腺样体扁桃体切除术对睡眠呼吸紊乱患儿生活质量的影响

目的：评价阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿行扁桃体和（或）腺样体切除手术治疗前后生活质量的改善程度,并与有睡眠呼吸紊乱（SDB）症状但整夜PSG阴性的患儿进行比较;同时分析PSG与疾病特异性生活质量调查结果之间的相关性。方法：SDB患儿术前1～2周内行整夜PSG监测,根据结果分为PSG阳性组和阴性组,术后6～9个月内进行随访。使用儿童OSAHS疾病特异性生活质量调查量表（OSA-18）对患儿术前及术后的生活质量进行评估,比较2组患儿术后生活质量改善情况。对PSG确诊的OSAHS患儿,分析术前整夜PSG与OSA-18指标之间的相关性。结果：共51例患儿入选,其中28例整夜PSG结果达到OSAHS诊断标准（阳性组）,另23例为PSG阴性组。2组的临床资料具有可比性。术前OSA-18评分在2组之间的差异无统计学意义。术后2组患儿的OSA-18总分及各维度评分较术前均明显降低（均P〈0．01）,且术前、术后评分的变化值2组比较差异无统计学意义（P〉0．05）。在PSG确诊的OSAHS患儿,术前AHI与OSA-18量表中睡眠障碍、身体症状和对监护人影响3个维度的评分有明显相关性（均P〈0．01）,而与总分及其他2个维度无显著相关（均P〉0．05）。结论：对整夜PSG确诊的OSAHS患儿,扁桃体和（或）腺样体切除术后整夜PSG指标显著改善伴随生活质量明显提高,但没有发现术前OSA-18量表评分与整夜PSG检测指标之间有显著相关性。对有睡眠呼吸紊乱症状而其他方面健康的患儿,即使整夜PSG阴性,也能从手术治疗中受益。     

Measuring quality of life in children with obstructive sleep disorders

OBJECTIVE: To validate a disease-specific health-related quality of life (HRQOL) instrument for children with obstructive sleep disorders (OSDs). DESIGN: Prospective cohort study using a 6-item health-related instrument (OSD-6). SUBJECTS: One hundred caregivers of patients with OSDs secondary to adenotonsillar hypertrophy (age range, 2-12 years) from 2 tertiary care, pediatric otolaryngology practices. INTERVENTION: The OSD-6 was administered on initial presentation and 4 to 5 weeks after adenotonsillectomy. A subset of patients repeated the OSD-6 within 3 weeks after presentation to assess test-retest reliability. MAIN OUTCOME MEASURES: Test-retest reliability, internal consistency, construct validity, and responsiveness to clinical change of the OSD-6 score. RESULTS: Test-retest reliability was good (intraclass correlation coefficient = 0.74). Median OSD-6 score was 4.5 (0- to 6-point scale) with higher scores indicating poorer quality of life (QOL). Construct validity was demonstrated by the moderate correlation between OSD-6 score and global adenoid and tonsil-related QOL (R = -0.62), strong correlation between the OSD-6 change score and change in global adenoid and tonsil-related QOL (R = -0.63), and the moderate correlation between the change score and parent estimate of clinical change (R = 0.40). The mean change in OSD-6 score after adenotonsillectomy was 3.0 (95% confidence interval, 2.7-3.4). The mean standardized response was 2.3 (95% confidence interval, 1.9-2.7) indicating the instrument's large responsiveness to clinical change. The change score was very reliable (R = 0.85). CONCLUSIONS: The OSD-6 is a reliable, responsive, easily administered instrument. It is valid for detecting change after adenotonsillectomy in children with OSDs. Arch Otolaryngol Head Neck Surg. 2000;126:1423-1429     

Long term change in quality of life after adenotonsillectomy for pediatric obstructive sleep disorders

