学龄前和学龄期阻塞性睡眠呼吸暂停低通气综合征患儿呼吸事件特点及影响因素分析

目的 探讨学龄前和学龄期阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿睡眠呼吸事件特点及相关影响因素.方法 统计2018年1月1日-2018年12月31日因打鼾、张口呼吸在首都医科大学附属北京儿童医院就诊,年龄3～14岁,并在睡眠中心行多导睡眠监测(PSG)确诊为OSAHS儿童.按年龄分为学龄前(3～5岁)和学龄期(...     

Contribution of drug-induced sleep endoscopy to the management of pediatric obstructive sleep apnea/hypopnea syndrome

ObjectivesThe role of drug-induced sleep endoscopy (DISE) in the management of obstructive sleep apnea/hypopnea syndrome (OSAHS) is not precisely defined in children. The primary objective of this study was to describe DISE-induced revision of airway obstruction site location and the ensuing treatment changes in children with OSAHS. Secondary objectives were to analyze the correlation of number of obstruction sites found on DISE with apnea-hypopnea index (AHI) and with type of OSAHS.Material and methodsA retrospective single-center study included 31 children (mean age: 5.5 ± 2.6 years) undergoing DISE for management of OSAHS between 2015 and 2018. Revisions of airway obstruction site location and in treatment were noted. The correlation of number of obstruction sites with AHI and with type of OSAHS was analyzed.ResultsAirway obstruction site location was reconsidered in 77% of children (n = 24), modifying treatment in 45.2% (n = 14). There was no significant correlation between number of obstruction sites and AHI: Spearman coefficient 0.20 (P = 0.26). Patients with type-III OSAHS did not show more obstruction sites than others: respectively, 2.0 versus 1.8 (P = 0.40).ConclusionDISE induced significant revision of the location and change in treatment of obstruction sites in children with OSAHS. Systematic implementation, especially in type-I OSAHS, would allow more precise pre-therapeutic classification and treatment adapted to actual airway obstruction.     

临床医师对儿童阻塞性睡眠呼吸暂停低通气综合征的认知度调查

目的 分析与儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)诊治关系最为密切的临床专科医师OSAHS知识水平和自我评估.方法 采用经原作者授权翻译的美国儿童阻塞性睡眠呼吸暂停低通气综合征知识及态度问卷(Obstructive sleep apnea knowledge and attitudes questionnaire in children,OSA-KIDS)中文版,以邮寄方式对山东省43所公立医院的耳鼻咽喉科和小儿内科医师进行问卷调查.结果 OSA-KIDS中文版经30名医师重测,r=0.92.回收有效问卷391份,占87.7%.18个知识条目平均正确率((x-)±s)为64.1%±19.1%,克朗巴赫α系数=0.76.耳鼻咽喉科与小儿内科医师知识条目总得分差异无统计学意义,但耳鼻咽喉科医师对"大约有2%的儿童患有OSAHS"判断正确率较高,小儿内科医师对"儿童OSAHS可以导致肺动脉高压"判断正确率较高(P值均＜0.05).仅有24.3%的医师知晓儿童打鼾的强弱程度与OSAHS的严重程度无关;正确回答婴幼儿心脏呼吸监测不能作为中枢性与阻塞性呼吸暂停的可靠鉴别手段只有16.1%.自我评估5个条目的 克朗巴赫α系数=0.72.90%以上的医师认为儿童OSAHS作为一种临床疾病具有重要意义,但仅有约36%的医师对儿童OSAHS的诊断与治疗感到自信.知识总得分与医师性别、学历等无关(P值均＞0.05),但随着医师年龄及执业年限的增加而增加(P＜0.05).医师对疾病重要性的认识及诊治自信心的自我评估等级呈正相关趋势(r=0.384,P＜0.0001).结论 对山东省部分耳鼻咽喉科和小儿内科医师的调查发现,临床专科医师对儿童OSAHS重要性认识不足,相关知识水平的掌握仍有待提高.     

