Study On The Effect Of Surgical Intervention On OSA Patients With Metabolic Syndrome And Changes Of Pulmonary Function

Objective:1.To investigate the relationship between the severity of sleep-disordered breathing and metabolic parameters and pulmonary ventilation dysfunction in patients with obstructive sleep apnea（OSA）with metabolic syndrome（MS）;2.To investigate the relationship between the therapeutic effect of surgical intervention on OSA patients with MS and metabolic parameters and pulmonary function changes.Methods:According to the inclusion and exclusion criteria,there were 77 OSA patients who underwent surgery in our hospital.According to the diagnostic criteria of MS,we selected 58 OSA patients（75.32%）with MS as the study subjects.Among them,34 patients underwent uvulopalatopharyngoplasty（UPPP）or UPPP+Plasma radiofrequency tongue base Punch ablation（CCT）in the Department of Otorhinolaryngology（Pharyngeal surgery group）;the other 24 obese patients underwent laparoscopic sleeve gastrectomy（LSG）（minus recombination）in the Department of Bariatric Surgery of our hospital.The study subjects were divided into mild,moderate and severe groups according to the diagnostic criteria of OSA,with 8 cases,14 cases and36 cases,respectively.The general conditions:age,gender,height H,weight W,body mass index（BMI）,neck circumference;sleep parameters apnea-hypopnea index（AHI）,Lowest oxygen saturation（LSaO₂）;metabolic parameters:waist circumference,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL-C）,fasting blood glucose;Pulmonary function parameters:forced expiratory volume in 1 second（FEV1）,forced expiratory volume in 1 second ratio（FEV1/FVC）and sleep apnea quality of life index（SAQLI）of all patients and 6 months after operation were recorded.The general conditions,sleep parameters,metabolic parameters and pulmonary function parameters of patients in mild,moderate and severe groups were compared;the correlation analysis was performed between preoperative sleep parameters and metabolic parameters and pulmonary function of all patients;the changes of sleep parameters,metabolic parameters and pulmonary function parameters at 6 months after operation were compared between the patients in the reduction groupand the patients in the pharyngeal surgery grouprespectively.Results:1.Comparison of mild,moderate,and severe OSA.General conditions:There was no significant difference in age and gender among the three groups（P>0.05）,BMI was higher in the moderate and severe groups than in the mild group,and BMI was higher in the severe group than in the severe group（P<0.05）.Sleep parameters:AHI and LSaO₂were statistically significant among the three groups（P<0.05）,AHI was higher in the moderate and severe groups than in the mild group,and AHI was higher in the severe group than in the moderate group;LSaO₂was lower in the moderate and severe groups than in the mild group,and LSaO₂ was lower in the severe group than in the moderate group.MS related parameters:waist circumference,SBP,DBP,TG,and HDL-C were higher in the severe group than in the mild group,DBP and HDL-C were higher in the moderate group than in the mild group,and waist circumference and SBP were higher in the severe group than in the moderate group,with statistical significance（P<0.05）;fasting blood glucose was not statistically significant among the three groups（P>0.05）.Pulmonary function parameters:FEV1 and FEV1/FVC were lower in the severe group than in the mild group,FEV1/FVC was lower in the severe group than in the moderate group,and FEV1 was lower in the moderate group than in the mild group,and the difference was statistically significant（P<0.05）.2.The sleep parameter AHI of OSA patients with MS was positively correlated with MS related parameters（waist circumference,SBP,DBP,TG）（r=0.484,P=0.000;r=0.469,P=0.004;r=0.356,P=0.006;r=0.343,P=0.008）,and negatively correlated with pulmonary function parameters（FEV1,FEV1/FVC）and MS related parameters HDL-C（r=-0.268,P=0.042;r=-0.657,P=0.000;r=-0.400,P=0.002）;the sleep parameter LSa O2 was positively correlated with MS related parameters HDL-C and pulmonary function parameters（FEV1,FEV1/FVC）（r=0.349,P=0.007;r=0.304,P=0.020;r=0.329,P=0.012）,and negatively correlated with MS related parameters（waist circumference,SBP,TG）（r=-0.504,P=0.000;r=-0.518,P=0.000;r=-0.332,P=0.011）（P<0.05）.3.In the pharyngeal surgery group,There are 26 patients complete follow-up data at 6 months after operation.The diagnosis and treatment of OSA were cured in 4 cases,markedly effective in 17 cases,and effective in 5cases.Compared with those before operation,AHI and TG were significantly decreased,and LSaO₂,pulmonary function parameters（FEV1,FEV1/FVC）,HDL-C,and SAQLI scores were significantly increased,and the differences were statistically significant（P<0.05）.In the bariatric surgery group,18patients were followed up completely at 6 months after operation,of which OSA was cured in 4 cases,markedly effective in 9 cases,and effective in 5cases;compared with that before operation,the sleep parameters AHI,BMI and MS related indicators（waist circumference,SBP,TG,fasting blood glucose）were significantly decreased;the pulmonary function parameters（FEV1,FEV1/FVC）,HDL-C,LSaO₂,SAQLI scores were significantly increased,and the differences had statistical significance（P<0.05）.Conclusions:1.With the aggravation of OSA,the degree of sleep-disordered breathing in OSA patients with MS increases,metabolic parameters show abnormal changes,and pulmonary function injury is aggravated;the degree of sleep-disordered breathing has a correlation with various metabolic parameters and pulmonary function parameters,respectively.These results indicate a close relationship between OSA and MS and lung function impairment.2.Bariatric surgery and pharyngeal surgery have a better therapeutic effect on the degree of sleep-disordered breathing in OSA patients with MS,and the metabolic parameters,Pulmonary function and quality of life before surgery are improved,indicating that surgical intervention effectively improves the condition of OSA patients with MS,thereby improving the pulmonary function and metabolic parameters of patients and improving the quality of life of patients.