BACKGROUND: To study short-term and long-term changes in quality of life (QOL) in children before and after adenotonsillectomy (T and A) for obstructive sleep disorders (OSDs). MATERIALS AND METHODS: Prospective study of 20 children underwent T and A for OSDs at the University hospital of Ulm/Germany. Caregivers were asked to complete the Brouillette-Score (BS) and OSA-18 survey, validated instruments for detecting symptoms and QOL change in children with OSDs, at the initial office visit prior to surgery (BS/1 and OSA-18/1) within 7.5 +/- 1.14 weeks after surgery (BS/2 and OSA-18/2), and 14.8 +/- 1.98 months after surgery (BS/3 and OSA-18/3). The BS comprises 3 items including: difficulty breathing during sleep, apnea observed by the caregivers and snoring. The OSA-18 survey comprises 18 items in 5 domains of sleep disturbance, physical suffering, emotional distress, daytime problems, and caregiver concerns. Scores from the preoperative and postoperative surveys were compared using the paired T-test and SPEARMAN-RANK test. RESULTS: 13 children were male (65 %). The mean age at the time of inclusion in the study was 6.2 +/- 1.63 years, mean preoperative body mass index (BMI) was 17.4 +/- 1.24 kg/m(2). Brouillette-Score: The mean Brouillette-Score before T and A (2.72) was significantly higher ( P = or < .001) than in the short-term (- 2.19) and in the long-term. (- 3.54). OSA-18 SURVEY: The mean total score for OSA-18/1 (83.4) was significantly higher ( P = or < .001) than the mean total score for OSA-18/2 (29.8) and OSA-18/3 (25.6). The overall correlation between BS and OSA-18 was R = .887 ( P = or < .001). CONCLUSION: Children with suspicious OSDs demonstrate significant short term and long-term improvement in the Brouillette-Score and OSA-18 survey. Caregivers perceive a long-term improvement for a minimum of one year in QOL after T and A for OSDs, although these improvements are not uniform across all domains of the OSA-18 survey. Use of the Brouillette-Score and the OSA-18 survey should decrease the need for polysomnographic monitoring and facilitate selection of children for T and A, whereas the OSA-18 questionnaire permits the more differentiated finding.     

OSA儿童腺样体扁桃体切除术后的生活质量分析

目的:研究阻塞性睡眠呼吸暂停(OSA)儿童腺样体扁桃体切除术后生活质量的变化。方法:对符合入选标准的66例OSA儿童实施腺样体扁桃体切除术。患儿家长于术前及术后6～18个月完成OSA-18生活质量问卷调查,术前和术后调查问卷的评分用配对t检验进行比较。结果:OSA-18总分术前平均分为70.59(SD=15.015),术后为39.94(SD=14.232),OSA-18术前评分显著高于术后评分(P<0.01)。术前术后的OSA-18总分,睡眠紊乱、身体症状、情绪影响、白天问题及看护者关心的问题五项评分,以及每一小项评分,均较术前有显著降低(P<0.01)。结论:OSA严重影响儿童生活质量,腺样体扁桃体切除术后患儿生活质量有显著改善。     

Quality of life after adenotonsillectomy for obstructive sleep apnea in children

OBJECTIVE: To study changes in quality of life in children after adenotonsillectomy for obstructive sleep apnea (OSA) documented by full-night polysomnography. DESIGN AND SETTING: Prospective study of children with OSA at the University of New Mexico Children's Hospital, Albuquerque. METHODS: Caregivers for children were asked to complete the OSA-18 quality of life survey prior to polysomnography. Children who met inclusion criteria and had a respiratory distress index higher than 1 were enrolled in the study and underwent adenotonsillectomy. Caregivers completed a second OSA-18 survey within 6 months of surgery. Scores from the preoperative and postoperative surveys were compared using the paired t test. RESULTS: The study population included 60 children (mean age, 7.1 [range, 3-12] years), of whom 43 (72%) were male and 30 (50%) were younger than 6 years. Forty-seven children (78%) had a respiratory distress index of 10 or higher. The mean interval between the 2 surveys was 126 days. The mean total OSA-18 score was 71.4 before surgery and 35.8 after surgery. The domain with the greatest change in mean score was sleep disturbance, which improved by 11.5. The changes in total score, in the scores for each domain, and for each item of the OSA-18 survey were highly significant (P<.002). CONCLUSIONS: Children without significant comorbidities show a marked improvement in the domains of sleep disturbance, physical symptoms, emotional symptoms, and daytime functioning as reported by their caregivers after adenotonsillectomy for OSA.     