临床疑似阻塞性睡眠呼吸暂停低通气综合征儿童的多道睡眠图分析

目的通过对临床怀疑为阻塞性睡眠呼吸暂停低通气综合征（obatructive sleep apnea hppopnea syndrome，OSAHS）儿童的多道睡眠图分析，探讨阻塞性呼吸暂停指数（obstructive apnea index，OAI）、呼吸暂停低通气指数（apnea—hypopnea index，AHI）、脑电醒觉反应指数的特点。方法对61例临床怀疑为OSAHS的儿童行多道睡眠监测，按照广州市儿童医院耳鼻咽喉科实验室标准[简称科室标准，将口鼻气流停止、胸腹呼吸运动存在的持续任何时间长度的阻塞性呼吸暂停事件均定义为阻塞性呼吸暂停，睡眠过程中呼吸气流强度（幅度）较基础水平降低50％以上并伴有动脉血氧饱和度较基础水平下降≥0．04定义为低通气]分析其OAI、AHI、脑电醒觉反应指数。再以乌鲁木齐草案的标准[对阻塞性呼吸暂停的时间长度定义为大于或等于2个呼吸周期，低通气为口鼻气流信号峰值降低50％，并伴有0．03以上的血氧饱和度下降和（或）觉醒]重新分析这组结果。结果①67．2％（41例）的疑似OSAHS儿童发生了共206次阻塞性呼吸暂停事件，88．5％（54例）的儿童发生了共2249次阻塞性低通气事件，呼吸事件主要发生在快动眼睡眠期（rapid eye movement sleep。REM sleep）；②采用科室标准61例疑似OSAHS儿童中有68．9％（42例）的儿童OAI〈1次／h，有34．4％（21例）的儿童AHI〈5次／h；采用乌鲁木齐草案标准61例儿童中有75．4％（46例）的疑似OSAHS儿童OAI〈1次／h，有24．6％（15例）的儿童AHI〈5次／h；③与呼吸有关的脑电醒觉反应指数与自发性脑电醒觉反应指数之间的差异有统计学意义（z=-5．787，P=0．000），自发性脑电醒觉反应指数大于与呼吸有关的脑电醒觉反应指数。结论在儿童OSAHS诊断标准的制订中应考虑到低通气事件的重要性，呼吸事件判断依据的确定应建立在大规模调查的基础上，应慎重考虑脑电醒觉反应在诊断中的地位。     

Obstructive Sleep Apnea–Hypopnea Ssyndrome and Hearing in Children

ObjectiveTo explore the relationship between hypoxemia and hearing in children with obstructive sleep apnea–hypopnea syndrome. Methods Auditory brainstem responses (ABRs) were recorded in 68 ears and distortion product otoacoustic emissions (DPOAEs) in 60 ears in children with OSAHS and type “A” tympanograms, and in 30 ears in normal children.ResultsABR latencies of waves I, III and V, and I–III, III–V and I–V intervals were not statistically different between OSAHS and normal children. Wave I latency was delayed in children with OSAHS compared to normal children3 (P < 0.05). DPOAE amplitudes in children with mild OSAHS were lower than normal children at 8 kHz (P < 0.05). DPOAEs were lower at 6 kHz and 8 kHz in children with moderate/severe OSAHS than normal children (P < 0.05).ConclusionCochlear function was affected when AHI was at or greater than 10/hour. ABR and DPOAE can be used to detect early changes in auditory function in children with OSAHS.     

