Abstract：
OBJECTIVE: After oropharyngeal reconstruction surgery, excessive flap volume within the oral cavity may increase the risk of pharyngeal obstruction during sleep. This prospective observational study aimed to test a hypothesis that the skin-flap oropharyngeal reconstructive surgery increases nocturnal apnea-hypopnea index (nAHI, primary variable) after surgery.
METHODS: Adult patients undergoing oropharyngeal reconstruction surgery participated in this study. The hypothesis was tested by comparing the results of portable type 4 sleep study and craniofacial assessments with lateral head and neck computed tomography scout image before and after surgery. Multiple linear regression analyses were performed to identify predictors for nAHI increase after the surgery.
RESULTS: In 15 patients, a postoperative sleep study was performed at 41 (27, 59) (median (IQR)) days after the surgery. nAHI did not increase after the surgery (mean (95% CI), 13.0 (7.2 to 18.7) to 18.4 (10.2 to 26.6) events.hour-1, p = 0.277), while apnea index significantly increased after the surgery (p = 0.026). Use of the pedicle flap for the oropharyngeal reconstruction (p = 0.051), small mandible (p = 0.008), longer lower face (0.005), and larger tongue size (p = 0.008) were independent predictors for worsening of nAHI after surgery. Hospital stay was significantly longer in patients with the pedicle flap (n = 8) than in those with the free flap (n = 7) (p = 0.014), and the period of hospital stay was directly associated with increase of nAHI after surgery (r = 0.788, p < 0.001, n = 15).
CONCLUSIONS: Oropharyngeal reconstruction surgery worsens sleep-disordered breathing in some patients with craniofacial and surgical risk factors.
BACKGROUND: UMIN Clinical Trial Registry (UMIN000036260, March 22, 2019), https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000036260.
METHODS: Adult patients undergoing oropharyngeal reconstruction surgery participated in this study. The hypothesis was tested by comparing the results of portable type 4 sleep study and craniofacial assessments with lateral head and neck computed tomography scout image before and after surgery. Multiple linear regression analyses were performed to identify predictors for nAHI increase after the surgery.
RESULTS: In 15 patients, a postoperative sleep study was performed at 41 (27, 59) (median (IQR)) days after the surgery. nAHI did not increase after the surgery (mean (95% CI), 13.0 (7.2 to 18.7) to 18.4 (10.2 to 26.6) events.hour-1, p = 0.277), while apnea index significantly increased after the surgery (p = 0.026). Use of the pedicle flap for the oropharyngeal reconstruction (p = 0.051), small mandible (p = 0.008), longer lower face (0.005), and larger tongue size (p = 0.008) were independent predictors for worsening of nAHI after surgery. Hospital stay was significantly longer in patients with the pedicle flap (n = 8) than in those with the free flap (n = 7) (p = 0.014), and the period of hospital stay was directly associated with increase of nAHI after surgery (r = 0.788, p < 0.001, n = 15).
CONCLUSIONS: Oropharyngeal reconstruction surgery worsens sleep-disordered breathing in some patients with craniofacial and surgical risk factors.
BACKGROUND: UMIN Clinical Trial Registry (UMIN000036260, March 22, 2019), https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000036260.
摘要：
目的：口咽重建术后，口腔内皮瓣体积过大可能会增加睡眠期间咽部阻塞的风险。这项前瞻性观察性研究旨在检验以下假设：皮瓣口咽重建手术会增加夜间呼吸暂停低通气指数（nAHI，主要变量)手术后。
方法：接受口咽重建术的成年患者参与本研究。通过比较便携式4型睡眠研究和颅面评估的结果与手术前后的侧头和颈部计算机断层扫描侦察图像来检验该假设。进行多元线性回归分析以确定手术后nAHI升高的预测因子。
结果：在15名患者中，在手术后41(27,59)天(中位数(IQR))进行了术后睡眠研究.nAHI在手术后没有增加(平均(95%CI)，13.0（7.2至18.7）至18.4（10.2至26.6）事件。小时-1，p=0.277），手术后呼吸暂停指数显著增加(p=0.026)。使用带蒂皮瓣进行口咽重建（p=0.051），小下颌骨（p=0.008），较长的下表面（0.005），和较大的舌头大小（p=0.008）是手术后nAHI恶化的独立预测因素。带蒂皮瓣患者（n=8）的住院时间明显长于游离皮瓣患者（n=7）（p=0.014），住院时间与术后nAHI升高直接相关(r=0.788,p<0.001,n=15)。
结论：口咽重建术使部分患者的睡眠呼吸紊乱恶化，有颅面和手术危险因素。
背景：UMIN临床试验注册（UMIN000036260，2019年3月22日），https://rctportal。尼夫.走吧。jp/s/detail/um?trial_id=UMIN000036260。
方法：接受口咽重建术的成年患者参与本研究。通过比较便携式4型睡眠研究和颅面评估的结果与手术前后的侧头和颈部计算机断层扫描侦察图像来检验该假设。进行多元线性回归分析以确定手术后nAHI升高的预测因子。
结果：在15名患者中，在手术后41(27,59)天(中位数(IQR))进行了术后睡眠研究.nAHI在手术后没有增加(平均(95%CI)，13.0（7.2至18.7）至18.4（10.2至26.6）事件。小时-1，p=0.277），手术后呼吸暂停指数显著增加(p=0.026)。使用带蒂皮瓣进行口咽重建（p=0.051），小下颌骨（p=0.008），较长的下表面（0.005），和较大的舌头大小（p=0.008）是手术后nAHI恶化的独立预测因素。带蒂皮瓣患者（n=8）的住院时间明显长于游离皮瓣患者（n=7）（p=0.014），住院时间与术后nAHI升高直接相关(r=0.788,p<0.001,n=15)。
结论：口咽重建术使部分患者的睡眠呼吸紊乱恶化，有颅面和手术危险因素。
背景：UMIN临床试验注册（UMIN000036260，2019年3月22日），https://rctportal。尼夫.走吧。jp/s/detail/um?trial_id=UMIN000036260。
