扁桃体腺样体切除术治疗阻塞性睡眠呼吸暂停综合征疗效研究

目的 研究扁桃体腺样体切除术治疗阻塞性睡眠呼吸暂停综合征疗效.方法 选取我院阻塞性睡眠呼吸暂停综合征患者78例(2018年1月至2019年1月),分为腺样体吸割术+扁桃体切除术治疗的观察组(39例)与腺样体吸割术治疗的对照组(39例),观察患者相关指标、症状改善情况及并发症发生率.结果 与对照组相比,观察组AHI、LS...     

腺样体扁桃体切除治疗儿童阻塞性睡眠呼吸暂停综合征

目的探讨腺样体扁桃体切除治疗儿童阻塞性睡眠呼吸暂停综合征的疗效.方法选择38 例诊断为儿童阻塞性睡眠呼吸暂停综合征的患者行腺样体扁桃体切除术,术前经CT检查确诊为腺样体肥大.手术在经口插管全身麻醉下进行.结果打鼾、鼻塞等症状消失或减轻,随访6～12个月无复发.结论儿童阻塞性睡眠呼吸暂停综合征可造成儿童多系统损害,应及早诊断,以便及时得到治疗.     

儿童阻塞性睡眠呼吸暂停低通气综合征扁桃体腺样体评价

目的探讨儿童扁桃体和/或腺样体肥大与阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)的相关性。方法对3～12岁的79例儿童鼾症患者及27例无鼾症儿童进行扁桃体大小及鼻内镜下腺样体大小的评价。对全部打鼾儿童进行多导睡眠监测(polysomnography,PSG)区分单纯性鼾症(primarysnoring,PS)和OSAHS,并了解他们的睡眠结构及呼吸紊乱情况,其中33例打鼾儿童进行了声阻抗检查。结果38例(66.7%)OSAHS儿童集中在3～6岁年龄阶段,单纯性鼾症儿童分布较均匀。3组间的扁桃体大小差异不显著(P>0.05),而腺样体大小差异有显著性,PS组和OSAHS组Ⅲ、Ⅳ级比例有明显增高的趋势(P<0.05)。扁桃体和腺样体均达到Ⅲ、Ⅳ级的对照组为22.2%、PS组为40.9%、OSAHS组为43.9%,虽有增高趋势但组间差异不显著(P>0.05)。PS和OSAHS两组Ⅰ期、Ⅱ期、慢波睡眠期、REM睡眠期的比例及进入睡眠的潜伏期、睡眠效率及觉醒指数基本一致(P>0.05),而最低血氧饱和度、平均血氧饱和度及睡眠呼吸暂停低通气指数(apneahypopneaindex,AHI)两组间有显著性差异(P<0.05)。两组儿童伴发鼻窦炎的情况为PS组6/22(27.3%),OSAHS组12/57(21.1%);伴发分泌性中耳炎的情况为PS组4/22(18.2%),OSAHS组11/57(19.3%),两组差异不显著(P>0.05)。结论PS和OSAHS的儿童睡眠结构差异不明显,伴发鼻窦炎、分泌性中耳炎的情况相似。在引起打鼾和OSAHS的阻塞性原因中,扁桃体的作用不明显,腺样体肥大与OSAHS之间有相关性,但不是导致OSAHS的唯一病因。     

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。     

扁桃体加腺样体切除术对阻塞性睡眠呼吸暂停低通气综合征患儿睡眠结构的影响

目的探讨扁桃体加腺样体切除术对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿睡眠结构的影响。方法选取45例OSAHS患儿行扁桃体加腺样体切除术,比较术前和术后3个月睡眠结构参数,包括睡眠效率（SE）、S1期比例、S2期比例、SWS期比例、REM期比例、觉醒指数（AI）、觉醒时间比例（AT%）、SaO2低于90%的持续时间占睡眠时间的百分比（SLT90%）、最低血氧饱和度（LSaO2）和氧减饱和度指数（ODI4）,并与正常儿童对照组比较,观察患儿各项指标的变化。结果 OSAHS患儿SE、SWS期、REM期和LSaO2比对照组均降低（P〈0.05）,S 1期、O D I 4和S LT 9 0%比对照组升高（P〈0.0 1）,AI和AT%比对照组升高（P〈0.05）。OSAHS患儿术后3个月SE、SWS期、REM期和LSaO2比术前均升高（P〈0.05）,S1期、AI、AT%、ODI4和SLT90%比术前降低（P〈0.05）。结论 OSAHS患儿存在睡眠结构紊乱,扁桃体加腺样体切除术能有效改善睡眠结构紊乱。     

