Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography

OBJECTIVE: To evaluate the outcome of adenotonsillectomy for obstructive sleep apnea (OSA) in children using objective data from polysomnography supplemented by subjective proxy reports from the OSA-18 quality of life instrument. STUDY DESIGN: Prospective cohort study. METHODS: Children 3 to 14 years of age with OSA diagnosed principally on the basis of polysomnography as having an obstructive apnea/hypopnea index (AHI) of 5 or greater underwent adenotonsillectomy. OSA was classified as mild (AHI > or = 5 < 10), moderate (AHI > or = 10 < 20), or severe (AHI > or =20). Children enrolled in the study also had postoperative polysomnography 3 to 6 months after surgery. Caregivers completed the OSA-18 survey before surgery and within 6 months after surgery. Pearson correlation was used to compare the pre- and postoperative AHI values with the pre- and postoperative OSA-18 total scores. SAS procedures (SAS Corp., Cary, NC) were used for statistical analyses. A P value less than or equal to .05 was considered significant. RESULTS: The study population included 79 healthy children, 40 of who were male. The mean age was 6.3 (range, 3.0-14.0) years. Only tonsillar size was correlated significantly with a high preoperative AHI. For all children, the preoperative AHI value was higher than the postoperative value. The mean preoperative AHI for the study population was 27.5, whereas the mean postoperative AHI was 3.5. This change was highly significant (P < .001). The percentage of children with normal polysomnography parameters after adenotonsillectomy ranged from 71% to 90% as a function of the criteria used to define OSA. It was highest when an obstructive apnea index less than 1 was used and lowest when an AHI less than 1 was used to define resolution of OSA. Overnight respiratory parameters after adenotonsillectomy were normal for all children with mild OSA. Three (12%) children with moderate preoperative OSA, and 13 (36%) children with severe preoperative OSA had persistent OSA after adenotonsillectomy. Resolution of OSA occurred in all children with a preoperative AHI less than or equal to 10 and in 73% of children with a preoperative AHI greater than 10. The mean total OSA-18 score and the mean scores for all domains showed significant improvement after surgery (P < .001). The preoperative AHI values had a fair correlation with the preoperative total OSA-18 scores (r = 0.28), but postoperative AHI values had a poor correlation with the postoperative total OSA-18 scores (r = 0.16). Caregivers reported snoring some, most, or all of the time in 22 (28%) children; this group included all children with persistent OSA. CONCLUSIONS: Adenotonsillectomy for OSA results in a dramatic improvement in respiratory parameters as measured by polysomnography in the majority of healthy children. Quality of life also improves significantly after adenotonsillectomy for OSA in children. However, the correlation between improvements in respiratory parameters and improvements in quality of life is poor. Severe preoperative OSA is associated with persistence of OSA after adenotonsillectomy. Postoperative reports of symptoms such as snoring and witnessed apneas correlate well with persistence of OSA after adenotonsillectomy.     

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.     

Long-term changes in quality of life after surgery for pediatric obstructive sleep apnea

OBJECTIVE: To study long-term changes in quality of life in children after adenotonsillectomy for obstructive sleep apnea (OSA) documented by polysomnography. DESIGN AND SETTING: Prospective study of children with OSA at the University of New Mexico Children's Hospital, Albuquerque. METHODS: Children who met inclusion criteria underwent adenotonsillectomy. Caregivers were asked to complete the OSA-18 quality of life survey prior to surgery (survey 1), within 7 months after surgery (short-term) (survey 2), and between 9 and 24 months after surgery (long-term) (survey 3). Scores from the preoperative and postoperative surveys were compared using the paired t test. RESULTS: The study population included 34 children, 27 (79%) of whom were male. The mean age of the children at the time of inclusion in the study was 6.7 years (range, 3.0-16.8 years). The mean total score for survey 1 (76.7) was significantly higher (P<.001) than the mean total score for survey 2 (32.0) or for survey 3 (40.9). However, the domains of sleep disturbance and physical suffering were significantly lower (P相似文献   

