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。     

Parental understanding and attitudes of pediatric obstructive sleep apnea and adenotonsillectomy

OBJECTIVE: To explore parental perceptions and knowledge of pediatric obstructive sleep apnea (OSA) and adenotonsillectomy. DESIGN: Cross-sectional study. SETTING: National polling organization. PARTICIPANTS: Population-based sample of 584 parents. INTERVENTION: Online surveys. MAIN OUTCOME MEASURES: Responses to questions regarding knowledge of pediatric OSA and treatment with adenotonsillectomy. RESULTS: Ninety-five percent of parents acknowledged that pediatric OSA is a "serious condition". Fifteen percent considered themselves to be "knowledgeable" about it. One fifth understood that untreated OSA could lead to cardiopulmonary disease, failure to thrive, or behavioral problems, such as attention deficit hyperactivity disorder. Less than 20% knew that pediatric OSA could be treated with adenotonsillectomy. Thirty-seven percent believed adenotonsillectomy to be an "outdated" procedure. Upon learning that adenotonsillectomy can treat OSA, 82% reported they would be eager to have a child with OSA undergo adenotonsillectomy. CONCLUSIONS: The majority of parents do not understand symptoms, consequences and treatment of pediatric OSA secondary to adenotonsillar hypertrophy. Otolaryngologists should be diligent in communicating issues of this disorder with parents and pediatricians.     

Psychiatric disorders and symptoms severity in patients with adenotonsillar hypertrophy before and after adenotonsillectomy

Objective

The objective of this study was to compare the frequency of psychiatric disorders and the severity of psychiatric symptoms in patients with adenotonsillar hypertrophy with a healthy control group and investigate the potential improvement after adenotonsillectomy.

Materials and methods

The study group consisted of 40 patients with adenotonsillar hypertrophy and a control group consisted of 35 healthy volunteers without adenotonsillar hypertrophy. A routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry were carried out. The same procedures were applied to the control group. The parents of all the participants were required to fill out the Early Childhood Inventory-4 form, the Strengths and Difficulties Questionnaire and a personal information form. At postoperative month six, the patients were re-examined, and their parents were required to fill out the same forms.

Results

Attention deficit hyperactivity disorders and sleep disorders determined with the Early Childhood Inventory-4 were more common in the patients with adenotonsillar hypertrophy than in the control group. There was a significant decrease in the rates of both types of disorders at postoperative month six. The total psychiatric symptom severity was higher in the patients with adenotonsillar hypertrophy and the following were more frequent: cases of attention deficit hyperactivity disorder, oppositional defiant disorder, symptom severity of anxiety disorders and sleep disorders determined with the Early Childhood Inventory-4, as well as emotional problems, attention deficit hyperactivity disorder problems, behavioural problems and peer problems determined with the Strengths and Difficulties Questionnaire parent-report form. There was a statistically significant decrease in all the other symptoms at postoperative month six, except for the severity of oppositional defiant disorder symptoms determined with the Early Childhood Inventory-4 and behavioural problems determined with the Strengths and Difficulties Questionnaire parent-report form. There were no differences in the severity of psychiatric disorders or symptoms between the adenotonsillar hypertrophy group and the control group at postoperative month six.

Conclusion

Adenotonsillar hypertrophy is associated with psychiatric disorders and symptoms. Adenotonsillectomy ameliorated the symptoms and the severity of these disorders in most cases.     

