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.     

扁桃体腺样体切除对儿童阻塞性睡眠呼吸暂停低通气综合征术后免疫功能的影响

儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OS-AHS)是一种在儿童中较为常见的呼吸道阻塞性疾病,常常会影响儿童的智力以及体格发育。对于伴有扁桃体反复发炎以及夜间睡眠呼吸暂停的OSAHS患儿,扁桃体和腺样体切除术是最有效的     

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.     

Nocturnal enuresis in children with upper airway obstruction

This article reviews 35 children between the ages of 3 1/2 and 11 years who have had symptoms of upper airway obstruction and enuresis. Twenty-eight patients had primary enuresis, and 7 had secondary enuresis. Removal of upper airway obstruction by surgical intervention led to a significant decrease or complete cure of nocturnal enuresis in 26 patients. Four children were studied with polysomnographic tracings in relationship to their enuresis.     

等离子射频消融术在儿童阻塞性睡眠呼吸暂停中的应用和进展

精准微创的科学理念推动耳鼻咽喉头颈外科手术方式不断进步,等离子射频消融术的应用与发展为典型代表.分析等离子射频消融术在儿童阻塞性睡眠呼吸暂停手术(扁桃体腺样体切除术)中的使用特点,包括操作简便,手术时间短;术野清晰,出血量少;温度较低,避免热灼伤且创面光滑平整,术后疼痛轻,恢复正常饮食较早;术后白膜形成早,但在炎性细胞...     

阻塞性睡眠呼吸暂停低通气综合征患者上气道的MRI研究

目的:应用MRI比较阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者和正常健康人上气道及其周围软组织的差异,分析判断阻塞部位,为OSAHS的临床诊疗提供参考.方法:对经PSG确诊的33例OSAHS患者(OSAHS组)应用超快速MRI对其上气道进行扫描观察,对患者软腭后区、舌后区和会厌后区的截面积、咽壁厚度等进行测量.选择20例无打鼾的同年龄组健康人作为对照组.结果:不同程度OSAHS患者咽部气道面积均小于对照组,程度越重,相应的气道面积越小、咽壁厚度越大.OSAHS组软腭截面积、长度和厚度均大于对照组,OSAHS程度越重,软腭截面积、长度和厚度越大.OSAHS组软腭后区气道截面积与AHI呈负相关,舌后区气道截面积与颈围呈负相关.结论:运用MRI进行上气道扫描并辅以形态测量可有效判定OSAHS患者上气道咽腔狭窄情况,对确定治疗措施具有一定指导意义.     

Surgical management of obstructive sleep apnea in children with cerebral palsy.

OBJECTIVES: To evaluate the surgical management of obstructive sleep apnea in children with cerebral palsy. STUDY DESIGN: Retrospective review of 27 children with cerebral palsy who underwent surgical treatment for obstructive sleep apnea. METHODS: Charts were reviewed. Data gathered included primary complaint, coexisting illnesses, initial procedure performed, age at initial surgery, number of days the child was monitored postoperatively in the intensive care unit, notation of postoperative respiratory distress and management, and outcome. RESULTS: Nineteen children underwent adenotonsillectomy for initial treatment of obstructive sleep apnea. Three of these children also had a uvulectomy. Six children had an adenoidectomy alone as their initial procedure. Neither uvulopalatopharyngoplasty nor tracheostomy was performed as an initial procedure. Mean follow-up was 34 months. Seventy-six percent of these children have not required any further surgery. Of the six children who have undergone further surgery, one has required a revision adenoidectomy, and another underwent a tonsillectomy and uvulectomy 2 months after the initial adenoidectomy. Four children ultimately required a tracheotomy. CONCLUSIONS: Eighty-four percent of these children were successfully managed without a tracheotomy. We recommend tonsillectomy and/or adenoidectomy for initial surgical treatment of obstructive sleep apnea in children with cerebral palsy.     

阻塞性睡眠呼吸暂停综合征患者上气道MRI观察

目的　通过比较清醒状态下阻塞性睡眠呼吸暂停综合征 (obstructivesleepapneasyndrome,OSAS)患者与健康人上气道及其周围软组织的差异 ,探讨OSAS的发生机制。方法　应用磁共振成像 (magneticresonanceimagiug ,MRI)对 1 8例经多导睡眠监测 (PSG)确诊的OSAS患者的上气道扫描 ,对上气道的软腭后区 (retropalatalregion ,RP)、舌后区 (retroglossalregion ,RG)和会厌区 (epiglottalregion ,EPG)截面积、各区咽壁厚度、RP区咽侧脂肪垫 (lateralparapharyngealfatpad ,LPFP)的截面积等进行测量。选择 1 9例无打鼾的同年龄组健康人做对照组。结果　①患者组RP、RG区气道截面积小于对照组 (P <0 0 5 ) ;患者组EPG区气道截面积与对照组无统计学差异 (P =0 2 0 4) ;②患者组RP、RG、EPG区气道前后径与左右径 (AP/L)比值均大于对照组 (P <0 0 5 ) ;③患者组RP区LPFP截面积大于对照组 ,(P <0 0 1 ) ;④患者组RP、RG、EPG区咽后壁厚度大于对照组 (P <0 0 5 ) ,患者组RP区咽侧壁厚度与对照组无统计学差异 ,而患者组RG和EPG区咽侧壁厚度均大于对照组 (P <0 0 5 ) ;⑤正中矢状位测量患者软腭截面积、厚度和长度均大于对照组 (P <0 0 1 )。结论　上气道截面积及其AP/L比值、咽侧壁厚度、咽后壁厚度 ,RP区L     

儿童阻塞性睡眠呼吸暂停低通气综合征上气道结构的MRI研究分析

目的 利用磁共振成像(MRI)对儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的上气道结构进行测量分析,探讨儿童OSAHS上气道的结构特点。方法 选择原发性鼾症组(PS组)30例和OSAHS组30例,同时随机选择30例正常儿童作为对照组,应用MRI对上气道进行空间测量和软组织测量,结果进行统计学分析。结果 ①空间测量： 3组儿童之间相比,鼻咽气道截面积、口咽气道截面积、腭咽气道截面积、气道斜径,比较差异有统计学意义(P＜0.05);②软组织测量：舌体截面积3组之间差异无统计学意义(P>0.05);OSAHS组比PS组及对照组腺样体截面积大、腺样体斜距长,比较有统计学意义(P＜0.05); OSAHS组、PS组比对照组扁桃体截面积大,比较有统计学意义(P＜0.05)。结论 应用MRI可以判定OSAHS儿童上气道的狭窄情况,可作为诊断儿童OSAHS的重要辅助手段。