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。     

Long-term effect of adenotonsillectomy on quality of life in pediatric patients

HYPOTHESIS: Adenotonsillectomy improves general and disease-specific quality of life for properly selected patients suffering for upper airway obstruction secondary to adenotonsillar hypertrophy (UAO) and obstructive sleep apnea (OSA). STUDY DESIGN: Prospective, nonrandomized questionnaire. SPECIFIC AIMS: To evaluate quality of life in patients with UAO and OSA using general quality of life instruments as well as disease-specific instruments. The results will be compared both pre- and postoperatively. METHODS: Fifty-five patients aged 2 to 16 with the clinical diagnosis of UAO or OSA were recruited. The caregivers completed Children's Health Questionnaire Parent Form-28 (CHQPF-28) and OSA-18 quality of life measures both pre- and postoperatively in the long and short term. Statistical analysis was performed using the unpaired Student t test, P value less than.05, and Spearman Rank coefficient. RESULTS: CHQ-PF28 scores were improved in the Physical Summary parameter in long-term follow-up. Psychosocial scores did not improve significantly. OSA-18 scores showed improvement in both the short-and long-term scores. Physical findings and symptoms did not impact scores in any domain. CONCLUSIONS: Quality of life in children with OSA does improve after adenotonsillectomy. Disease-specific clinometric instruments show improvement in domains affected by the disease process. However, instruments used to assess general quality of life may show physical improvement but not psychosocial.     

Quality of life after adenotonsillectomy for children with sleep-disordered breathing: A linear mixed model analysis

Objective

To study changes in quality of life (QoL) after adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB), and to elucidate discrepancies in QoL improvements after T&A in children of different gender, age, adiposity status, and disease severity.

Materials and methods

Children aged 2–18 years were recruited. All children had SDB-related symptoms and underwent preoperative full-night polysomnography (PSG). Caregivers completed the first obstructive sleep apnea 18-items questionnaire (OSA-18) prior to T&A and the second OSA-18 survey within 3 months after surgery. Disease severity was defined as primary snoring (apnea/hypopnea index, AHI < 1), mild obstructive sleep apnea (OSA) (5 > AHI ≥1), and moderate-to-severe OSA (AHI ≥ 5). Discrepancies in OSA-18 score changes after T&A for different groups were assessed using the linear mixed model.

Results

In total, 144 children were enrolled (mean age, 7.0 ± 3.6 years; 76% boy). The OSA-18 total score changes after surgery were not significantly different by gender (boys vs. girls), age group (≥6 years vs. <6 years), or adiposity (obese vs. non-obese). The OSA-18 total score changes after surgery differed by disease severity (primary snoring vs. moderate-to-severe OSA, P = 0.004; mild OSA vs. moderate-to-severe OSA, P = 0.003). Children with moderate-to-severe OSA had greater improvement in OSA-18 total score after surgery than those with mild OSA or primary snoring.

Conclusions

Children with SDB had QoL improvement after T&A, as documented by OSA-18 score changes. The QoL improvement after T&A for SDB children increased as disease severity increased, and the improvement was not affected by gender, age, or adiposity.     

Behavioral changes in children with mild sleep-disordered breathing or obstructive sleep apnea after adenotonsillectomy

OBJECTIVE: To compare changes in behavior after adenotonsillectomy in children with either mild sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA). STUDY DESIGN: Prospective cohort study. METHODS: Children at the University of New Mexico Children's Hospital, Albuquerque with mild SDB or OSA were included in the study. All children underwent preoperative polysomnography before adenotonsillectomy. Mild SDB was defined as an apnea-hypopnea index (AHI) less than 5 or an apnea index (AI) less than 1. OSA was defined as an AHI 5 or greater or an AI 1 or greater. Pre- and postoperative scores from the Behavioral Assessment System for Children (BASC) survey were compared using repeated measures analysis of variance. RESULTS: The mean preoperative AHI for children with mild SDB (n=17) was 3.1 (range, 1.7-4.7), and for children with OSA (n=23) it was 25.3 (range, 10.0-48.0). The mean preoperative BASC scores for children with mild SDB were not significantly different from the scores for children with OSA. The demographics in the two groups of children were similar. The behavior symptom index, a global measure of behavior, showed significant improvement after surgery for both groups of children (P<.01). Children also showed significant improvement after adenotonsillectomy in the BASC scales of atypicality, depression, hyperactivity, and somatization. Mean changes in BASC scores after adenotonsillectomy were not significantly different in the two groups of children. CONCLUSIONS: Behavioral problems are prevalent in children with either mild SDB or OSA, and both groups of children show significant improvements in behavior after adenotonsillectomy.     

