Effects of multilevel OSA surgery on patients with poor cardiopulmonary performance: A prospective pilot study

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY Auris Nasus Larynx Pub Date : 2024-10-28 DOI:10.1016/j.anl.2024.10.005

Chung-Wei Lin , Pei-Wen Lin , Li-Wen Chiu , Mao-Chang Su , Han-Tan Chai , Chun-Tuan Chang , Michael Friedman , Anna M. Salapatas , Hsin-Ching Lin

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Abstract

Objective

Multilevel airway surgery for obstructive sleep apnea/hypopnea syndrome (OSA) has benefits in improving sleep quality, but its effect on polysomnography (PSG) and 6-minute walk test (6MWT) parameters, including walking distance and cardiopulmonary performance, in patients with poor pre-operative cardiopulmonary performance remains understudied, which should be further investigated.

Methods

This prospective pilot study enrolled 27 consecutive OSA patients with poor pre-operative 6MWT results. All patients received multilevel OSA surgery, and the alterations of sleep parameters and 6MWT profiles were studied. The pre- and post-operative values of polysomnographic data and 6MWT profiles were analyzed using the Wilcoxon signed-rank tests. The relationships among changes of the indices of PSG and 6MWT were further investigated with the Spearman's correlations.

Results

After surgery, the sleep parameters and certain cardiopulmonary indices improved. When analyzing the correlations among changes of the indices of PSG and 6MWT, the improvement of daytime sleepiness (with ESS) was found related to farther walking distance (ρ=-0.414, p = 0.032) and higher percentage of “distance/target distance” (ρ=-0.435, p = 0.023). Moreover, the change of maximal expiratory pressure was the only index associated with the changes of AHI (apnea/hypopnea index, /hr.; ρ=-0.407, p = 0.035) and AHI in REM (ρ=-0.502, p = 0.009) among the cardiopulmonary performance parameters.

Conclusion

This pilot study showed that OSA patients with poor pre-operative cardiopulmonary status undergoing multilevel sleep surgery could experience improvement in the sleep study and 6MWT to some extent. The relatively better walking distance and cardiopulmonary performance after the operation might potentially result from the improvement of daytime sleepiness and better respiration.

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多层次 OSA 手术对心肺功能不佳患者的影响：前瞻性试验研究。

目的：多水平气道手术治疗阻塞性睡眠呼吸暂停/低通气综合征（OSA）可改善睡眠质量，但对于术前心肺功能较差的患者，其对多导睡眠图（PSG）和6分钟步行测试（6MWT）参数（包括步行距离和心肺功能）的影响仍未得到充分研究，有待进一步探讨：这项前瞻性试验研究连续纳入了27名术前6MWT结果不佳的OSA患者。所有患者均接受了多层次 OSA 手术，并对睡眠参数和 6MWT 资料的改变进行了研究。采用 Wilcoxon 符号秩检验分析了多导睡眠图数据和 6MWT 资料的术前术后值。用 Spearman 相关性进一步研究了 PSG 和 6MWT 各项指标之间的变化关系：结果：手术后，患者的睡眠参数和某些心肺功能指标有所改善。在分析 PSG 和 6MWT 各项指标变化之间的相关性时，发现白天嗜睡（ESS）的改善与步行距离的延长（ρ=-0.414，p = 0.032）和 "距离/目标距离 "百分比的提高（ρ=-0.435，p = 0.023）有关。此外，最大呼气压力的变化是心肺功能参数中唯一与 AHI（呼吸暂停/低通气指数，/小时；ρ=-0.407，p = 0.035）和快速动眼期 AHI（ρ=-0.502，p = 0.009）变化相关的指数：本试验研究表明，术前心肺功能较差的OSA患者接受多层次睡眠手术后，睡眠检查和6MWT在一定程度上会有所改善。术后步行距离和心肺功能的相对改善可能源于白天嗜睡的改善和呼吸的改善。

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来源期刊

Auris Nasus Larynx 医学-耳鼻喉科学

CiteScore

3.40

自引率

5.90%

发文量

169

审稿时长

30 days

期刊介绍： The international journal Auris Nasus Larynx provides the opportunity for rapid, carefully reviewed publications concerning the fundamental and clinical aspects of otorhinolaryngology and related fields. This includes otology, neurotology, bronchoesophagology, laryngology, rhinology, allergology, head and neck medicine and oncologic surgery, maxillofacial and plastic surgery, audiology, speech science. Original papers, short communications and original case reports can be submitted. Reviews on recent developments are invited regularly and Letters to the Editor commenting on papers or any aspect of Auris Nasus Larynx are welcomed. Founded in 1973 and previously published by the Society for Promotion of International Otorhinolaryngology, the journal is now the official English-language journal of the Oto-Rhino-Laryngological Society of Japan, Inc. The aim of its new international Editorial Board is to make Auris Nasus Larynx an international forum for high quality research and clinical sciences.