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首页> 外文期刊>Journal of Oral and Maxillofacial Surgery >Comparative effectiveness of maxillomandibular advancement and uvulopalatopharyngoplasty for the treatment of moderate to severe obstructive sleep apnea
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Comparative effectiveness of maxillomandibular advancement and uvulopalatopharyngoplasty for the treatment of moderate to severe obstructive sleep apnea

机译：上颌下颌前突和上睑下颌窦成形术治疗中度至重度阻塞性睡眠呼吸暂停的比较效果

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Purpose: To directly compare the clinical effectiveness of maxillomandibular advancement (MMA) and uvulopalatopharyngoplasty (UPPP) - performed alone and in combination - for the treatment of moderate to severe obstructive sleep apnea (OSA). Patients and Methods: The investigators designed and implemented a retrospective cohort study composed of patients with moderate to severe OSA (baseline AHI >15). The predictor variable was operative treatment and included MMA, UPPP, and UPPP followed by MMA (UPPP/MMA). The primary outcome variable was the apnea-hypopnea index (AHI) measured preoperatively and 3 months to 6 months postoperatively. Other variables were grouped into the following categories: demographic, respiratory, and sleep parameters. Descriptive and bivariate statistics were computed. Results: The sample was composed of 106 patients grouped as follows: MMA (n = 37), UPPP (n = 34), and UPPP/MMA (n = 35) for treatment of OSA. There were no significant differences between the 3 groups for the study variables at baseline, except for AHI. Surgical treatment resulted in a significant decrease in AHI in each group: MMA (baseline AHI, 56.3 ± 22.6 vs AHI after MMA, 11.4 ± 9.8; P < .0001), UPPP/MMA (baseline AHI, 55.7 ± 49.2 vs AHI after UPPP/MMA, 11.6 ± 10.7; P < .0001), and UPPP (baseline AHI, 41.8 ± 28.0 vs AHI after UPPP, 30.1 ± 27.5; P =.0057). After adjusting for differences in baseline AHI, the estimated mean change in AHI was significantly larger for MMA compared with UPPP (MMA AHI, -40.5 vs UPPP AHI, -19.4; P = <.0001). UPPP/MMA was no more effective than MMA (P =.684). Conclusion: The results of this study suggest that MMA should be the surgical treatment option of choice for most patients with moderate to severe OSA who are unable to adequately adhere to CPAP.
机译：目的：直接比较单独或联合进行的颌下颌前移（MMA）和上睑下颌窦成形术（UPPP）在治疗中度至重度阻塞性睡眠呼吸暂停（OSA）中的临床效果。患者和方法：研究者设计并实施了一项回顾性队列研究，该研究由中度至重度OSA（基线AHI> 15）的患者组成。预测变量是手术治疗，包括MMA，UPPP和UPPP，其次是MMA（UPPP / MMA）。主要结果变量是术前和术后3个月至6个月测得的呼吸暂停低通气指数（AHI）。其他变量分为以下几类：人口统计，呼吸和睡眠参数。计算描述性和双变量统计量。结果：该样本由106位患者组成，分为以下几类：MMA（n = 37），UPPP（n = 34）和UPPP / MMA（n = 35），用于治疗OSA。在基线时，除AHI外，三组之间的研究变量无显着差异。手术治疗使每组的AHI显着降低：MMA（基线AHI，56.3±22.6 vs MMA后AHI，11.4±9.8; P <.0001），UPPP / MMA（基线AHI，55.7±49.2 vs UPPP后的AHI /MMA，11.6±10.7; P <.0001）和UPPP（基线AHI，41.8±28.0，而UPPP后为AHI，30.1±27.5; P = .0057）。调整基线AHI的差异后，与UPPP相比，MMA的估计AHI平均变化显着更大（MMA AHI，-40.5 vs UPPP AHI，-19.4; P = <.0001）。 UPPP / MMA没有比MMA更有效（P = .684）。结论：这项研究的结果表明，对于大多数不能充分遵守CPAP的中度至重度OSA患者，MMA应该是手术治疗的选择。

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