non-surgical interventions or no intervention. DATA COLLECTION AND ANALYSIS Two reviewers assessed electronic literature search results for possibly relevant studies. Characteristics and data from studies meeting the inclusion criteria were extracted and entered into RevMan 4.2. MAIN RESULTS In the 2005 update for this review eight studies (412 participants) of mixed quality met the inclusion criteria. Data from seven studies were eligible for assessment in the review. No data could be pooled. Uvulopalatopharyngoplasty (UPPP) versus conservative management (one trial): An un validated symptom score showed intermittent significant differences over a 12-month follow-up period. No differences in Polysomnography (PSG) outcomes were reported. Laser-assisted uvulopalatoplasty (LAUP) versus conservative management/placebo (two trials): One study recruited mixed a population, and separate data could not be obtained for this trial. In the other study no significant differences in Epworth scores or quality of life reported. A significant difference in favour of LAUP was reported in terms of apnoea hypopnoea index (AHI) and frequency and intensity of snoring. UPPP versus oral appliance (OA) (one trial): AHI was significantly lower with OA therapy than with UPPP. No significant differences were observed in quality of life. UPPP versus lateral pharyngoplasty (lateral PP) (one trial): No significant difference in Epworth scores, but a greater reduction in AHI with lateral PP was reported. Tongue advancement (mandibular osteotomy) + PPP versus tongue suspension + PPP (one trial): There was a significant reduction in symptoms in both groups, but no significant difference between the two surgery types. Complications reported with all surgical techniques included nasal regurgitation, pain and bleeding. These did not persist in the long term. An additional study assessed the effects of four different techniques. No data were available on between group comparisons. Multilevel temperature-controlled radiofrequency tissue ablation (TCRFTA) versus sham placebo and CPAP (one trial): There was an improvement in primary and secondary outcomes of TCRFTA over sham placebo and but no difference in symptomatic improvement when compared with CPAP. AUTHORS' CONCLUSIONS There are now a small number of trials assessing different surgical techniques with inactive and active control treatments. The studies assembled in the review do not provide evidence to support the use of surgery in sleep apnoea/hypopnoea syndrome, as overall significant benefit has not been demonstrated. The participants recruited to the studies had mixed levels of AHI, but tended to suffer from moderate daytime sleepiness where this was measured. Short-term outcomes are unlikely to consistently identify suitable candidates for surgery. Long-term follow-up of patients who undergo surgical correction of upper airway obstruction is required. This would help to determine whether surgery is a curative intervention, or whether there is a tendency for the signs and symptoms of sleep apnoea to re-assert themselves, prompting patients to seek further treatment for sleep apnoea.