The nasopharyngeal prong airway: an effective post-operative adjunct after adenotonsillectomy for obstructive sleep apnoea in children

OBJECTIVES: Obstructive sleep apnoea is a common childhood disorder. Adenotonsillar enlargement is most commonly implicated, with adenotonsillectomy representing an effective treatment in the majority of cases. Such children may develop respiratory compromise post-operatively, sometimes necessitating admission to the intensive care unit. We describe insertion of a nasopharyngeal "prong" airway and evaluate its benefits after adenotonsillectomy for obstructive sleep apnoea and milder forms of sleep-disordered breathing. METHODS: The prong is easily fashioned from a paediatric endotracheal tube. It is inserted once surgery is complete, remaining in situ overnight. We retrospectively examine its elective use over an 18-month period in selected children considered to be at high risk of post-operative respiratory compromise. Existing practice over the preceding 18-month period is also examined, by way of comparison. RESULTS: Forty-three children underwent adenotonsillectomy for sleep-disordered breathing/OSAS in the 18 months prior to introduction of the prong. Ten were considered "high risk" cases: post-operative intensive care beds were pre-booked for these, but none were eventually required. During the subsequent 18 months, 60 children underwent adenotonsillectomy for the same indication. Seventeen "high risk" cases received the prong post-operatively. No intensive care beds were pre-booked and all children were managed safely on the ENT ward, with minimal intervention. CONCLUSIONS: Use of a nasopharyngeal prong significantly improves the post-operative course of selected children who are at high risk of respiratory compromise after adenotonsillectomy. This largely avoids the need for medical intervention and intensive care admission.     

Beyond adenotonsillectomy: Outcomes of sleep endoscopy-directed treatments in pediatric obstructive sleep apnea

Objectives

In this study we determine the subjective and objective outcomes of pediatric patients with refractory OSA undergoing drug-induced sleep endoscopy (DISE)-directed surgical treatment.

Methods

31 consecutive children with OSA following TA underwent DISE. 26 completed DISE-directed operative management of the level(s) of ongoing upper airway obstruction. Pre- and postoperative OSA were assessed through a detailed history (of nighttime symptoms (NS) and daytime symptoms (DS)), physical examination, and polysomnography.

Results

Age ranged 5–18 years (mean 9.7 ± 3.4). Fourteen of 26 had trisomy 21 (51%). Operations were performed in the following frequencies: lingual tonsillectomy (LT) (22), midline posterior glossectomy (MPG) (16), revision adenoidectomy (11), inferior turbinate submucosal resection (7), uvulopalatoplasty (2), and supraglottoplasty (2). Overall, 92% reported subjective improvement. NS improved from 5.8 ± 2.9 preoperatively to 2.1 ± 2.5 postoperatively (p < 0.05), while DS improved from 2.1 ± 1.3 preoperatively to 0.6 ± 1.1 postoperatively (p < 0.05). Seventeen patients completed preoperative polysomnography, while only 11 of them also completed postoperative polysomnography. Mean OAHI fell from 7.0 (±5.8) events/hr to 3.6 (±1.8) events/hr (t-test, p = 0.09).

Conclusions

Individualized, multilevel, DISE-directed operative therapy was associated with substantial improvement in subjective measures of sleep.     

Velopharyngeal dysfunction in children with Prader-Willi syndrome after adenotonsillectomy

Introduction

Prader-Willi syndrome (PWS) is a rare genetic disorder with an incidence rate of 1 in 10,000–30,000. Patients with PWS typically have symptoms related to hypotonia, obesity, and hypothalamic dysfunction. A high rate of obstructive sleep apnea (OSA) is found among this population of patients. Adenotonsillectomy has been advocated as a first line approach for treatment of OSA in patients with PWS. Velopharyngeal dysfunction (VPD) is a known complication of adenotonsillectomy. VPD can also be present in patients with global hypotonia, such as those with PWS. The objective of this study is to review the occurrence of VPD in patients with PWS after adenotonsillectomy for OSA.

Methods

A retrospective review was performed of all patients with PWS and OSA from a tertiary pediatric hospital between the years of 2002 and 2012. Pre- and post-operative sleep studies and sleep disordered breathing symptoms, post-operative VPD assessment by the speech-language pathologist (SLP), and VPD treatments were evaluated.

