{"title":"阻塞性睡眠呼吸暂停患者上颌下颚前移后鼻部修饰对鼻窦功能的影响。","authors":"Nicolas S Poupore, Mohamed Abdelwahab","doi":"10.1007/s11325-025-03262-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To assess sinonasal function after preservation maxillomandibular advancement (MMA), as initial reports have shown it may decrease postoperatively.</p><p><strong>Methods: </strong>This prospective study was performed at a tertiary referral center starting January 2023. MMA was performed with previously published nasal modifications to help mitigate negative sinonasal outcomes. Sino-nasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation Survey (NOSE) were collected preoperatively, and one and three months postoperatively. Repeated measures ANOVAs with a Bonferroni adjustment were performed for total score, total sinonasal score (sum of questions 1-12), and each symptom. Both p-values and partial eta squared (n<sub>p</sub><sup>2</sup>) were reported.</p><p><strong>Results: </strong>Twenty patients were included. Median age was 50.7 years (range 31-65), with 20.0% being female. Preoperative AHI (65.1 ± 28.9) and SpO2 Nadir (78.0% [69.0-82.0]) improved to 12.1 ± 12.1 and 86.0 ± 3.2%. NOSE significantly decreased at one month (55.9 ± 28.4 vs. 8.11 ± 12.0, p < 0.001). Total score and total sinonasal scores significantly decreased postoperatively (49.0 ± 21.6 vs. 18.1 ± 17.4 vs. 12.5 ± 14.1, p < 0.001; 17.3 ± 12.5 vs. 9.2 ± 9.3 vs. 6.3 ± 7.3, p = 0.003) with MMA having large effects on both variables (n<sub>p</sub><sup>2</sup>=0.72 and 0.35, respectively). MMA had large significant effects on improvement in need to blow nose, nasal blockage, sneezing, runny nose, cough, post-nasal discharge, dizziness, and ear pain at one and three months postoperatively. Facial pain/pressure significantly worsened at one-month but then improved to baseline at three months postoperatively ((1.2 ± 1.4 vs. 1.9 ± 1.5 vs. 1.2 ± 1.4, p = 0.026).</p><p><strong>Conclusion: </strong>Patients who underwent preservation MMA did not show evidence of worsening sinonasal function, with some evidence that sinonasal function may improve after MMA at three months postoperatively. Long-term follow-up with more patients is needed to support these findings.</p>","PeriodicalId":21862,"journal":{"name":"Sleep and Breathing","volume":"29 1","pages":"92"},"PeriodicalIF":2.1000,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807084/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of nasal modifications on sinonasal function after maxillomandibular advancement for obstructive sleep apnea.\",\"authors\":\"Nicolas S Poupore, Mohamed Abdelwahab\",\"doi\":\"10.1007/s11325-025-03262-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To assess sinonasal function after preservation maxillomandibular advancement (MMA), as initial reports have shown it may decrease postoperatively.</p><p><strong>Methods: </strong>This prospective study was performed at a tertiary referral center starting January 2023. MMA was performed with previously published nasal modifications to help mitigate negative sinonasal outcomes. Sino-nasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation Survey (NOSE) were collected preoperatively, and one and three months postoperatively. Repeated measures ANOVAs with a Bonferroni adjustment were performed for total score, total sinonasal score (sum of questions 1-12), and each symptom. Both p-values and partial eta squared (n<sub>p</sub><sup>2</sup>) were reported.</p><p><strong>Results: </strong>Twenty patients were included. Median age was 50.7 years (range 31-65), with 20.0% being female. Preoperative AHI (65.1 ± 28.9) and SpO2 Nadir (78.0% [69.0-82.0]) improved to 12.1 ± 12.1 and 86.0 ± 3.2%. NOSE significantly decreased at one month (55.9 ± 28.4 vs. 8.11 ± 12.0, p < 0.001). Total score and total sinonasal scores significantly decreased postoperatively (49.0 ± 21.6 vs. 18.1 ± 17.4 vs. 12.5 ± 14.1, p < 0.001; 17.3 ± 12.5 vs. 9.2 ± 9.3 vs. 6.3 ± 7.3, p = 0.003) with MMA having large effects on both variables (n<sub>p</sub><sup>2</sup>=0.72 and 0.35, respectively). MMA had large significant effects on improvement in need to blow nose, nasal blockage, sneezing, runny nose, cough, post-nasal discharge, dizziness, and ear pain at one and three months postoperatively. Facial pain/pressure significantly worsened at one-month but then improved to baseline at three months postoperatively ((1.2 ± 1.4 vs. 1.9 ± 1.5 vs. 1.2 ± 1.4, p = 0.026).