Quality of life and sleep study findings after adenotonsillectomy in children with obstructive sleep apnea

OBJECTIVES: To assess polysomnogram (PSG) results and global and disease-specific quality of life (QOL) in children with obstructive sleep apnea (OSA), before and after adenotonsillectomy, and to assess the association between PSG findings and QOL. DESIGN: Prospective observational study. We performed overnight PSG using standardized techniques and assessed disease-specific and global QOL using validated instruments. Follow-up was assessed at 1 year. We compared QOL outcomes between children who underwent adenotonsillectomy and children who did not. SETTING: A large tertiary care children's hospital. PATIENTS: Children with sleep-disordered breathing who were suspected of having OSA. INTERVENTION: Adenotonsillectomy. MAIN OUTCOME MEASURES: We evaluated PSG parameters, disease-specific QOL, and global QOL. RESULTS: We enrolled 47 children, 31 of whom met PSG criteria for OSA. Disease-specific and global QOL were not significantly different between children with OSA and children without. Global QOL was significantly worse for children with OSA than healthy children on several subscales: general health perception, behavior, and parental impact-emotional. Children who underwent adenotonsillectomy had significant improvements in QOL scores and PSG parameters (apnea-hypopnea index, P = .004; minimum saturation, P = .004). We found significantly larger QOL changes in children who underwent surgery compared with children without surgery (subscales: infections, P = .01; airway, P = .002; swallowing, P = .02; and behavior, P = .03). No strong association was identified between QOL scores and PSG parameters. CONCLUSIONS: Children with OSA and sleep-disordered breathing have significantly worse QOL than healthy children. However, the association between PSG findings and QOL was only moderate. Children with OSA treated with adenotonsillectomy demonstrated large improvements in disease-specific and global QOL as well as PSG parameters.     

Impact of adenotonsillectomy in children with severe obstructive sleep apnea: A systematic review

ObjectivesTo determine the impact of adenotonsillectomy for treatment of severe obstructive sleep apnea (OSA) in children without comorbidities.MethodsA systematic review was performed to identify studies regarding adenotonsillectomy for treatment of children with severe sleep apnea. Polysomnographic parameters were considered as metric of cure and the number of patients of persistent apnea was calculated. Quality of evidence was graded using OCEBM (Oxford Center for Evidence Based Medicine) and MINORS (Methodological Index for Nonrandomized Studies) scores.ResultsThe systematic review included nine studies. Five studies were prospective and four retrospectives. No one was controlled. The number of subjects with severe OSA included was 499 with a prevalence of male. The mean age varied from 4.3 to 8.2. The follow-up period ranges from 1 to 23 months. The criteria for considering severe OSA ranges from AHI or RDI ≥10 to ≥30.All the trials have found a statistically significant reduction of postoperative AHI or RDI values in patients who had undergone adenotonsillectomy for severe OSA. The AHI and RDI improving varied from 57.7% to 93.3%. All the studies documented persistent OSA after adenotonsillectomy. The number of residual OSA considering AHI≥5 varied from 30 to 55.5%, in case of AHI ≥1 from 60 to 90.6%.ConclusionTo the best of our knowledge, this is the first review regarding the effectiveness of adenotonsillectomy for severe OSA in otherwise healthy children. Adenotonsillectomy is partially effective in the treatment of severe OSA in children without comorbidities. However, it reduces the severity of OSA determining a significant reduction of polysomnographic parameters. These results suggest a clinical and polysomnographic follow-up after surgery in order to manage the residual mild and moderate OSA.     

腺样体扁桃体切除术治愈儿童阻塞性睡眠呼吸暂停综合征的偏误研究

阻塞性睡眠呼吸暂停综合征（OSAS）在我国儿童中的发病率分别为男童5.8%和女童3.8%,会影响儿童正常的生长发育,导致儿童生长迟滞、神经认知缺陷、智力发育及行为异常等问题,因此早期识别与诊断并进行适当的早期治疗至关重要。儿童OSAS的治疗方法多种多样,从内科的药物治疗到外科的手术治疗,从耳鼻咽喉的专科治疗到多学科联合治疗,治疗效果参差不齐,公认的一线治疗仍然是手术,而手术又以腺样体扁桃体联合切除术（AT）为主流。AT术后疗效及并发症众说纷纭,有学者认为AT治疗儿童OSAS疗效显著,症状可完全缓解;另有一部分学者则认为AT治疗儿童OSAS的疗效有待商榷,术后并发症及残余疾病很难避免,AT还不足以治愈OSAS患儿。对儿童OSAS的AT治疗进行阐述,以期为临床治疗儿童OSAS提供参考。     

Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea.

