Clinical Assessment And Cost-effectiveness Analysis Of Nasal Cavity Ventilation Expansion Techniques On Patients With Obstructive Sleep Apnea/hypopnea Syndrome

【Objectives】 1. To evaluate morphologic changes of nasal cavity and pharyngeal soft tissue measurement after nasal cavity ventilation expansion techniques on OSAHS by using three-dimensional CT scan. 2. To compare the changes of objective and subjective symptoms before and after nasal cavity ventilation expansion techniques to evaluate the clinical treatment effect of nasal cavity ventilation expansion techniques on OSAHS. 3. To explore whether nasal surgery for those intolerant of CPAP are cost-effective by using cost-effective analysis.【Methods】 1. A total of 36 adult patients with OSAHS were included in this study. Patients with chronic rhinosinusitis with/without polyps were excluded.Pre-operative upper airway CT(from the level of skull base to below the level of vocal cords) of each subject was acquired. Each subject underwent nasal cavity ventilation expansion techniques. Postoperative upper airway CT was obtained at least 6 months later. Three-dimensional CT scans were conducted with Osirix. Cross-section area and nasal cavity volume as well as surface area was calculated from anterior nasal spine to posterior nasal spine. The thickness of soft tissue in the pharynx region was also measured. 2. 36 adult patients mentioned above with OSAHS were clinical researched. Nasal cavity ventilation expansion techniques were performed. Each subject underwent upper airway CT and polysomnography. They all filled VAS of nasal obstruction, Snore Outcome Survey and Epworth Sleep Scores. Postoperative data were obtained at least 6 months later. 3. A Markov model of cardiovascular disease, stroke and motor vehicle collisions was conducted for a 50-year-old male with untreated OSAHS. Using this model, we compare the cost-effectiveness of CPAP and CPAP-nasal surgery.【Result】 1. All 36 patients showed significant increase of cross-section area and volume of nasal cavity post-operatively. SAVR also showed significant decrease postoperatively. the thickness of soft tissue in pharynx region revealed significant decrease post-operatively. 2. Compared with pre-operative examination, in all OSAHS patients, the postoperative VAS scores of nasal obstruction and the Epworth Sleep Scores showed significant decrease. The AHI and the lowest Sp O2 significantly decreased in mildmoderate OSAHSand did not change significantly in severe OSAHS patients. 36 patients with nasal cavity ventilation expansion techniques of postoperative efficient reached to 27.8%. 3. Compared with CPAP only strategy, CPAP followed by nasal surgery adds 0.3 QALYs at an increase of 9115 yuan.【Conclusion】 1. Three-dimensional CT scan assessment of upper airway can play an important role in evaluation of treatment outcome. 2. In OSAHS patients, nasal cavity ventilation expansion techniques can significantly improve subjective severity of sleepy and snoring. It improves the severity of apnea and hypopneas in some patients with OSAHS to some extent. Nasal cavity ventilation expansion techniques provide a new concept of therapy in treating OSAHS and should be performed individually. 3. Nasal surgery appears cost-effective in middle-aged men with OSAHS intolerant of CPAP. Further research is warranted to better define surgical candidacy as well as short-term and long-term surgical outcomes.