儿童上气道阻力综合征与阻塞性睡眠呼吸暂停低通气综合征的临床分析

目的 分析上气道阻力综合征(upper airway resistance syndrome,UABS)与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床表现的异同,探讨两者临床特点和睡眠呼吸特征.方法 采用双盲法收集资料,所有患儿多道睡眠临测南1名睡眠技师和1名耳鼻咽喉科医师分析监测结果确诊为UARS和OSAHS,再由另外的耳鼻咽喉科医师详细记录两者的临床表现和体格检查.结果 睡眠监测结果,253例OSAHS患儿的呼吸暂停低通气指数和最低血氧饱和度中位数[25分位数;75分位数]分别为3.60[2.00;7.55]次/h和0.90[0.85;0.91],而102例UARS的同类指标分别为0.90[0.50;1.10]次/h和0.95[0.92;0.96],秩和检验差异均有统计学意义(P值均<0.001).两组学龄前期患儿比例均较学龄期患儿高.两组患儿均以睡眠打鼾为主诉,均以睡眠打鼾、睡眠不安、注意力缺陷和多动、张口呼吸为主要症状,以上症状的发生率:UARS分别为94.1%、72.5%、62.7%、37.3%,OSAHS分别为92.9%、78.7%、57.7%、45.5%,卡方检验差异均无统计学意义(P值均>0.05).两组患儿均多伴扁桃体和腺样体肥大,但差异没有统计学意义(x2=0.27,P=0.87),而OSAHS患儿较UARS患儿更容易观察到睡眠出现呼吸暂停情况,差异有统计学意义(x2=34.07,P<0.001).结论 UARS和OSAHS的临床表现相近,根据患儿的临床表现难以判断两者的差别,OSAHS患儿更易被观察到睡眠出现呼吸暂停的情况,两者的确诊要依据睡眠监测.     

Value of pulse oximetry watch for diagnosing pediatric obstructive sleep apnea/hypopnea syndrome

Objective: To evaluate the clinical value of pulse oximetry watch (POW) for diagnosing pediatric Obstructive sleep apnea/hypopnea syndrome (OSAHS).

Methods: We selected 32 children (boys: 25, 4–16 years old) who came to the hospital for diagnosing OSAHS from July to October 2016. Polysomnography (PSG) and POW were used simultaneously and recorded the apnea hypopnea index (AHI), LSpO₂, and ODI₄. Pearson analysis, t test, and receiver-operating characteristic (ROC) were used to analyze the correlation between PSG-AHI and other indicators, the diagnosis accordance rate, and the sensitivity and specificity of POW, respectively.

Results: According to PSG-AHI, 32 children were divided into two groups: primary snoring (n?=?5) and OSAHS (n?=?27). There was no significant difference between PSG-ODI₄ and POW-ODI₄ (p?>?.05). A statistically significant correlation between PSG-AHI and POW-ODI₄ was found (r?=?.719, p?1, 5, 10, 15, and 20 events/h, the area under the curve (AUC) was 0.685 (p?>?.05), 0.733, 0.798, 0.922, and 0.929 (p?20 events/h level, whereas the sensitivity and specificity were unacceptable (<75%) at the level of AHI >1, 5, 10, and 15 events/h.

Conclusions: POW cannot replace PSG to diagnose pediatric OSAHS because of low sensitivity and specificity, but can be used for screening severe OSAHS in children.     

French Society of ENT (SFORL) guidelines (short version) on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome

ObjectiveThe authors present the guidelines of the French Society of ENT and Head & Neck Surgery (SFORL) on the role of the ENT physician in childhood obstructive sleep apnea-hypopnea syndrome (OSAHS). This section of the guidelines concerns the roles of the various medical and surgical treatment options.MethodA multidisciplinary work-group was entrusted with a review of the scientific literature on the topic. Based on the retrieved articles and the group members’ own experience, guidelines were drawn up, then read over by a reading group independent of the work-group. An editorial meeting then produced the final text.ResultsAdenotonsillectomy is the reference treatment for childhood OSAHS with adenotonsillar hypertrophy. Respiratory assistance is recommended in children with severe OSAHS without nasal and/or oropharyngeal obstacle, after surgery in case of persistent OSAHS, in case of contraindications to surgery, in complex obstruction related to pharyngolaryngeal or laryngeal pathology or comorbidity, or as an alternative to tracheotomy. Nasal route corticosteroids may be used in childhood OSAHS in with associated nasal obstruction.     