Results

Eleven patients (five males and six females), fitting the inclusion criteria, were identified. The age of the patient at the initial otolaryngologic evaluation ranged from 2 to 9 years. All patients underwent adenotonsillectomy for sleep disordered breathing. Four patients were diagnosed with post-operative hypernasality after assessment by a speech-language pathologist. The hypernasality ranged from mild to moderately severe. Of the four patients with hypernasality, two were found to have structural issues requiring surgery (pharyngeal flap). Both of the surgical patients experienced significant improvement in their VPD after surgery. The remaining two patients were found to have articulation error patterns that were considered more developmental in nature and both responded to speech therapy. All patients, except one, had improvement in their polysomnogram or sleep symptoms after adenotonsillectomy. However, three patients continue to require continuous positive airway pressure at night.

Conclusion

Velopharyngeal dysfunction may occur after adenotonsillectomy in patients with Prader-Willi Syndrome. Families should be counseled of this risk and the potential need for operative intervention to correct it.     

Child behavior after adenotonsillectomy for obstructive sleep apnea syndrome

OBJECTIVE: To study the behavior of children with obstructive sleep apnea syndrome (OSAS) before and after adenotonsillectomy using a standardized behavioral rating scale completed by caregivers. DESIGN AND SETTING: Prospective study of children with OSAS at the University of New Mexico Children's Hospital, Albuquerque, New Mexico. METHODS: Children between 2.5 and 18 years of age were included in the study and underwent adenotonsillectomy if the results of polysomnography showed an obstructive apnea/hypopnea index (AHI) of 5 or greater. Caregivers completed the Behavior Assessment System for Children (BASC) before surgery and a second time within 6 months of surgery. Pre- and postoperative BASC t scores were compared using a paired t test. Repeated measures analysis of variance was used to evaluate the contributions of several covariants to these change scores. RESULTS: The study population included 52 children. The mean age was 7.1 (range 2.5-14.9) years, and the mean AHI was 16.2 (range 5.0-88.0). Preoperative mean BASC t scores for all behavioral scales and composites were greater than 50. The behavioral scales that showed significant improvement after adenotonsillectomy were aggression, atypicality, depression, hyperactivity, and somatization (p < or = .001). Age, ethnicity, parental education, parental income, and AHI were not correlated with changes in BASC scores. CONCLUSIONS: A high proportion of children with OSAS have externalizing (hyperactivity and aggression) and internalizing (anxiety, depression, and somatization) behavioral problems. These problems improve significantly after adenotonsillectomy. The improvement is dramatic regardless of sex, age, ethnicity, parental education, parental income, or the relative severity of OSAS.     

Guidelines to decrease unanticipated hospital admission following adenotonsillectomy in the pediatric population

Introduction

Tonsillectomy has become one of the most commonly performed surgical procedures in the pediatric-aged patient. Many of these children are diagnosed with obstructive sleep apnea (OSA). Although polysomnography is considered the gold standard, many practioners rely on the clinical examination and parental history. Nationwide Children's Hospital recently instituted pediatric adenotonsillectomy guidelines for hospital admission to help determine which patients should be done in main hospital OR vs. outpatient surgery facility. The main goal was to decrease unanticipated admissions. The secondary goal was to determine areas for practice improvement.

Methods

Using databases for the hospital, operating room, and otolaryngology, all cases with CPT codes 42820, 42830, 42825, 42826, and 42821 were evaluated from October 2009 to August 2012 in the main operating room and 2 outpatient surgery centers. Data for each unanticipated admission were reviewed to determine whether the criteria were met according to the developed guidelines. Fisher's exact test was applied to the unplanned admission rate before and after the institution of the guidelines. Non-paired t-test and a Fisher's exact test were used for comparison of the demographic data between the two groups.

Results

Following the institution of the pediatric adenotonsillectomy guidelines, the number of unanticipated admissions decreased from an absolute number of 88 to 43. This represents a decrease from 2.38% to 1.44% (p = 0.008). Forty-two percent of the unanticipated admissions prior to establishing guidelines were in patients who would have met criteria for admission based on the guidelines. This decreased to 30% after establishing the guidelines.