Cross-cultural adaptation and validation of the Greek OSA-18 questionnaire in children undergoing polysomnography

ObjectiveTranslations of validated questionnaires help to compare different countries/cultures populations and establish protocols for global health. OSA-18 is a validated disease-specific questionnaire for pediatric Obstructive Sleep Apnea (OSA). Our aim was to validate OSA-18 in Greek and correlate it with polysomnography results and OSA severity.Study designProspective instrument validation study.Subjects and methodsOSA-18 was translated in Greek and back into English. Children undergoing polysomnography due to snoring were recruited prospectively. OSA-18 was completed by parents during the initial clinic visit (test), in the evening prior to the sleep study (retest), and 3 months postoperatively for subjects who underwent adenotonsillectomy. Internal consistency and test–retest reliability were evaluated. Validity was assessed by exploring correlations between OSA-18 and AHI, by comparing OSA-18 of OSA and non-OSA groups, and by calculating questionnaire's sensitivity and specificity for detecting OSA. Total scores of non-OSA, mild, moderate and severe OSA subgroups were compared. In OSA children who underwent adenotonsillectomy, preoperative and postoperative total scores were compared to assess responsiveness.ResultsTest–retest questionnaires were fully completed for 141 children. OSA-18 in Greek had good internal consistency (Cronbach's alpha 0.951 for test and 0.947 for retest) and test–retest reliability (Pearson's correlation coefficients between test and retest scores: 0.850–0.946; P < 0.05). Total and subscale OSA-18 scores and AHI were significantly correlated (Spearman's correlation coefficients: 0.376–0.633; P < 0.01), while children with OSA had higher total OSA-18 score than those without OSA [median (interquartile range): 61 (35) vs. 38 (22), respectively; P < 0.001)]. Sensitivity was 53.4%, suggesting poor validity compared to polysomnography. All OSA severity subgroups had significant higher score than non-OSA. OSA-18 scores postoperatively were significantly lower compared to preoperatively (22.91 ± 5.49 vs. 67.13 ± 15.27, respectively; P < 0.001), indicating good responsiveness.ConclusionGreek OSA-18 is an instrument with satisfactory internal consistency, reliability, and responsiveness, but it is a poor predictor of OSA severity.     

Efficacy of powered intracapsular tonsillectomy and adenoidectomy

Objectives/Hypothesis: We sought to determine the effectiveness of powered intracapsular tonsillectomy and adenoidectomy (PITA) in the treatment of children with moderately severe obstructive sleep apnea and to measure changes in quality of life that occur with such treatment. Study Design: Prospective, nonrandomized clinical trial in an academic pediatric otolaryngology practice. Methods: Convenience sample of children ages 3 to 12 years diagnosed with obstructive sleep apnea of moderate severity, defined as an apnea‐hypopnea index (AHI) between 5 and 20 on polysomnography. Children with recurrent streptococcal pharyngitis, chromosomal abnormalities, craniofacial abnormalities, neuromotor disease, sickle cell disease, obesity, or coagulopathy were excluded. PITA was performed by using the microdebrider. Polysomnography was performed before surgery and repeated 4 to 8 weeks after surgery. The Obstructive Sleep Apnea (OSA)‐18 questionnaire was completed at surgery and at the time of postoperative polysomnography to assess quality of life changes. The main outcome measure was cure of obstructive sleep apnea, as defined by a postoperative AHI of 1 or less for complete cure and less than 5 for partial cure. Improvements in quality of life were assessed by changes in the OSA‐18 questionnaire. Results: Nineteen children underwent PITA for moderate obstructive sleep apnea syndrome (OSAS), and 14 completed postoperative polysomnography. All 14 subjects who completed the study achieved at least partial cure. Thirteen of 14 (93%) subjects had a complete cure of OSAS after PITA. The median preoperative AHI was 7.9, and the median AHI after surgery was 0.1. The mean number of arousals per hour before surgery was 9.5, and this was reduced to a mean of 5.6 after surgery. Quality of life measures on OSA‐18 also improved, with large improvements in total quality of life scores and in all five domains seen after surgery. Conclusions: PITA cures otherwise healthy children with obstructive sleep apnea of moderate severity, at least in the short‐term, as documented by postoperative polysomnography. Improvements in quality of life measures, as documented by changes in OSA‐18, were seen in all children as well.     

