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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2022, Vol. 08 ›› Issue (03) : 181 -190. doi: 10.3877/cma.j.issn.2095-9605.2022.03.007

循证医学

腹腔镜袖状胃切除术治疗肥胖患者呼吸睡眠暂停综合征的Meta分析
张家鸣1, 孙晓芳2,†()   
  1. 1. 225001　扬州，扬州大学护理学院·公共卫生学院
    2. 225001　扬州，扬州大学护理学院·公共卫生学院；江苏省苏北人民医院内分泌科
  • 收稿日期:2022-07-22 出版日期:2022-08-30
  • 通信作者: 孙晓芳

The effect of laparoscopic sleeve gastrectomy on OSAHS in obesity patients: a Meta-Analysis

Jiaming Zhang1, Xiaofang Sun2,†()   

  1. 1. College of Nursing and Public Health, Yangzhou University, Yangzhou 225009, China
    2. College of Nursing and Public Health, Yangzhou University, Yangzhou 225009, China; Northern Jiangsu People’s Hospital, Yangzhou 225001, China
  • Received:2022-07-22 Published:2022-08-30
  • Corresponding author: Xiaofang Sun
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引用本文：

张家鸣, 孙晓芳. 腹腔镜袖状胃切除术治疗肥胖患者呼吸睡眠暂停综合征的Meta分析[J]. 中华肥胖与代谢病电子杂志, 2022, 08(03): 181-190.

Jiaming Zhang, Xiaofang Sun. The effect of laparoscopic sleeve gastrectomy on OSAHS in obesity patients: a Meta-Analysis[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2022, 08(03): 181-190.

目的

荟萃分析腹腔镜袖状胃切除术（LSG）对肥胖性阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者夜间低氧血症的影响。为肥胖患者OSAHS的治疗方案提供循证学依据。

方法

从1980年1月到2022年6月计算机检索数据库：PubMed，Embase，Cochrane Library，Web of Science，CNKI，万方数据库，维普数据库，CBM数据库。严格按照纳入与排除标准，检索以LSG手术为主要干预手段治疗肥胖患者OSAHS并以多导睡眠监测为结局指标的高质量临床研究。睡眠呼吸暂停低通气的严重程度以呼吸暂停和低通气指数（AHI）、睡眠期间最低血氧浓度、睡眠效率、爱泼沃斯嗜睡量表（ESS）评分作为评价标准，减重的效果以BMI、颈围为评价标准。提取筛选后文献的数据，并进行质量评估。

结果

纳入了7项合格研究，共316例患者，均为前后自我对照研究，纳入研究的异质性较高。LSG手术对以下指标都有明显改善且具有统计学意义，BMI（MD=13.36，95%CI：[11.55，15.18]，P<0.05），呼吸暂停低通气指数（AHI）（MD=24.54，95% CI：[15.44，33.73]，P<0.05)，Epworth嗜睡量表评分（ESS）（MD=5.17，95%CI：[1.99，8.35]，P<0.05），颈围（MD=5.65，95%CI：[4.52，6.78]，P<0.05），最低血氧饱和度（MinSaO2）（MD=–13.95，95%CI：[–22.61，–5.29]，P<0.05），快速眼动（REM）睡眠占总睡眠时间百分比（MD=–2.70，95% CI：[–4.37，–1.02]，P<0.05）。对睡眠效率（MD=–6.30，95% CI：[–12.88，0.28]，P=0.06）无明显影响。

结论

LSG在肥胖患者呼吸睡眠暂停综合征的治疗中具有良好的临床效果。然而，由于纳入文献的质量和数量有限，需要更多大样本和多中心的随机对照试验进一步验证。

关键词: 腹腔镜袖状胃切除术, 减重手术, 肥胖, 阻塞性睡眠呼吸暂停症, 腹腔镜检查, 荟萃分析
Objective

To evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG) in obese patients obstructive sleep apnea and hypopnea syndrome (OSAHS). To provide an evidence-based basis for LSG treatment of obesity OSAHS.

Methods

Computer search databases from January 1980 to June 2022: PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Database, VIP Database, Chinese BioMedical Literature Database. We searched for high-quality clinical studies on obesity OSAHS patients, LSG as an intervention, and postoperative polysomnography monitoring as an outcome indicator, strictly according to the inclusion and exclusion criteria. Data extraction and assessment of publication bias were performed for the included literature. The postoperative apnea-hypopnea index (AHI), minimum SpO2 during sleep, sleep efficiency, and Epworth Sleepiness Scale (ESS) was used to objectively evaluate the severity of sleep apnea and hypoventilation. Body Mass Index (BMI) and neck circumference were used as indicators to objectively evaluate weight loss. They were compared with their preoperative baseline data. Forest plots showed a large heterogeneity among studies, which was mainly attributed to the small number of included literature and the fact that they were all owned before and after controlled studies.

Results

A total of 7 studies were included in 316 patients with obesity OSAHS and with a high risk of migration. The results of this meta-analysis showed that LSG has significant and statistically significant improvements in all of the following indicators, BMI (MD=13.36, 95%CI: [11.55, 15.18], P<0.05), apnea hypoventilation index (AHI)(MD=24.54, 95%CI: [15.44, 33.73], P<0.05) , minimum oxygen saturation (MinSaO2) (MD=–13.95, 95%CI: [–22.61, –5.29], P<0.05) , rapid eye movement (REM) sleep as a percentage of total sleep time (MD=–2.70, 95% CI: [–4.37, –1.02], P<0.05), Epworth Sleepiness Scale score (ESS) (MD=5.17, 95%CI: [1.99, 8.35], P<0.05) and neck circumference (MD=5.65, 95%CI: [4.52, 6.78], P<0.05).There was no significant effect on sleep efficiency (MD=–6.30, 95%CI:[–12.88, 0.28], P=0.06).