扁桃体腺样体切除术治疗阻塞性睡眠呼吸暂停综合征患儿的疗效观察

目的 探讨扁桃体腺样体切除术对阻塞性睡眠呼吸暂停综合征（OSAS）患儿的治疗效果。方法 多导睡眠检测(PSG)确诊OSAS患儿60例。随机分为实验组A组（30例）、对照组B组（30例）。A组住院行扁桃体腺样体切除术,B组给予口服安慰剂维生素C（剂量均为0.1mg）,比较A组与B组治疗前及治疗3个月后的呼吸暂停低通气指数（AHI）及最低动脉血氧饱和度（SaO2）的变化,同时对比两组患儿家长的语言评价量表(VRS)评价结果的差异。结果 治疗前A组及B组的AHI和最低SaO2无明显差异。治疗3个月后A组AHI为2.6±1.8、最低SaO2为92.9±2.5与B组相应的AHI为17.1±8.2、最低SaO2为81.4±9.1差异明显,差异有统计学意义。另外,根据患儿家长的语言评价量表评价结果,实验组OSAS患儿睡眠打鼾、憋气及张口呼吸症状改善有效率分别为86.7％、93.3％、86.7％,明显高于对照组( 6.7%、13.3%、13.3%)。结论 腺样体和扁桃体术对儿童OSAS有较好的疗效,是治疗儿童OSAS的有效方法。     

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。     

阻塞性睡眠呼吸暂停低通气综合征患儿扁桃体腺样体切除术临床疗效分析

目的 评价扁桃体腺样体切除术对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿的临床疗效。方法 行扁桃体及腺样体切除术患儿80例,术前、术后3个月或6个月行多道睡眠描记术（PSG）监测及OSA-18量表生活质量调查,分析手术疗效、PSG参数及OSA-18评分的变化。结果 80例患儿治愈70例（87%）,显效8例（10%）,有效2例（3%）,总有效率为100%。显效及有效的10例中8例合并变应性鼻炎经治疗变应性鼻炎后症状明显改善,另2例肥胖者经控制体质量后症状减轻。术后呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO2）、OSA-18总分与术前比较差异有统计学意义（P<0.05）。结论 扁桃体、腺样体切除术是治疗儿童OSAHS的有效方法,同时应治疗合并的其他上呼吸道阻塞因素。PSG结合OSA-18调查表可对患儿进行手术前后主客观的综合评价。     

儿童睡眠呼吸暂停扁桃体与腺样体切除前后血气分析

目的探讨扁桃体、腺样体切除对儿童睡眠呼吸暂停的影响。方法对1998年10月-2003年12月施行的229例慢性扁桃体和／或腺样体切除术患儿术前术后血气分析的指标加以对照并进行分析。结果血气分析指标血氧分压、二氧化碳分压及pH值显示,34例有睡眠呼吸暂停病史者血气分析参数变化显著,195例没有睡眠呼吸暂停病史者血气分析参数变化不明显。结论扁桃体和／或腺样体的异常肥大是导致儿童睡眠呼吸暂停的主要原因,通过手术切除扁桃体及腺样体可以获得满意的疗效。     

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     

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.     

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.     