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。     

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.     

儿童阻塞性睡眠呼吸暂停低通气综合征诊断和治疗

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）患儿的诊断标准、治疗方法及疗效观察。方法 78例经多导睡眠仪监测（polysomnography,PSG）确诊的OSAHS儿童采取扁桃体和（或）腺样体切除术68例,鼻内镜下双下甲减容手术14例,上颌窦自然开口扩大术6例;选择长期正压通气治疗（continuous positive airway pressure,CPAP）2例。采用儿童OSAHS生活质量调查表（OSA-18）对78例进行治疗前后随访。结果 围手术期无术后出血和急性呼吸道梗阻发生。随访18个月以上,OSA-18调查评分显示;显效69例（88．5％）,有效8例（10．2％）,无效1例（1．3％）。结论 儿童OSAHS在诊断上一定要详细进行询问及查体,并根据PSG结果确诊。治疗主要采用手术治疗,经2．4mm鼻内镜引导下行腺样体刮除术,CPAP治疗对于不适合手术者有效。     

腺样体扁桃体切除术对儿童睡眠结构和生活质量的影响

目的对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿行腺样体扁桃体切除术,并评价手术前后睡眠呼吸参数及生活质量的改善情况。方法对57例OSAHS患儿术前1～2周及术后6～9个月行多导睡眠监测（PSG）和生活质量调查（OSA-18）,分析手术治疗前后患儿PSG参数和OSA-18评分的变化。结果术前呼吸暂停低通气指数（AHI）或阻塞性呼吸暂停指数（OAI）平均值为17．7,术后降至6．5;术前最低血氧饱和度（LSaO2）平均值为82．1,术后升至88．3;术前OSA-18总分为86．9,术后降至45．3,各组术前术后比较均有统计学意义（P〈0．01）。结论腺样体扁桃体切除术能明显改善OSAHS患儿的睡眠呼吸参数和生活质量。     

Quality of life in children with obstructive sleeping disorder after tonsillectomy, tonsillotomy or adenotomy

BACKGROUND: To study the effectiveness of adenotomy (AT), adenotonsillectomy (ATE) and adenotonsillotomy (ATT) with respect to the quality of life improvement in children with obstructive sleep disorders (OSD), OSA 18 survey and Brouillette score were used. METHODS: Prospectively, 92 children with an age ranging from 2 to 6 years with OSD underwent AT, ATE or ATT at the University hospital of Ulm (Germany), respectively. 30 age-matched children served as controls. Caregivers were requested to complete the Brouillette score and the OSA 18 survey, which are validated instruments for detecting symptoms and quality of life change in children with OSDs, at the initial office visit prior to surgery (BS/1 and OSA 18/1) and 7 - 14 months after surgery (BS/2 and OSA 18/2). RESULTS: The mean total score of the OSA 18 survey for AT, ATE and ATT was reduced significantly after these operations (p < 0.001). Similar results were also observed in the Brouillette score (p < 0.002). The improvement of life quality in the AT group was less effective than in the ATE and ATT group. CONCLUSION: ATE and ATT have about the same effectiveness to improve life quality for children with OSD. Children after ATE or ATT have a comparable life quality as healthy children (Mann Whitney U-test; p approximately 0.15), while children who only received AT have a slightly lower life quality after the operation. In summary, ATT was recommend.     

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.     