Complicaciones postoperatorias tras adenoamigdalectomía en niños con síndrome de apnea-hipopnea del sueño severo. ¿Requieren ingreso en unidad de cuidados intensivos?

Introduction and objectivesIn recent years, with the rise of sleep-disordered breathing, we have been seeing more articles related to post-operative complications after adenotonsillectomy in children with sleep apnea-hypopnea syndrome (OSAS), especially in those with severe sleep apnea. The objective of this study was to evaluate post-operative complications in children with severe OSAS compared to children who had adenotonsillectomy for a different reason, and establish whether they needed admission to an intensive care unit or not.MethodsAll children undergoing adenotonsillectomy in our hospital in the last 5 years were initially included in this study. Complications were analysed with a retrospective review.ResultsTwo hundred and twenty nine children admitted for adenotonsillectomy were finally included. In the whole group, complications occurred in 3.5% of children, 2.2% corresponding to respiratory complications. Children with sleep apnea (3.23% vs 1.47%, P = .39) or severe sleep apnea (3.77% vs 1.70%, P = .32) presented a higher incidence of respiratory complications, which was not statistically significant and was far below those published by other authors. All respiratory complications took place in the immediate post-operative period (operating theatre or anaesthesia recovery), with none in the paediatric ward.ConclusionsIn our population, children who undergo adenotonsillectomy, without any other comorbidities, malformation syndrome or neuromuscular disease, are more than 2 years old and have an immediate postoperative period without incidence, do not need to be systematically admitted to an intensive care unit, even if they present with severe OSAS.     

The use of dual-energy X-ray absorptiometry in the evaluation of obesity in women with obstructive sleep apnea–hypopnea syndrome

The inflammatory state caused by obesity increases the level of adipokines, such as leptin, with a direct impact on the central respiratory regulation. The present study addresses this problem by evaluation of the association of sleep apnea diagnosis in relation to body fat measured by dual-energy X-ray absorptiometry (DXA), anthropometric parameters and biochemical variables. All patients carried out overnight polysomnography, anthropometric evaluations [Body Mass Index (BMI), neck and waist circumference], body composition analyzed by DXA and blood sample collection (lipid profile, fasting glycemia, insulin, glycated hemoglobin, C-reactive protein and serum leptin levels). Obstructive sleep apnea–hypopnea syndrome (OSAHS) was defined by the apnea–hypopnea index (AHI) from the overnight polysomnography. According to the AHI, the women were divided into two groups: with and without apnea. Twenty-seven of them had OSAHS (AHI = 22.04 ± 17.55). The main results are the following: (a) BMI was not capable of predicting OSAHS in this study (p = 0.204); (b) for each 1 % increase in TBF %, the probability of having sleep apnea increased by 12.8 %; (c) comparing all variables (anthropometrics, DXA and blood sample), serum leptin was the only variable with a significant difference between the groups (p = 0.0257). The results reinforce the role of total body fat and leptin in the etiology of OSAHS and the need to include the evaluation of corporal composition measures by DXA in studies of sleep apnea.     

Normalization of breathing with adenotonsillectomy in Japanese pediatric OSA

ObjectiveSince reports on surgical results for pediatric obstructive sleep apnea (OSA) in Japan are insufficient for debate, this study aimed to evaluate the feature of Japanese OSA children and surgical result and document whether is obesity and affecting factor similar to non-Asian countries.MethodsThis is a retrospective study. A total of 242 children with OSA at the Department of Otolaryngology and the Good Sleep Center, Nagoya City University Hospital and the Toyohashi Mates Sleep Disorders Center were included in the study. All children underwent pre- and postsurgical polysomnography. OSA was defined as an apnea hypopnea index (AHI) 5 or greater. Pre- and postsurgical respiratory parameters were compared using paired T test.ResultsNormalization of breathing after surgery for OSA children was 40% with AHI < 2 and 85% with AHI < 5. Japanese OSA children are not as obese as OSA children in many non-Asian countries. However, the normalization of breathing as a result of surgery in Japanese OSA children does not differ much from non-Asian countries.ConclusionJapanese pediatric OSA that is not normalized by surgery may be affected by factors other than obesity.     

