Objective: To evaluate the clinical efficacy of weight management combined with pharyngoplasty for treatment of obesity-related obstructive sleep apnea-hypopnea syndrome (OSAHS).
Methods: Sixty obese patients with OSAHS were randomly assigned into the combined treatment group and control group (n=30) and received treatment with uvulopalatopharyngoplasty (UPPP) combined with cognitive-behavioral-psychological intervention for family weight management and uvulopalatopharyngoplasty with conventional management. At 3 and 6 months of the treatment, the patients were examined for changes in body mass index (BMI), neck circumference, waist circumference, Epworth Sleepiness Scale (ESS) scores, apnea-hypopnea index (AHI), the lowest oxygen saturation (LSaO2) and the percentage of time with oxygen saturation below 90% (CT90).
Results: After 6 months of treatment, the patients receiving the combined treatment showed significant reductions of BMI, neck circumference and waist circumference as compared with the measurements before treatment and with those in the control group (P < 0.01); these parameters showed no significant changes in the control group (P > 0.05). In the combined treatment group, the ESS score, CT90, AHI, and LSaO2 at 6 months were all superior to those in the control group (P < 0.01) and differed significantly cross different time points during the treatment, and their improvements were the most obvious after 6 months (P < 0.01). After 6 months of treatment, the combined treatment group had a similar cure rate with the control group (6.6% vs 7.1%; χ2=1.66, P > 0.05) but a significantly higher good response (defined as an AHI < 20 h-1 and an AHI reduction by ≥50%) rate (60% vs 35.7%; χ2=8.71, P < 0.01) and a higher overall response (a AHI reduction ≥50%) rate (83.3% vs 53.6%; χ2=10.62, P < 0.01).
Conclusions: Weight management combined with uvulopalatopharyngoplasty can produce a good clinical efficacy for treatment of OSAHS with obesity, and the patients should have strengthened continuous family weight management while receiving surgical treatment.
目的: 探讨体质量管理联合腭咽成形术治疗肥胖相关性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的策略及其临床效果。
方法: 将60例OSAHS伴肥胖患者随机分入联合治疗组和对照组，每组30例; 联合治疗组予以悬雍垂腭咽成形术(UPPP)治疗联合认知-行为-心理干预模式的家庭延续体质量管理，主要包含：术前健康知识宣教、心理辅导、术后延续家庭的运动与饮食调整相结合的体质量管理等措施; 对照组予以悬雍垂腭咽成形术及传统管理模式治疗。于治疗3月、6月后观察比较2组患者治疗前后体质量指数(BMI)、颈围、腰围、日间Epworth嗜睡量表(ESS)评分，呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、血氧饱和度低于90%的累积时间占总监测时间的百分比(CT90)的变化情况; 分析两组患者治疗后显效率、有效率及治愈率，判断两种方案的临床疗效。
结果: 随访治疗6月后，联合治疗组BMI、颈围、腰围与对照组比较，差异均有统计学意义(P < 0.01)，联合治疗组体质量变化显著; 对照组在治疗3月时与治疗前有统计学差异(P < 0.05)，而在治疗后6月与治疗前比较差异无统计学意义(P > 0.05);联合治疗组中，患者BMI、颈围、腰围在治疗6月后与治疗前比较均差异有统计学意义(P < 0.01)。睡眠相关指标ESS，CT90，AHI，LSaO2在治疗后6月后，联合治疗组患者优于对照组，差异有统计学意义(P < 0.01)。联合治疗组中，患者ESS，CT90，AHI，LSaO2在不同时间比较差异均有统计学意义(P < 0.01)，治疗6月后效果更显著; 对照组中AHI、ESS评分在治疗3、6月后与治疗前比较差异有统计学意义(P < 0.01)，CT90，LSaO2治疗3、6月后与治疗前比较有统计学差异(P < 0.05)，治疗后3月与6月比较差异无统计学意义(P > 0.05)。6月后联合治疗组与对照组中治愈率分别为6.6%、7.1%(χ2=1.66，P > 0.05)，显效率分别为：60%、35.7%(χ2=8.71，P < 0.01)，有效率分别为：83.3%、53.6%(χ2=10.62，P < 0.01)，显效率、有效率组间比较差异有统计学意义(P < 0.05)。
结论: 体质量管理联合腭咽成形术治疗能有效改善肥胖相关性阻塞性睡眠呼吸暂停低通气综合征患者临床治疗效果，患者在接受手术治疗的同时应该强化家庭延续的体质量管理。
Keywords: cognitive-behavior-psychological interv-entions; obesity; obstructive sleep apnea-hypopnea syn-drome; uvulopalatopharyngoplasty; weight management.