Conclusion

We found that the institution of pediatric adenotonsillectomy guidelines for patients undergoing adenotonsillectomy significantly decreased the rate of unanticipated admission. However, there was still a significant percentage (30%) of unanticipated admissions due to non-compliance with the guidelines demonstrating the need for ongoing practice improvement.     

Late-onset laryngomalacia: a cause of pediatric obstructive sleep apnea

Objective

To describe the presentation, diagnosis, and treatment of late-onset laryngomalacia in children with obstructive sleep apnea syndrome (OSAS).

Design

Retrospective study.

Setting

Tertiary care children's hospital.

Patients

Seventy-seven children were identified who had OSAS diagnosed by polysomnography and underwent airway endoscopy to evaluate for laryngomalacia between July 2006 and December 2008. Children with significant neurologic disease or craniofacial malformations were excluded. Seven children under 3 years of age had laryngomalacia and OSAS (Group A), 19 children 3-18 years of age had laryngomalacia and OSAS (Group B), and 51 children 3-18 years of age had OSAS but not laryngomalacia (Group C).

Main outcome measures

Comparison of pre-operative findings, intra-operative findings, interventions, and outcomes between the 3 groups.

Results

Group A was consistent with previous reports of congenital laryngomalacia with respect to presentation, diagnosis, and treatment. Groups B and C had similar pre-operative findings, including a high incidence of adenotonsillar hypertrophy, and the only significant difference was the intra-operative finding of laryngomalacia in Group B. Treatments were individualized to include supraglottoplasty, adenoidectomy, tonsillectomy, adenotonsillectomy, or a combination of the above. Of the 52 patients who returned in follow-up, 44 noted improvement, but this was rarely confirmed by polysomnogram.

Conclusions

Late-onset laryngomalacia may act alone or in concert with additional dynamic or fixed lesions to cause pediatric OSAS. Although there is no specific pre-operative indicator to diagnose late-onset laryngomalacia, it can be readily identified intra-operatively and effectively treated with supraglottoplasty, with or without concurrent adenotonsillectomy.     

咽部肌肉和结构与阻塞性睡眠呼吸暂停的关系

上呼吸道包括鼻、咽、喉和胸腔外气管。研究最为关注的是咽部气道,这是阻塞性睡眠呼吸暂停综合征(OSAS)患者睡眠中发生部分或完全性阻塞的部位。在神经调节和化学调节下,咽部气道周围的肌肉可根据需要来调节气道口径和强直度。就睡眠期咽部肌肉和结构相互作用所维持的正常咽部气道,以及可能与睡眠呼吸障碍病理生理学相关的新研究作了阐述。     

The effect of adenotonsillectomy on right ventricle function and pulmonary artery pressure in children with adenotonsillar hypertrophy

Objectives

Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction in children. Severe upper airway obstruction may have an effect on chronic alveolar hypoventilation, which consequently may lead to right ventricle (RV) dysfunction induced by hypoxemic pulmonary vasoconstriction. The investigators aimed to study RV function and mean pulmonary artery pressure (mPAP) in patients with ATH who were undergoing adenotonsillectomy by using tissue Doppler echocardiography (TDE).

Methods

The study examined 27 children with ATH who had a mean age of 8 ± 2 years. The subjects were comprised 17 (63%) males and 10 (37%) females. Hypertrophy of the tonsils was graded according to the Brodsky scale. Children having either grade 3 or 4 hypertrophied adenotonsils were recruited for the study. Adenotonsillectomy was performed on all subjects in the study group and echocardiographic examination was repeated 3 months postoperatively.