变态反应与儿童OSAHS的关系

儿童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。扁桃体和腺样体均为淋巴组织,位于消化道、呼吸道的入口处且长期接触各种食入、吸入性变应原的刺激,越来越多的研究表明,变态反应在儿童OSAHS的发病中起一定作用,但对此也有不同的观点被提出。对变态反应与儿童OSAHS的关系进行综述,为儿童OSAHS的内科治疗提供依据。     

Exercise capacity,respiratory mechanics and posture in mouth breathers

Chronic and persistent mouth or oral breathing (OB) has been associated with postural changes. Although posture changes in OB causes decreased respiratory muscle strength, reduced chest expansion and impaired pulmonary ventilation with consequences in the exercise capacity, few studies have verified all these assumptions.ObjectiveTo evaluate exercise tolerance, respiratory muscle strength and body posture in oral breathing (OB) compared with nasal breathing (NB) children.Material and methodA cross-sectional contemporary cohort study that included OB and NB children aged 8-11 years old. Children with obesity, asthma, chronic respiratory diseases, neurological and orthopedic disorders, and cardiac conditions were excluded. All participants underwent a postural assessment, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), the six-minute walk test (6MWT), and otorhinolaryngologic evaluation.ResultsThere were 107 children (45 OB and 62 NB). There was an association between abnormal cervical posture and breathing pattern: 36 (80.0%) OB and 30 (48.4%) NB presented abnormal head posture (OR=4.27 [95% CI: 1.63-11,42], p<0.001). The mean MIP and MEP were lower in OB (p=0.003 and p=0.004).ConclusionOB children had cervical spine postural changes and decreased respiratory muscle strength compared with NB.     

脉搏传导时间在检测呼吸驱动力中的价值

目的 评价脉搏传导时间(pulse transit time,PTT)在判断呼吸暂停性质方面的准确性,为临床应用该方法 提供依据.方法 32例阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者被纳入本研究.多道睡眠监测(PSG)共监测得到10 305次呼吸暂停事件.应用PTT和食管压分别分析所有呼吸暂停事件,综合比较两次分析结果 ,探讨PTT的准确性.比较动眼和非动眼睡眠期的PTT准确性,并分析每个患者PTT准确性与临床资料的关系.结果 在判断呼吸暂停性质方面,PTT与食管压的总体一致率达到96.7%(9970/10305).以食管压的判断为金标准,PTT检出中枢性、阻塞性和混合性呼吸暂停的敏感度分别为88.0%、91.3%和97.8%;特异度分别为99.8%、97.8%和92.8%.暂停事件的错判主要集中于阻塞性和混合性呼吸事件间相互错判.动眼和非动眼睡眠期PTT判断的准确性差异无统计学意义.PTT判断呼吸事件的准确率与年龄、BMI、最低血氧饱和度、AHI等无明显相关性.结论 PTT与食管压在判断呼吸事件性质方面有很好的一致性,对各类呼吸暂停的检出都具有很高的敏感度和特异度,是无创检出呼吸驱动力的良好方法 .     