A retrospective study of pediatric patients with obstructive sleep apnea who underwent adenotonsillectomy between 1987 and 1990 was undertaken to determine the frequency of postoperative respiratory compromise and to determine if risk factors for its development could be identified. Sixty-nine patients less than 18 years old had polysomnographically documented obstructive sleep apnea and were observed postoperatively in the pediatric intensive care unit. Of these, 16 (23%) had severe respiratory compromise, defined as intermittent or continuous oxygen saturation of 70% or less, and/or hypercapnia, requiring intervention. Compared with patients without respiratory compromise, these patients were younger (3.4 +/- 4 vs 6.1 +/- 4 years) and had more obstructive events per hour of sleep on the polysomnogram (49 +/- 41 vs 19 +/- 30). They were more likely to weight less than the fifth percentile for age (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.4 to 18.7), to have an abnormal electrocardiogram and/or echocardiogram (OR, 4.5; 95% CI, 1.3 to 15.1), and to have a craniofacial abnormality (OR, 6.2; 95% CI, 1.5 to 26). Multiple logistic regression analysis revealed the most significant risk factors were age below 3 years and an obstructive event index greater than 10. Children with obstructive sleep apnea are at risk for respiratory compromise following adenotonsillectomy; young age and severe sleep-related upper airway obstruction significantly increase this risk. We recommend in-hospital postoperative monitoring for children undergoing adenotonsillectomy for obstructive sleep apnea.     

腺样体扁桃体切除术对阻塞性睡眠呼吸暂停低通气综合征儿童生活质量的影响

目的　探讨腺样体扁桃体和（或）切除术对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿生活质量的影响。方法　对OSAHS患儿行疾病特异性生活质量调查表（OSA-18）,分析术前、术后结果差异,评估生活质量变化。结果　246例患儿临床症状均缓解,OSA-18总分由（64.80±8.95）降至（30.11±4.49）,差异具有统计学意义（P <0.01）。生活质量改善总体有效率达99.60%,睡眠障碍、全身症状、对监护人的影响显著改善。结论　腺样体和（或）扁桃体切除术能够直接解除呼吸道梗阻,提高患儿睡眠质量、生活质量,可作为儿童OSAHS的主要治疗手段。     

Outcome of adenotonsillectomy for severe obstructive sleep apnea in children

OBJECTIVE: To study changes in sleep behavior and quality of life in children after adenotonsillectomy for severe obstructive sleep apnea identified by a respiratory distress index > or = 30. METHODS: Children enrolled in the study underwent adenotonsillectomy and had both pre- and post-operative polysomnography. Caregivers also completed an OSA-18 quality of life survey prior to polysomnography and within 6 months of surgery. Paired Student's t-tests were used to compare pre- and post-operative scores. RESULTS: The study population included 29 children. The mean age was 7.1 years (range 1.4-17.0). The most common comorbidities were obesity, asthma and allergic disease. The mean pre-operative RDI was 63.9 and the mean post-operative RDI was 14.2 (P < .0001). The mean total OSA-18 score before surgery was 77.6 and after surgery was 33.2. The differences in pre- and post-operative OSA-18 total scores and domain scores were significant (P < .0001). CONCLUSION: Children with severe OSA who undergo adenotonsillectomy show a significant improvement in RDI and in quality of life over a period of several months after surgery. However, OSA does not resolve in the majority of these children and post-operative PSG is recommended to identify those who may require additional therapy.     

