The Efficacy of Multilevel Surgery of the Upper Airway in Adults With Obstructive Sleep Apnea/Hypopnea Syndrome
The Efficacy of Multilevel Surgery of the Upper Airway in Adults With Obstructive Sleep Apnea/Hypopnea Syndrome
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DOI：
10.1097/mlg.0b013e31816422ea
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发表时间：
2008-05-01
期刊：
影响因子：
2.6
通讯作者：
Gurpinar, Berk
中科院分区：
文献类型：
--
作者：
Lin, Hsin-Ching;Friedman, Michael;Gurpinar, Berk
目的：阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者存在持续气道正压通气困难。因此，这些患者转向手术选择作为挽救治疗。早期的研究和综述主要集中在悬雍垂腭咽成形术（一种治疗OSAHS的单节段手术）的疗效上。由于阻塞性睡眠呼吸暂停低通气综合征通常是由多节段阻塞引起的，因此真正关注疗效的应该是多节段手术干预。本文的目的是提供一个多节段手术治疗OSAHS患者的文献综述。研究设计：对多节段上气道手术治疗OSAHS患者的主观和客观结果进行系统回顾和荟萃分析。方法：我们检索了截至2007年3月31日的PubMed、科克伦数据库和MEDLINE书目数据库，用于研究多节段手术改良上气道以治疗OSAHS。从参考文献列表中确定了其他研究。文章被列入只有当手术干预涉及至少两个经常涉及的解剖部位：鼻，口咽，下咽部。结果：应用特定的纳入标准后，49多层次手术的文章（58组）被确定。共有1，978名患者参与了这项研究。平均最短随访时间为7.3个月（范围：1至100个月）。进行了荟萃分析，以重新定义成功率，使其与普遍认可的标准一致，即“呼吸暂停/呼吸不足指数（AHI）降低50%或更多，且AHI小于20。“成功”意味着病情的改善，并不意味着治愈。重新计算的成功率为66.4%。总并发症发生率为14.6%。这49项研究的循证医学（EBM）水平显示，只有一项研究是EBM 1级，两篇论文是EBM 3级，其他46篇论文被列为4级evidence.Conclusions：多节段手术治疗OSAHS明显与改善的结果，虽然这种好处在很大程度上是由4级证据支持。未来的研究应侧重于前瞻性和对照研究。
Objective: Many patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) are incapable of using continuous positive airway pressure. These patients therefore turn to surgical options as a salvage treatment. Early studies and reviews focused on the efficacy of uvulopalatopharyngoplasty, a single-level procedure for the treatment of OSAHS. Since OSAHS is usually caused by multilevel obstructions, the true focus on efficacy should be on multilevel surgical intervention. The purpose of this paper is to provide an overview of the literature on multilevel surgery for OSAHS patients.Study Design: Systematic review of the literature and meta-analysis focusing on subjective and objective outcomes of patients with OSAHS treated with multilevel surgery of the upper airway.Methods: We searched PubMed, the Cochrane database, and MEDLINE bibliographic databases up to March 31, 2007, for studies dealing with multilevel surgical modification of the upper airway for the treatment of OSAHS. Additional studies were identified from their reference lists. Articles were included only if the surgical intervention involved at least two of the frequently involved anatomic sites: nose, oropharynx, and hypopharynx.Results: After applying specific inclusion criteria, 49 multilevel surgery articles (58 groups) were identified. There were 1,978 patients included in the study. The mean minimal follow-up time was 7.3 months (range, 1 to 100 months). A meta-analysis was performed to redefine the success rate to be consistent with the commonly agreed upon criteria, namely "a reduction in the apnea/hypopnea index (AHI) of 50% or more and an AHI of less than 20." "Success" implies an improved condition and is not meant to imply cure. The recalculated success rate was 66.4%. The overall complication rate was 14.6%. The evidence-base medicine (EBM) level of these 49 studies revealed that only one study was EBM level 1, two papers were EBM level 3, and the other 46 papers were ranked as level 4 evidence.Conclusions: Multilevel surgery for OSAHS is obviously associated with improved outcomes, although this benefit is supported largely by level 4 evidence. Future research should focus on prospective and controlled studies.