睡眠呼吸中止症手術前後的聲學評估

研究目的：本研究探討阻塞型睡眠呼吸中止症患者經機械手臂手術治療後，是否在主客觀上會造成音聲的改變，此外亦研究手術對發音的頻率的影響。研究方法及資料：本研究為觀察型研究，收集28名確診睡眠呼吸中止症病患進行音聲評估，並於手術後3個月再次執行睡眠參數與各項音聲參數的後測。收集的客觀音聲參數，包含語音採樣(speech sample)、長音(phonation)、音高(common pitch)、最高音閾與最低音閾，以及患者主觀感受嗓音障礙指數量表(Voice Handicap Index-10，VHI-10)。研究排除走右兩耳500、1K、2K、4K頻率的聽力閥值大於25分貝者三人，及無法順利閱讀中文，曾接受聲帶手術，單側聲帶麻痺，目前有活動性鼻竇炎，過敏性鼻炎，唇顎裂等顱顏疾患與中樞型語言表達障礙者。研究結果： 25名個窒息與通氣不良指數(Apnea hyponia index, AHI)從44.21times/hr降到21.36 times/hr，最低血氧濃度(Lowest SPO2)從79.64%提升到85.32%，血氧飽和度下降指數ODI(Oxygen dioxygen index )從35.37 下降至12.01，鼾聲指標(Snoring index)從480.42 times/hr降到288.68 times/hr。手術治癒率有12%，48%個案可脫離呼吸器，累積共60%個案達到傳統成功率。術後客觀音質參數差距並未達到統計上顯著差異；而主觀嗓音障礙指數呈現較術前微幅上升，由6.76±7.85分增加到7.48±8.52分，亦未達顯著差異。但主觀最低音節的增加(r=0.539，P=0.007)、與嗓音障礙指數增加有顯著的相關。結論與建議：本研究目前的結論是，接受達文西機械手臂手術後3個月，客觀的音聲品質，音域高低，並無有意義的變化，也與VHI-10 無相關性。但主觀最低音節的增加(r=0.539，P=0.007)可能與主觀的滿意度有關連性。

關鍵字

睡眠呼吸中止症；聲學；懸雍垂腭咽成形術；經口機械手臂手術

並列摘要

Objective：The objective of this study is to establish a symptom based postoperative pitch and phonation changing survey after transoral robotic surgery(TORS) for obstructive sleep apnea(OSAS) Methods and Materials： From January 2018 to August 2018, we collected 28 adults with polysomnography-diagnosed OSA and underwent TORS treatment. 3 of the patients were excluded due to hearing loss (define as unable to hear sounds that are quieter than about 25 decibels (dB) at the frequencies of 500、1K、2K、4K). These patients were given a standardized questionnaire and objective exams to collect VHI-10 and acoustic parameter before and 3 months after TORS surgery. After the data collection, valid samples were processed and analyzed by descriptive statistics Results： Twenty-five patients underwent TORS for tongue base reduction. 3(12%) of the patients were cured (AHI<5 and ESS<10), 12(48%) of the patient doesn’t need continuous positive airway pressure anymore. About 60 % of our study group achieved definition successful (defined as postoperative AHI of < 20 events/h along with at least 50% decrease from the baseline AHI) There was a 48 % reduction in the mean AHI (44.21 ± 19.89 to 21.2 ± 16.40, p < 0.001) and a sustained reduction in the mean Epworth Sleepiness Score (p = 0.022) and Snoring index (480.42±98.81to 288.684±139.90, p < 0.001). Mean SaO2 significantly increased after surgery compared to pre-operative values (94.66 ± 1.38 to 95.98 ± 1.33, p = 0.019) along with ODI(Oxygen dioxygen index, 35.37±25.65 to 12.01±13.12, p < 0.001) and Lowest Desaturation (79.64±7.07 to 85.32±7.68 , p < 0.001 ) o significant change was found in objective acoustic parameter. A significant change in Lowest note of the VHI-10 score was noticed (P=.007). Conclusion and Suggestion： This prospective clinical trial demonstrates that there is no significant changes between objective acoustic parameter and TORS surgery treatment after 3 months. However, an increase of subjective lowest note may possible influence the patient’s satisfaction.