扁桃体切除术和悬雍垂腭咽成形术（UPPP）后主观日间嗜睡的长期变化：一项前瞻性队列研究

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中文摘要

背景： 腭扁桃体疾病可能与不同程度的主观日间嗜睡（SDS）相关，该症状可能影响日常功能。本研究评估了患者在接受扁桃体切除术或悬雍垂腭咽成形术（UPPP）前后SDS的长期变化。
目的： 本研究的主要目的是评估扁桃体切除术或UPPP后SDS的长期变化。次要目标包括评估患者满意度，以及人口学和临床因素（包括性别、年龄、慢性疾病、扁桃体大小和组织病理学发现）对治疗结果的影响。
方法： 一项前瞻性队列研究纳入105例成年患者，随访率为85%：89例患者（26例女性，63例男性）。在手术前和平均6年随访后使用Epworth嗜睡量表评估SDS。额外分析考虑了人口学和临床变量。患者满意度使用视觉模拟量表以及是否愿意再次接受手术来衡量。
结果： 扁桃体切除术和UPPP均与SDS的显著长期降低相关。平均ESS评分从术前7.29降至随访时的4.37（P < .05）。71.9%的患者达到ESS评分≥2分的临床有意义改善，ESS评分正常（≤10）的患者比例从75.3%增至92.1%（P < .001）。虽然未调整的ESS降低幅度在UPPP后大于扁桃体切除术后（4.22分 vs 1.81分），但多变量分析显示手术方式与基线ESS之间存在显著交互作用，表明改善幅度因基线主观嗜睡程度而在两种手术之间有所不同。性别、扁桃体大小、组织病理学发现和慢性疾病未显著影响结果。
结论： 扁桃体切除术和UPPP与SDS的持续长期降低相关。术后改善幅度随基线主观嗜睡程度增加而增大，两种手术之间的相对差异在基线ESS值较高时变得更大。这些发现提示，上气道手术可能与患者报告的日间嗜睡的持久改善相关，包括基线ESS评分处于非EDS范围的患者。

英文摘要

Diseases of the palatine tonsils may be associated with varying degrees of subjective daytime sleepiness (SDS), a symptom that may affect daily functioning. This study evaluated long-term changes in SDS in patients before and after tonsillectomy or uvulopalatopharyngoplasty (UPPP). The primary aim of this study was to evaluate long-term changes in SDS following tonsillectomy or UPPP. Secondary objectives included the assessment of patient satisfaction and the influence of demographic and clinical factors, including sex, age, chronic diseases, tonsil size, and histopathological findings, on treatment outcomes. A prospective cohort study included 105 adult patients, with an 85% follow-up rate: 89 patients (26 women, 63 men). SDS was assessed using the Epworth Sleepiness Scale before surgery and after a mean follow-up of 6 years. Additional analyses considered demographic and clinical variables. Patient satisfaction was measured using a visual analog scale and willingness to undergo repeat surgery. Both tonsillectomy and UPPP were associated with a significant long-term reduction in SDS. The mean ESS score decreased from 7.29 preoperatively to 4.37 at follow-up (P < .05). A clinically meaningful improvement in ESS of ≥2 points was achieved in 71.9% of patients, and the proportion of patients with normal ESS scores (≤10) increased from 75.3% to 92.1% (P < .001). While the unadjusted ESS reduction was greater after UPPP than after tonsillectomy (4.22 vs 1.81 points), multivariable analysis demonstrated a significant interaction between surgical procedure and baseline ESS, indicating that the magnitude of improvement differed between procedures according to baseline subjective sleepiness. Sex, tonsil size, histopathological findings, and chronic diseases did not significantly influence the outcomes. Tonsillectomy and UPPP were associated with a sustained, long-term reduction in SDS. The magnitude of postoperative improvement increased with baseline subjective sleepiness, with the relative difference between procedures becoming greater at higher baseline ESS values. These findings suggest that upper airway surgery may be associated with durable improvements in patient-reported daytime sleepiness, including among patients with baseline ESS scores within the non-EDS range.