Hearing loss and airway problems in children with mucopolysaccharidoses

IntroductionMucopolysaccharidoses (MPS) are a group of systemic diseases characterised by a genetic deficiency of lysosomal enzymes that causes the accumulation of glycosaminoglycans in different tissues. The onset of symptoms usually occurs in early childhood, causing problems of otitis media, hearing loss and airway obstruction in the ENT area.ObjectiveDescribing the audiological findings and airway pathology found in 9 children diagnosed as having MPS.MethodsA retrospective review was performed of the clinical and audiological findings, exploratory results and therapeutic ENT procedures for 9 children diagnosed with MPS in an ENT service at a tertiary paediatric public centre in the period 2007-2010.ResultsSubtypes found were 4 MPS type I, 2 moderate MPS type II, 1 severe MPS type II, 1 MPS type IV and 1 MPS type VI. All patients presented chronic middle ear effusions. A child developed mild bilateral sensorineural hearing loss; another case was diagnosed as mixed hearing loss. The remaining auditory pattern was moderate bilateral conductive hearing loss. Four patients showed secondary obstructive sleep apnoea/hypopnoea syndrome (OSAHS) due to Waldeyer ring hyperplasia; surgery could not be performed on one of them because of cervical spinal cord compression from mucopolysaccharide deposits. In 2 cases, there was OSAHS relapse.ConclusionsChildren with MPS are at increased risk for developing sensorineural hearing loss. The OSAHS syndrome appears in greater proportion than in the general child population, and recurrences may occur more frequently after surgery. Such children can also be risk patients in airway management.     

Age specific differences in pediatric obstructive sleep apnea

Background

Some have suggested that younger children have a more severe form of obstructive sleep apnea than older children and therefore are at a higher risk for respiratory compromise after tonsillectomy and adenoidectomy. However, at present there are few studies that have identified any significant correlation between age and severity of obstructive sleep apnea.

Objective

To determine if age specific differences in obstructive sleep apnea are present in children.

Design

Retrospective chart review.

Setting

Tertiary care children's hospital.

Patients

The records of children (1-18 years of age) with obstructive sleep apnea diagnosed by overnight polysomnography between January 1998 and January 2001 were reviewed. Children included in the study also had evidence of adenotonsillar hypertrophy and had no other co-existing medical problems.

Main outcome measures

Overnight polysomnography was performed in all children. Apnea-hypopnea index (AHI), baseline and lowest O₂ saturation, baseline and peak end tidal CO₂, and total number of obstructive apneas, hypopneas, central apneas and mixed apneas were measured during each polysomnogram. Children were subdivided into the following age groups: 1-2, 3-5, 6-11 and 12-18 years. Polysomnograms were classified into normal, mild, moderate and severe categories.

Results

Three hundred and sixty-three children were studied; 45 children were ages 1-2 years, 159 children were ages 3-5 years, 137 children were 6-11 years and 22 children were 12-18 years. Although there appears to be a trend towards a greater mean number of obstructive apneas, hypopneas, central apneas, mixed apneas, a higher mean AHI, lower mean SaO₂ nadir, and a higher mean PETCO₂ in the younger age groups when compared to the older groups, a Student's t-test demonstrates that there is no statistical significance for most OSA parameters. An analysis of variance using the F-test reveals statistical significance (p < 0.01) when children ages 1-2 were compared to those 3-5, 6-11 or 12-18 years of age for the variables AHI, mean number of central apneas, hypopneas and mixed apneas. When comparing patients in the various severity categories, children ages 1-2 years show a distinct distribution with a larger percentage in the moderate to severe categories. Chi square analysis reveals a significant difference between the frequency distribution of children in age group 1-2 years and that of the other age groups (p < 0.01).

Conclusion

There is a predilection for children less than 3 years of age to have more severe obstructive sleep apnea as documented by polysomnography. Central apnea also appears to be more common in this age group. These findings may be explained by anatomic and physiologic differences related to age and support a period of observation following adenotonsillectomy in younger children.     

Polysomnographic results of prone versus supine positioning in micrognathia

BackgroundChildren with micrognathia commonly present with upper airway symptoms and are at risk for developing obstructive sleep apnea (OSA). Prone positioning is widely used as first-line management for micrognathic children with obstructive symptoms. The aim of the present study was to document the effect of positioning on oxygenation and upper airway obstruction as measured by polysomnography (PSG).MethodsThree children with micrognathia from two institutions underwent PSG in both the prone and supine position.ResultsPatient ages were 1 week, 3 months, and 7 months. Supine obstructive apnea–hypopnea indices (oAHI) were severe for all 3 children, with a mean of 21.9 events/hour (range 16.8 to 26.3). In the prone position, the oAHI significantly improved in 2 of 3 children, with a mean of 5.1 events/hour (range 0.3 to 10.3). The frequency of central apnea events increased in 1 child following supine positioning. Nadir oxygen saturation improved in 2 of 3 children and remained within normal limits in the third.ConclusionsThis is the first report of the effect of positioning on changes in PSG indices of micrognathic children. Improvement in obstructive PSG indices occurred with prone positioning, though OSA persisted in 2 of 3 children. The effect of positioning on central apnea was unclear. In light of these findings, we recommend that routine PSG be considered in micrognathic children undergoing prone positioning for definitive therapy of upper airway obstruction.     