C-reactive protein in children with obstructive sleep apnea and effects of adenotonsillectomy

ObjectiveC-reactive protein (CRP) is an important serum marker of inflammation associated with cardiovascular outcomes. This study aims to evaluate the association between CRP and childhood obstructive sleep apnea (OSA) and clarify the effects of adenotonsillectomy on serum CRP levels in children with OSA.MethodsChildren with symptoms suggestive of OSA who underwent an overnight polysomnography were recruited from a tertiary medical center. Their serum CRP levels were measured. For children who underwent adenotonsillectomy for OSA treatment, polysomnography and serum high-sensitivity CRP (hs-CRP) level measurement were conducted after surgery.ResultsThis study included 326 children (mean age: 7.2 ± 3.0 years; boys: 67%). Children with apnea-hypopnea index (AHI) > 5 events/h had significantly higher hs-CRP levels than children with AHI of 1–5 events/h and AHI < 1 event/h [median (interquartile range): 0.08 (0.03–0.25) vs 0.03 (0.02–0.14) vs 0.04 (0.01–0.10), P < 0.001]. Log-transformed hs-CRP levels were positively associated with log AHI values (r = 0.2, P < 0.001). In multiple linear regression analysis, hs-CRP levels were independently associated with AHI; 101 children with OSA (ie, AHI > 1) underwent adenotonsillectomy. In children with OSA in the study cohort, a significant reduction of hs-CRP levels did not occur after surgery [from 0.07 (0.02–0.22) to 0.08 (0.03–0.17), P = 0.716]. In children with OSA having abnormal hs-CRP levels (ie, CRP > 1 mg/dL), hs-CRP levels significantly decreased after surgery [from 1.87 (1.11–2.78) to 0.20 (0.07–1.04), P = 0.043].ConclusionChildren with OSA had increased hs-CRP levels. Children with OSA and abnormal hs-CRP levels exhibited significantly reduced hs-CRP levels following adenotonsillectomy.     

The effect of adenotonsillectomy on oxygen saturation in children with sleep breathing disorders

OBJECTIVE: To evaluate the effect of adenotonsillectomy on the oxygen saturation measures by nocturnal pulse oximetry in children with sleep breathing disorders (SBD). METHODS: A non-controlled clinical trial was performed. Thirty-one children with suspected SBD and a clinical indication for adenotonsillectomy were recruited. All of them underwent overnight oxygen saturation monitoring before and after surgery. RESULTS: Twenty-seven patients completed the study. The mean age was 5.2+/-1.8 years. Eighteen (66.7%) were male. The most prevalent symptoms were: snoring (100%), respiratory pauses (96.8%), nocturnal mouth breathing (96.8%), restless sleep (80%) and drooling (74.1%). Twenty-three children (85.2%) presented grade 3 or 4 tonsillar hyperplasia. There was a significant improvement in the postoperative oxygen desaturation index (ODI) (0.65; 0.5-1.3) compared with the preoperative index (1.63; 1.1-2.4) (p<0.001). CONCLUSION: Adenotonsillectomy improved the oxygen saturation measures by nocturnal pulse oximetry in children with sleep breathing disorders.     

Changes during medical treatments before adenotonsillectomy in children with obstructive sleep apnea

ObjectivesThe severity of pediatric obstructive sleep apnea (OSA) can vary from mild to very severe (AHI ≥ 30 events/h) with the seasons. The efficacy of medical treatment has been investigated in cases of mild and moderate pediatric OSA, but not in severe cases thoroughly.MethodsOur prospective cohort study involved 205 children who visited our outpatient clinic between December 2014 and May 2020. We performed home sleep tests after the initial visit, and then polysomnography after optimizing the control of rhinitis, sinusitis, adenoid hypertrophy, and tonsillitis by using medical treatments.ResultsThe respective proportions of patients who improved to obstructive AHI (O-AHI) < 1/h or who proceeded to surgery were 43.4% and 62.3% in mild cases; 43.3% and 52.2% in moderate cases; 30.2% and 68.4% in severe cases; and 0.0% and 100% in very severe cases. Additionally, nadir SaO₂ improved significantly between before and after medical treatment in both O-AHI < 1/h and O-AHI ≥ 1/h patients (respectively p < 0.0001, p = 0.0009). The lowest nadir SaO₂ before medical treatment was 74% in patients in whom O-AHI was normalized after medical treatments.ConclusionMedical treatment instituted before a surgical decision is made can provide substantial benefits and avoid unnecessary surgery if there is time for such treatments. In contrast, it may be difficult to normalize the O-AHI in pediatric patients with very severe OSA or a nadir SaO₂ of less than 74% by medical treatment.     

