鼻腔扩容术联合下颌前移口腔矫治器序贯治疗多平面阻塞的重度阻塞性睡眠呼吸暂停低通气综合征的临床疗效分析OA

OBJECTIVE To evaluate the clinical efficacy of sequential nasal expansion surgery followed by mandibular advancement device(MAD)therapy in patients with severe obstructive sleep apnea hypopnea syndrome(OSAHS)and concurrent nasopharyngeal and oropharyngeal obstruction.METHODS Patients with severe OSAHS who visited Beijing Jishuitan Hospital,Capital Medical University,between January 2023 and December 2024 were retrospectively included.All patients were diagnosed by polysomnography(PSG),clinically confirmed to have concurrent nasopharyngeal and oropharyngeal obstruction,and declined continuous positive airway pressure(CPAP)therapy.A total of 60 patients were enrolled and divided according to treatment modality into a combination therapy group(n=30),this group underwent nasal expansion surgery followed by sequential MAD therapy after PSG reassessment 3 months postoperatively;a MAD-only group(n=30),this group received custom-made MAD therapy directly.Changes in PSG parameters and Epworth sleepiness scale(ESS)scores were compared before and after treatment between the two groups,and overall efficacy was evaluated according to guideline-based criteria.RESULTS In the combination group,the apnea-hypopnea index(AHI)decreased from(51.84±16.40)events/h to(42.15±15.23)events/h after nasal surgery(P<0.05),and further to(16.48±13.47)events/h after sequential MAD therapy(P<0.001).Lowest oxygen saturation(LSaO₂)improved from 72.10%±8.47%to 86.23%±5.46%,and the ESS score decreased from 11.50±5.30 to 4.30±2.34(P<0.001).In the MAD-only group,AHI decreased from(53.72±15.18)events/h to(27.89±13.01)events/h,LSaO₂ improved from 71.37%±8.92%to 78.20%±8.90%,and the ESS score decreased from 13.20±4.65 to 9.40±3.03.No significant differences in baseline AHI or LSaO₂ were observed between the groups(P=0.647 and P=0.746,respectively).The overall response rate was 93.3%in the combination group versus 50.0%in the MAD-only group(Fisher's exact test,OR=14.0,95%CI:2.82-69.6,P<0.001).Post-treatment AHI,LSaO₂,ESS scores,AHI reduction rate,absolute LSaO₂improvement,and ESS improvement were all significantly superior in the combination group(all P<0.05).CONCLUSION Sequential nasal expansion surgery combined with MAD therapy effectively and simultaneously improves sleep respiratory parameters,nocturnal hypoxemia,and subjective daytime sleepiness in patients with severe OSAHS and dual-level obstruction.Compared with MAD monotherapy,the combined approach demonstrates significantly greater comprehensive clinical benefits in reducing AHI,elevating LSaO₂,improving ESS scores,and achieving higher overall efficacy rates.This sequential treatment strategy represents a valuable individualized therapeutic option for severe OSAHS patients with concurrent nasopharyngeal and oropharyngeal obstruction.