Transoral robotic surgery vs. endoscopic partial midline glossectomy for obstructive sleep apnea

ObjectiveTo compare sleep-related outcomes in obstructive sleep apnea hypopnea syndrome (OSAHS) patients following base of tongue resection via robotic surgery and endoscopic midline glossectomy.MethodsThis was a retrospective study. A total of 114 robotic and 37 endoscopic midline glossectomy surgeries were performed between July 2010 and April 2015 as part of single or multilevel surgery. Patients were excluded for indications other than sleep apnea or if complete sleep studies were not obtained. Thus, 45 robotic and 16 endoscopic surgeries were included in the analysis.ResultsIn the robotic surgery group there were statistically significant improvements in AHI [(44.4 ± 22.6) events/h–(14.0 ± 3.0) events/h, P < 0.001] Epworth Sleepiness Scale (12.3 ± 4.6 to 4.5 ± 2.9, P < 0.001), and O₂ nadir (82.0% ± 6.1% to 85.0% ± 5.4%, P < 0.001). In the endoscopic group there were also improvements in AHI (48.7 ± 30.2 to 27.4 ± 31.9, P = 0.06), Epworth Sleepiness Scale (12.6 ± 5.5 to 8.3 ± 4.5, P = 0.08), and O₂ nadir (80.2% ± 8.6% to 82.7% ± 6.5%, P = 0.4). Surgical success rate was 75.6% and 56.3% in the robotic and endoscopic groups, respectively. Greater volume of tissue removed was predictive of surgical success in the robotic cases (10.3 vs. 8.6 ml, P = 0.02).ConclusionsBoth robotic surgery and endoscopic techniques for tongue base reduction improve objective measures of sleep apnea. Greater success rates may be achieved with robotic surgery compared to traditional methods.     

Rate and risk factors for post-adenotonsillectomy complications in children under 24 months and 24 to 36 months old

PurposeThe primary purpose of this study was to assess the overall rate of postoperative complications after adenotonsillectomy in children under 24 months old relative to children 24–36 months old. Our secondary goal focused on quantifying specific preoperative risk factors that predispose children to postoperative complications.MethodsWe retrospectively reviewed 248 patients who underwent adenotonsillectomy at our ENT office from 2006 to 2011. We stratified these patients into two groups: under 2 years old; and 2–3 years old. We identified 42 preoperative risk factors and 22 postoperative complications for each age group and conducted tests of statistical significance.ResultsWe found that children under 24 months old had a statistically significant higher postoperative complication rate of 38% compared to 22.3% in children 2–3 years old (p = 0.0320, chi-squared test). For specific complications, younger children had a higher rate of respiratory distress within 24 h (p = 0.0355), endotracheal re-intubation (p = 0.0281), and retractions (p = 0.0281). The only identified risk factors aside from age demonstrating statistical significance were nasal steroid sprays used preoperatively in children under 24 months (p = 0.005) and concurrent tympanostomy tube placement in children 24–36 months (p = 0.026).ConclusionOur data demonstrates that children under 2 years of age have an overall increased rate of postoperative complications after adenotonsillectomy when compared to children between 2 and 3 years old, with a significantly higher rates of early respiratory distress, endotracheal re-intubation, and retractions. This study is one of the largest that compares postoperative complication rates and risk factors after adenotonsillectomy in this age group.