Results

Tricuspid Em significantly increased after adenotonsillectomy (17.7 ± 3.6 vs. 19.1 ± 5.5, p = 0.04). The RV myocardial performance index (MPI) and mPAP significantly decreased after adenotonsillectomy (RV MPI: 0.57 ± 0.13 vs. 0.40 ± 0.12, p < 0.001 and mPAP (mm Hg): 31 ± 9 vs. 25 ± 7, p = 0.001).

Conclusion

The results of this study, evaluated with the results of previous studies, demonstrated that adenotonsillectomy improved RV performance and reduced mPAP in children with ATH.     

关于儿童阻塞性睡眠呼吸暂停低通气综合征我们面临的问题

儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)为耳鼻喉科常见病,其发病率高,且严重危害儿童生长发育。儿童OSAHS的发病与多种因素有关,其中最常见的原因是扁桃体肥大及腺样体肥大。扁桃体腺样体切除术是治疗儿童OSAHS的首选方法,但是仍然有一些问题需要面对,现就儿童OSAHS的术前评估、术后对生活质量的影响、术后继续干预等问题进行述评。     

Computational modeling of upper airway before and after adenotonsillectomy for obstructive sleep apnea

Adenotonsillectomy, the first-line surgical treatment for obstructive sleep apnea (OSA) in children, is successful in only 50% of obese children. Computational fluid dynamics tools, which have been applied to differentiate OSA patients from those without OSA based on the airway flow characteristics, can be potentially used to identify patients likely to benefit from surgical intervention. We present computational modeling of the upper airway before and after adenotonsillectomy in an obese female adolescent with OSA. The subject underwent upper airway imaging on a 1.5 Tesla magnetic resonance imaging (MRI) scanner, and three-dimensional airway models were constructed using airway boundary coordinates from cross-sectional MRI scans. Our results using computational simulations indicate that, in an obese child, the resolution of OSA after adenotonsillectomy is associated with changes in flow characteristics that result in decreased pressure differentials across the airway walls and thus lower compressive forces that predispose to airway collapse. Application of such findings to an obese child seeking surgical treatment for OSA can potentially lead to selection of the surgical procedure most likely to result in OSA resolution. Effective intervention for OSA in this high-risk group will result in reduction in morbidity and the public health concerns associated with OSA.     

重视阻塞性睡眠呼吸暂停低通气综合征儿童腺样体

儿童阻塞性睡眠呼吸暂停低通气综合征(OSAS)是常见的儿童睡眠呼吸疾病。OSAS对儿童体格、神经认知发育、心血管系统以及内分泌代谢水平都可能产生危害。腺样体、扁桃体肥大是儿童OSAS的主要病因,腺样体、扁桃体切除术(T&A)因而是治疗儿童OSAS的一线治疗方法。多数接受T&A治疗的儿童睡眠呼吸障碍有显著改善,但按照研究定义的不同,儿童T&A术后OSAS残留的发生率在21.6%~49.0%之间。一些儿童存在术后OSAS残留的危险因素,对这些患儿后续的监测和管理有助于纠正残留疾病导致的病理生理危害及并发症。就腺样体、扁桃体切除术后残留的危险因素以及后续检查、治疗做一综述,旨在加强对儿童OSAS术后随访和管理的重视,提高儿童睡眠疾病的整体诊断和治疗水平。     

Lingual tonsils hypertrophy; a cause of obstructive sleep apnea in children after adenotonsillectomy: operative problems and management

Objective

Although adenotonsillar hypertrophy has been reported to be the commonest cause of pediatric obstructive sleep apnea (OSA), enlargement of the lingual tonsils is increasingly being recognized as a cause, even after adenotonsillectomy. The aim of our study was to elucidate the lingual tonsils hypertrophy as a cause of pediatric OSA and also to evaluate the efficacy of lingual tonsillectomy in relieving symptoms of the disease considering the peri-operative problems and management.