Conclusions

LSG has significant therapeutic effects on obesity and OSAHS in obese OSAHS patients, but further observation is needed for the long-term efficacy of this operation.

Key words: Laparoscopic sleeve gastrectomy, Bariatric surgery, Obesity, Obstructive sleep apnea-hypopnea syndrome, Meta-analysis
图1 通过搜索和选择过程检索的研究的PRISMA流程图
表1 纳入研究的特点
作者及发表年份 国家 研究类型 样本量 随访时间（月） BMI（kg/m2） AHI（events/h） REM/% NadirSaO2/% ESS SSE 颈围
术前 术后 术前 术后 术前 术后 术前 术后 术前 术后 术前 术后 术前 术后
艾克拜尔et al. 2020 中国 前瞻性 74 12 43±6 28±3 30±19 6±4 NS NS 64.9±11.3 88±3.1 19.4±2.6 9.2±1.5 NS NS 42.9±3 36.5±1.4
H.Shaarawy et al., 2015 埃及 回顾性 22 12 48.2±7.3 35.9±4.8 55.8±8.3 12.8±11.3 20.4±2.9 22.4±1.9 67.2±11.3 92.2±5.3 16.8±6.8 10.2±4.5 69.4±3.25 75.4±6.25 38.2±3.6 32.2±4.6
Suliman et al., 2015 埃及 回顾性 20 8.25±0.96 60.5±8.9 41.9±5.9 18（8.2-42） 10(3-22) NS NS 82.35±6.44 87.10±4.78 5.4±2.54 2.7±1.5 83.75±7.18 90.35±3.66 42.05±2.87 38.6±2.76
Salmanet al., 2019 埃及 前瞻性 79 12 46.23±3.8 34.2±2.7 27.3±12.2 14.0±9.8 NS NS NS NS 9.2±3.6 5.0±3.0 NS NS 45.1±2.6 38.24±2.7
Timmerman et al., 2019 法国 前瞻性 36 9.9±6.1 47.4±8.4 36.3±7.1 45.8±25.6 11.3±11.9 14.2±6.4 16.3±7.4 NS NS 7.2±5.0 3.3±3.4 NS NS 43.9±3.9 40.2±3.7
Kara et al., 2020 土耳其 前瞻性 31 12 49.8±8.5 33.2±8.2 36.1±27 10.3±11.8 14.0±6.3 18.9±5.8 74.3±12.1 79.2±14.7 5.1±3.7 1.6±1.6 NS NS 44.4±4.2 37.4±4.0
Yufei Chen et al., 2021 中国 回顾性 67 9.7±2.8 42.6±7.7 31.9 ± 5.9 31.9 ± 28.6 13.3 ± 15.8 NS NS 79.0 (63.0–83.0) 87.0 (82.0–90.0) NS NS NS NS NS NS
表2 每项纳入研究的偏倚风险
条目 研究
艾克拜尔et al., 2020 H.Shaarawy et al., 2015 Suliman et al., 2015 Salman et al., 2019 Timmerman et al., 2019 Kara et al., 2020 Yufei Chen et al., 2021
1.是否清晰地说明了研究的假设、目的和目标？ 1 1 1 1 1 1 1
2.是否描述了患者特点？ 1 1 1 1 1 1 1
3.是否在多中心收集病例？ 0 0 0 1 0 0 0
4.研究纳入标准和排除标准是否明确合理？ 1 1 1 1 1 1 1
5.患者的纳入是否连续？ 0 0 0 0 1 0 0
6.患者的病情是否一致？ 1 1 1 1 1 1 1
7.是否清楚地描述了主要的干预措施？ 1 1 0 0 0 0 1
8.是否明确描述了联合干预措施？ 1 0 0 0 0 0 1
9.是否事先确定研究要测量的结局？ 1 1 1 1 1 1 1
10.是否应用合理的客观和（或）主观方法测量了相关结局指标？ 1 1 1 1 1 1 1
11.干预前后是否均测量了结局指标？ 1 1 1 1 1 1 1
12.是否应用了合理的统计学检验来评价相关结局指标？ 1 1 1 1 1 1 1
13.是否报告了随访时间？ 1 1 1 1 1 1 1
14.是否报告了失访情况？ 1 1 1 1 1 1 1
15.是否在相关的结局指标的数据分析中提供了随机变量估计？ 1 1 1 1 1 1 1
16.是否报告了干预相关的不良事件？ 1 1 0 1 0 1 1
17.研究的结果是否支持其结论？ 1 1 1 1 1 1 1
18.是否说明了研究的利益冲突和支持来源？ 1 1 1 1 1 1 1
19.该研究是否为前瞻性研究？ 0 1 1 1 0 1 0
20.是否对结局评价人员施盲？ 0 0 0 0 0 0 0
总分 16 16 14 16 14 15 16
图2 肥胖型OSAHS患者LSG手术前后BMI水平比较的Meta分析
图3 肥胖型OSAHS患者LSG手术前后AHI水平比较的Meta分析
图4 肥胖型OSAHS患者LSG手术前后MinSaO2水平比较的Meta分析
图5 肥胖型OSAHS患者LSG手术前后快速眼动睡眠时间占总睡眠时间百分比比较的Meta分析
图6 肥胖型OSAHS患者LSG手术前后睡眠效率比较的Meta分析
图7 肥胖型OSAHS患者LSG手术前后ESS评分比较的Meta分析
图8 肥胖型OSAHS患者LSG手术前后颈围比较的Meta分析
图9 报道BMI文献的漏斗图
图10 报道AHI文献的漏斗图
图11 报道MinSaO2文献的漏斗图
图12 报道ESS评分文献的漏斗图
图13 报道颈围文献的漏斗图
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