阻塞性睡眠呼吸暂停患者侧咽成形术后低氧负荷降低：超越呼吸暂停低通气指数

文献信息

中文摘要

目的： 传统上用于评估阻塞性睡眠呼吸暂停（OSA）严重程度和手术结局的呼吸暂停低通气指数（AHI）在反映心血管风险和病理生理负担方面存在局限性。尽管侧咽成形术在降低AHI方面已显示出良好结局，但其对低氧负荷（HB）的影响仍不清楚。本研究评估了OSA患者侧咽成形术后HB的变化，包括根据Sher标准被归类为手术失败的患者。
方法： 这项采用回顾性与前瞻性混合设计的观察性纵向研究纳入了27名在2016年至2025年间接受侧咽成形术（第6版）的成人OSA患者，这些患者具有完整的用于HB评估的术前和术后多导睡眠监测数据。HB使用经过验证的商业软件计算。组内和组间比较采用非参数检验。手术成功根据Sher标准定义。
结果： 在所有变体中均观察到HB显著降低：总睡眠时间（中位数从97.1%·min/h降至35.0%·min/h，p < 0.0001）、REM睡眠、NREM睡眠以及仰卧位和非仰卧位，同时中位AHI显著降低（中位数从33.8降至12.3次/小时，p < 0.0001）。即使在根据Sher标准判定为手术失败的患者中，HB也显著降低（中位数从102.5%·min/h降至67.3%·min/h，p = 0.0107），提示仅凭AHI无法捕捉的病理生理改善。
结论： HB可能是评估OSA治疗反应更敏感的指标，其纳入了AHI之外的夜间低氧血症的多个维度。侧咽成形术促进了HB的一致降低，包括在手术失败者中，支持HB作为治疗评估的补充工具，并可能在心血管风险分层中具有应用价值。

英文摘要

PURPOSE: The apnea-hypopnea index (AHI), traditionally used to assess obstructive sleep apnea (OSA) severity and surgical outcomes, has limitations in reflecting cardiovascular risk and pathophysiological burden. Although lateral pharyngoplasty has demonstrated favorable outcomes regarding AHI reduction, its impact on hypoxic burden (HB) remains unknown. This study evaluated HB changes after lateral pharyngoplasty in patients with OSA, including those classified as surgical failures according to Sher's criteria.
METHODS: This observational, longitudinal study with a mixed retrospective and prospective design included 27 adults with OSA who underwent lateral pharyngoplasty (version 6) between 2016 and 2025, with complete preoperative and postoperative polysomnographic data for HB assessment. HB was calculated using validated commercial software. Nonparametric tests were used for intra- and intergroup comparisons. Surgical success was defined according to Sher's criteria.
RESULTS: A significant reduction in HB was observed across all variants: total sleep time (median from 97.1%·min/h to 35.0%·min/h, p < 0.0001), REM sleep, NREM sleep, and supine and non-supine positions, with a significant reduction in median AHI (median from 33.8 to 12.3 events/h, p < 0.0001). Even among surgical failures according to Sher's criteria, HB decreased significantly (median from 102.5%·min/h to 67.3%·min/h, p = 0.0107), suggesting pathophysiological improvement not captured by AHI alone.
CONCLUSION: HB is a potentially more sensitive metric to assess therapeutic response in OSA, incorporating multiple dimensions of nocturnal hypoxemia beyond AHI. Lateral pharyngoplasty promoted consistent HB reduction, including in surgical failures, supporting HB as a complementary tool for therapeutic evaluation, with potential applications in cardiovascular risk stratification.