The effect of adenotonsillectomy on obstructive sleep apnea in children with Down syndrome*

Objective: Children with Down syndrome (DS) are liable to develop obstructive sleep apnea (OSA) due to many anatomical airway abnormalities. The tonsils and adenoid occupy part of the airway space, and their removal may be helpful in relieving airway obstruction. The aim of this study was to assess the effectiveness of adenotonsillectomy in the treatment of OSA in those children.

Methods: Fifty DS children with difficult breathing were recruited, and they were subjected to polysomnographic examination (PSG). Patients with apnea-hypopnea index (AHI)?>?1 were considered to have OSA. Adenotonsillectomy was performed for patients who had OSA and adenotonsillar hypertrophy, and after 3 months PSG was done for them with recording of the same preoperative parameters.

Results: Forty-three children demonstrated OSA on PSG, and they were included in the study. The preoperative mean AHI was 9.18 (±?6.17) that improved postoperatively to 2.72 (±?3.80) with its normalization in 72% of patients. Also, significant improvement of arousal index, minimum oxygen saturation, desaturation index, and peak end-tidal CO₂ was achieved postoperatively.

Conclusion: Adenotonsillectomy is an effective method for the treatment of OSA in children with DS. However, the condition may persist in some children who usually have airway narrowing at multiple levels.     

Improvement in quality of life by adenotonsillectomy in children with adenotonsillar disease

Clin. Otolaryngol. 2010, 35 , 383–389 Objectives: To evaluate the effect of adenotonsillectomy on quality of life of children with adenotonsillar disease and to evaluate the basal differences and post-surgical changes of life quality in children with different disease severity. Study design: Prospective, case – controlled study. Setting: Tertiary referral center. Participants and main outcome measures: Preoperative and postoperative quality of life of 40 children with adenotonsillar disease were determined by pedsQL™, and disease severity was assessed in terms of a score obtained by tonsil and adenoid health status instrument (TAHSI). These children comprised the study group. Median of scores of study group was 31. Twenty-one children with a score less than 31 comprised the study subgroup I, while 19 children with a score bigger than 31 comprised the study subgroup II. Thirty normal children comprised the control group. Comparisons of data obtained from affected and healthy children and their parents were made. Results: The mean preoperative physical, emotional, social, school and total quality of life scores of the study group were 64.81, 49.62, 76.37, 66.62 and 64.41; postoperatively 83.67, 75.75, 85.75, 87.25, 83.18; and control group were 82.21, 77.50, 92.50, 90.50, 85.40, respectively. There was highly statistically significant difference between all preoperative and postoperative scores of the study group. There was highly statistically significant difference between all preoperative scores of the study and control group. There was no statistically significant difference in preoperative and postoperative scores between the study subgroups. The improvement after surgery was not statistically significant between mild and severe group except for emotional scale. Conclusion: Children with adenotonsillar disease showed significant improvements in disease-specific and global quality of life after adenotonsillectomy as measured by TAHSI and PedsQL™. Preoperative and postoperative life quality does not differ according to severity of the disease. The improvement provided by adenotonsillectomy in the children with mild disease is statistically not different from the severely affected children in overall life quality.     

手术治疗对阻塞性睡眠呼吸暂停低通气综合征患儿生活质量的影响

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome OSAHS)对患儿生活质量的影响,以及手术前后生活质量变化.方法 对105例患儿进行儿童OSAHS疾病特异性生活质量调查(disease-specific quality of life for children with obstructive sleep apnea 18 items survey, OSA-18)和多导睡眠监测(polysomnography, PSG),分析两者的相关性,术后3～18个月进行生活质量的随访.结果 术前OSAHS对患儿生活质量造成严重影响者占61.90%.术后得到明显改善,术后3个月总评分＞80者降至12.58%,18个月时降至4.76%.结论 OSAHS患儿行腺样体或扁桃体切除术后,PSG指标显著改善和生活质量明显提高,并发现术后OSA-18量表评分与PSG检测指标间有明显相关性.