儿童阻塞性睡眠呼吸暂停低通气综合征手术前后生活质量调查

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)对儿童生活质量的影响，分析手术治疗前后生活质量的变化。方法在术前4周内对54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)，并分析二者的相关性；其中单纯扁桃体切除术8例，扁桃体切除术 腺样体切除术32例，单纯腺样体切除术14例。在术后12～18个月进行生活质量随访。结果 OSAHS对61．11％患儿生活质量造成严重影响；手术前OSA-18评分与呼吸暂停低通气指数、最低血氧饱和度存在明显相关；手术后约75．92％的患儿生活质量得到明显改善，各项目依次为：睡眠障碍(88．89％)、对患儿监护人的影响(74．07％)和身体症状(70．37％)。结论 儿童OSAHS严重影响患儿的生活质量，OSA-18评分与PSG客观监测之间存在明显的相关关系，可作为儿童OSAHS临床诊断和疗效观察的评价指标。     

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.     

Child behavior and quality of life in pediatric obstructive sleep apnea

OBJECTIVE: To assess behavior and quality of life in children with obstructive sleep apnea (OSA) undergoing tonsillectomy and adenoidectomy compared with control children. DESIGN: Prospective controlled study. SETTING: Hospital-based pediatric otolaryngology practice. PARTICIPANTS: Forty-two children (25 boys and 17 girls; mean [SD] age, 5.8 [2.5] years) with OSA confirmed by positive findings on polysomnography undergoing tonsillectomy and adenoidectomy and 41 control children (29 boys and 12 girls; mean [SD] age, 7.3 [3.8] years) with no history of snoring undergoing unrelated elective surgery. INTERVENTIONS: Parents completed the standardized Child Behavior Checklist and a validated pediatric OSA quality-of-life survey before and 3 months after surgery. MAIN OUTCOME MEASURES: Child Behavior Checklist T scores and score classifications and quality-of-life survey mean scores. RESULTS: Change in mean total problem T score was significantly greater in the OSA group (from 51.6 at baseline to 48.3 at follow-up) than in controls (from 45.5 at baseline to 46.7 at follow-up) (P = .03). The improvement in total T score classification (normal vs borderline or abnormal) was significant for children with OSA compared with control children (P = .009). Children with OSA had significant improvements in the quality-of-life survey mean total score and all individual domain scores compared with controls (P<.001). CONCLUSIONS: Behavioral and emotional difficulties are found in children with documented OSA compared with control children, and they improve after treatment. Large improvements in disease-specific quality of life are also found. Scores on a standardized measure of behavior assessment demonstrated significant correlation with scores on a validated quality-of-life instrument.     

Obesity increases the risk for persisting obstructive sleep apnea after treatment in children

OBJECTIVE: To evaluate the impact of obesity at diagnosis on treatment outcomes in paediatric obstructive sleep apnea (OSA). METHODS: Children were included if they had both diagnostic and follow-up studies for OSA. Anthropological and polysomnographic data were collected at the time of both studies. Polysomnograms were scored using standard criteria and OSA was defined as a respiratory disturbance index (RDI) >or=5. Obesity was defined as a body mass index standard deviation (z-)score (BMIsds) greater than 2, adjusted for age and gender. RESULTS: For 69 children (49 males), mean age was 7.1+/-4.2 years and 29 (42%) children were obese. There was no significant difference in RDI between obese and non-obese children at diagnostic study. Following adenotonsillectomy the obese children had a significantly higher mean RDI (10.7+/-15.6 versus 3.7+/-4.3; p=0.01). Disease resolution occurred in 77.5% of non-obese compared to 45% of obese children (p=0.011). The odds ratio (OR) for persistent OSA in obese compared to non-obese children was 4.2 (95% CI: 1.5-11.9; p=0.005). Using initial RDI as a covariate, these data show that obesity in children has an adjusted OR for persistent OSA after adenotonsillectomy 3.7 (95% CI: 1.3-10.8, p=0.016). CONCLUSION: For children, obesity at the time of diagnosis is a major risk for persisting OSA after treatment, regardless of the severity of initial disease.     

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.