Risk Factors For Non-positional Obstructive Sleep Apnea-hypopnea Syndrome And The Effect Of Roux-en-Y Gastric Bypass Surgery

OBJECTIVE To explore the main factors associated with non-positional obstructive sleep apnea(NPOSA),and the efficacy and main related factors of Roux-en-Y gastric bypass surgery(RYGB)on obstructive sleep apne(OSA)and non-obstructive sleep apnea(NPOSA).METHODS The difference and relationship of the body parameters,the values of PSG and CT data between NPOSA and POSA was compared and analyzed.Analysed of the differences and effects of RYGB surgery on these parameteres between NPOSA and POSA,and investigate its main relevant factors.RESULTS There was 55.1% NPOSA patients.The neck circumference(NC),waist circumference(WC),hip circumference(HC),ESS score,apnea hyponea index(AHI)and lateral-AHI(L-AHI)of NPOSA were higher than POSA group(P< 0.01).AHI was included in the logistic regression modeland the cutpoint of AHI was 49.7per hour.Besides,when the parameters of PSG(such as AHI,MinSpO2)were excluded,WC and ESS were included in the new regression model.Additionally,significant differences were found in soft palate length(SPL),cross-sectional area of palatopharyngeal(PP),coronal diameter(CD)of PP between NPOSA and POSA(p<0.05),which was higher in POSA except SPL.The SPL,CD of the narrowest level of GP and age were included in the simplified regression model.The AHI,body mass index(BMI),and concentrations of total albumin,prealbumin,total cholesterol,fasting blood glucose,albumin,and C-reactive protein were significantly lowered after RYGB surgery,The changes in the AHI(delta AHI)was assessed by multiple linear analysis as follows: delta AHI = 0.105 ×(delta prealbumin)+ 1.509 ×(delta BMI)+ 1.006.There was no statistically significant difference in the postoperative efficacy between NPOSA and POSA group(p>0.05).After divided all patients into effective group and void group according to the efficacy,the delta S-AHI%,delta BMI and delta weight of effective group were significantly greater than the void group(p< 0.05),but the delta L-AHI%was similar(p>0.05).The S-AHI% and delta weight were included in the simplified regression model CONCLUSION AHI was strongly associated with NPOSA,which may be useful in ruling out POSA when it higher than 49.7.Furthermore,WC and ESS were the independent risk factors of NPOSA as the parameters of clinical characteristics.The NPOSA had a smaller CD of upper airway and a shorter SPL than POSA.The main factors for the substantial differences between POSA and NPOSA include SPL,CD of the narrowest level of GP and age.RYGB is an effective therapeutic option for OSAHS patients with obesity and T2DM;the postoperative efficacy of NPOSA was similar with POSA group.Additionally,the improvement of S-AHI and L-AHI were associated with the degree of weight loss,and the potential factors associated with postoperative efficacy include changes in weight and the change in AHI%.