Methods

Sixteen children with lingual tonsils hypertrophy after adenotonsillectomy were included in the study. Computerized tomography (CT) and/or magnetic resonance imaging (MRI) were used for detection of the lesions. They underwent lingual tonsillectomy with special anesthetic care, flexible laryngoscopy and polysomnography were done pre- and post-operatively. Follow up of the patients was carried out for at least 1 year.

Results

Three cases developed post-operative airway obstruction that is caused by tongue base edema. Complete improvement of snoring and apnea was achieved in 10 cases. Despite complete ablation of lingual tonsils, persistent snoring was detected in six cases, while apnea was detected in two cases. Down's syndrome, mucopolysaccharidoses, and obesity may be underlying factors for persistent symptoms.

Conclusions

Lingual tonsils hypertrophy could be the cause of obstructive sleep apnea in children after adenotonsillectomy, lingual tonsillectomy is an effective treatment for these cases, however peri-operative airway problems should be expected and can be managed safely. Persistent symptoms after lingual tonsillectomy may be due to the presence of co-morbidities such as cranio-facial deformities, obesity, and/or mucopolysaccharidoses.     

男性阻塞性睡眠呼吸暂停低通气综合征患者血液学指标与睡眠呼吸暂停低通气指数的关系

目的 了解男性阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的血液常规及生化指标和睡眠呼吸暂停低通气指数（AHI）的关系。方法 对2011年1月—2019年12月住院手术治疗且入院前整夜睡眠监测数据完整的474例成年男性患者进行回顾性研究。根据AHI将患者分为4组：A组（AHI<30次/h,56例）、B组（30次/h≤AHI<60次/h,162例）、C组（60次/h≤AHI<90次/h,217例）和D组（AHI≥90次/h,39例）。收集的数据包括睡眠参数、Epworth嗜睡量表评分（ESS）、血液常规及生化指标和人口统计学特征。结果 4组患者的红细胞计数、血小板计数、白细胞计数、中性粒细胞、谷丙转氨酶（ALT）、谷草转氨酶（AST）、AST/ALT、葡萄糖、尿酸、甘油三酯、高密度脂蛋白差异均具有统计学意义（P<0.05）;高密度脂蛋白和甘油三酯与AHI的线性相关性较好,且前者呈负相关,后者呈正相关（r=-0.252,r=0.192）;多元线性回归分析表明红细胞计数（β=0.140,P=0.004）和甘油三酯（β=0.122,P=0.017）与AHI独立相关,多个相关系数R²=0.332。结论 高密度脂蛋白、甘油三酯与AHI的线性相关性较好,且前者呈负相关（r=-0.252）,后者呈正相关（r=0.192）,红细胞计数、甘油三酯与AHI独立相关,有潜力成为判断经多导睡眠监测（PSG）检查后诊断为OSAHS患者综合严重程度的辅助指标。     

阻塞性睡眠呼吸暂停低通气综合征与耳鸣的相关性研究

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与耳鸣的相关性。方法 选取经多导睡眠监测(PSG)确诊的OSAHS患者71例,根据患者睡眠呼吸暂停低通气指数(AHI)分组,比较各组间耳鸣的发生率及各组间年龄、体质指数(BMI)、血氧饱和度、血压、平均听阈(PTA)的差异。利用多因素Logistic分析患者AHI、BMI、最低血氧饱和度与耳鸣发生的相关性。结果 71例OSAHS患者中,轻度14例,中度16例,重度41例;轻度缺氧41例,中度缺氧18例,重度缺氧12例。无耳鸣者42例,有耳鸣者29例。29例伴有耳鸣患者中,听力损失：轻度9例,中度3例,重度17例,听阈值以4～8 kHz为主。轻、中、重度OSAHS组耳鸣发生率分别为：44.4%(6/14)、58.3%(9/16)、34.1%(14/41)。结论 OSAHS患者更易损伤高频听力,OSAHS患者耳鸣的发生率与其严重程度无关。OSAHS患者耳鸣的发生可能是多种因素共同作用的结果。     

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。