</p><p><strong>Conclusion: </strong>Patients who underwent preservation MMA did not show evidence of worsening sinonasal function, with some evidence that sinonasal function may improve after MMA at three months postoperatively. Long-term follow-up with more patients is needed to support these findings.</p>\",\"PeriodicalId\":21862,\"journal\":{\"name\":\"Sleep and Breathing\",\"volume\":\"29 1\",\"pages\":\"92\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-02-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807084/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Sleep and Breathing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11325-025-03262-x\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Sleep and Breathing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11325-025-03262-x","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：评估保留上颌下颌前移（MMA）后的鼻窦功能，因为最初的报告显示它可能会在术后下降。方法：这项前瞻性研究于2023年1月开始在三级转诊中心进行。MMA采用先前发表的鼻腔修饰，以帮助减轻负面的鼻窦预后。术前、术后1个月和3个月收集鼻结果测试（SNOT-22）和鼻塞症状评估调查（NOSE）。采用Bonferroni调整对总分、鼻腔总分（问题1-12的总和）和每个症状进行重复测量方差分析。报告了p值和偏eta平方（np2）。结果：纳入20例患者。中位年龄为50.7岁（31-65岁），女性占20.0%。术前AHI（65.1±28.9）和SpO2 Nadir（78.0%[69.0 ~ 82.0]）分别改善至12.1±12.1和86.0±3.2%。术后1个月鼻翼指数明显下降（55.9±28.4比8.11±12.0，p p2分别=0.72和0.35）。MMA对术后1个月和3个月的需要擤鼻、鼻塞、打喷嚏、流鼻涕、咳嗽、鼻后溢液、头晕和耳痛的改善有显著的效果。面部疼痛/压力在术后1个月明显恶化，但在术后3个月改善至基线(（1.2±1.4 vs. 1.9±1.5 vs. 1.2±1.4,p = 0.026）。结论：术后3个月行保护性MMA的患者未出现鼻窦功能恶化的迹象，有证据表明MMA术后鼻窦功能可能有所改善。需要对更多患者进行长期随访来支持这些发现。
Impact of nasal modifications on sinonasal function after maxillomandibular advancement for obstructive sleep apnea.
Purpose: To assess sinonasal function after preservation maxillomandibular advancement (MMA), as initial reports have shown it may decrease postoperatively.
Methods: This prospective study was performed at a tertiary referral center starting January 2023. MMA was performed with previously published nasal modifications to help mitigate negative sinonasal outcomes. Sino-nasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation Survey (NOSE) were collected preoperatively, and one and three months postoperatively. Repeated measures ANOVAs with a Bonferroni adjustment were performed for total score, total sinonasal score (sum of questions 1-12), and each symptom. Both p-values and partial eta squared (np2) were reported.
Results: Twenty patients were included. Median age was 50.7 years (range 31-65), with 20.0% being female. Preoperative AHI (65.1 ± 28.9) and SpO2 Nadir (78.0% [69.0-82.0]) improved to 12.1 ± 12.1 and 86.0 ± 3.2%. NOSE significantly decreased at one month (55.9 ± 28.4 vs. 8.11 ± 12.0, p < 0.001). Total score and total sinonasal scores significantly decreased postoperatively (49.0 ± 21.6 vs. 18.1 ± 17.4 vs. 12.5 ± 14.1, p < 0.001; 17.3 ± 12.5 vs. 9.2 ± 9.3 vs. 6.3 ± 7.3, p = 0.003) with MMA having large effects on both variables (np2=0.72 and 0.35, respectively). MMA had large significant effects on improvement in need to blow nose, nasal blockage, sneezing, runny nose, cough, post-nasal discharge, dizziness, and ear pain at one and three months postoperatively. Facial pain/pressure significantly worsened at one-month but then improved to baseline at three months postoperatively ((1.2 ± 1.4 vs. 1.9 ± 1.5 vs. 1.2 ± 1.4, p = 0.026).
Conclusion: Patients who underwent preservation MMA did not show evidence of worsening sinonasal function, with some evidence that sinonasal function may improve after MMA at three months postoperatively. Long-term follow-up with more patients is needed to support these findings.
期刊介绍：
The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep.
Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.
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