阻塞性睡眠呼吸暂停综合征治疗模式的比较

目的 :分析比较阻塞性睡眠呼吸暂停综合征 (OSAS)不同治疗模式的疗效。方法 :将 5 2例患者分两组 :①单纯行悬雍垂腭咽成形术 (UPPP) (单纯UPPP组 ) 2 9例 ,②UPPP加经鼻持续正压通气 (CPAP)或口腔矫正器 (综合治疗组 ) 2 3例 ,进行治疗。结果 :两组近期疗效差异无显著性意义 (P >0 .0 5 ) ,但单纯UPPP组因术前未行CPAP治疗 ,故易出现手术并发症 ;两组远期疗效差异有极显著性意义 (P <0 .0 1)。结论 :OSAS采用多模式治疗是提高远期疗效的有效方法     

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.     

Relationship between obstructive sleep apnea-specific symptoms and cardiac function before and after adenotonsillectomy in children with adenotonsillar hypertrophy

Objective

The aim of our study was to investigate subclinical cardiac disturbances in patients with symptoms due to adenotonsillar hypertrophy (ATH) and the impact of adenotonsillectomy (AT) using conventional and novel echocardiographic measures.

Material and methods

Thirty patients with grade 3 or 4 ATH (mean age: 7.86 ± 3.83 years; 10 females) and 30 healthy, age- and sex-matched volunteers (mean age, 8 ± 2.77; 14 females) were enrolled in the study. In addition to conventional two-dimensional and Doppler echocardiographic parameters, tissue Doppler parameters, including myocardial performance indices (MPIs) of both the right (RV) and left ventricle (LV), were studied. The severity of obstructive sleep apnea (OSA) was determined using the OSA-18 health quality questionnaire. The OSA-18 questionnaire and echocardiographic examination were repeated after AT in patients with ATH.

Results

The total OSA-18 scores for the control, preoperative, and postoperative groups were 39.56 ± 19.98, 80.63 ± 22.32, and 44.10 ± 20.31, respectively. Conventional parameters were not different among the groups. The mean pulmonary artery pressure estimated using the Mahan formula was increased in the ATH group compared with that in the control group (21.72 ± 4.25 vs. 12.43 ± 3.83, respectively; p < 0.001) and significantly improved after AT (21.72 ± 4.25 vs. 16.09 ± 4.53; p < 0.001). The RV MPI was significantly different between the control and ATH groups (0.322 ± 0.052 vs. 0.383 ± 0.079, respectively; p = 0.001). Both the LV and RV MPI significantly improved (0.515 ± 0.066 vs. 0.434 ± 0.052, p < 0.001; and 0.383 ± 0.079 vs. 0.316 ± 0.058, p = 0.018, respectively) after surgery for ATH.

Conclusions

Our study revealed that the patients with OSA-specific symptoms due to ATH had higher pulmonary artery pressure and impaired RV function according to novel echocardiographic parameters. Surgery for ATH seems to have an important effect on both LV and RV function.     

Debates in pediatric obstructive sleep apnea treatment

Pediatric obstructive sleep apnea (OSA) is among the most common sleep-disordered breathing (SDB) diseases in children. Its high prevalence and multiple systemic complications lead to increasing numbers of children and families affected by OSA. Timely diagnosis and effective intervention in children with this condition is extremely important in improving their prognosis. The major approaches in the treatment of OSA in children are to eliminate the causes of upper airway obstruction and prevent and treat complications. Considering the specific individual differences in children's growth and development, as well as the diversity of etiologies in children's OSA, pediatric treatment strategies need to be precise, multidisciplinary, and individualized. First-line clinical treatment consists of surgical (adenotonsillectomy) and non-surgical therapies [including anti-inflammatory medications and non-invasive ventilation (NIV)]. However, a considerable controversy exists concerning the indications, treatment standards, and the evaluation of the efficacy of the aforementioned treatment methods. In this review, reviews and assessment of literature studies and multidisciplinary clinical experience were performed to analyze the application of each treatment and discuss controversial issues and future research directions. We suggest that the above interventions should be tailored to each child's needs, comorbidities, and the availability and expertise of the practitioner. The ideal case is when a multidisciplinary team of doctors together with the patients and their parents, or guardians, have a thorough discussion regarding the benefits and risks of all available treatment options and all agree on an effective treatment plan.     

Preoperative continuous positive airway pressure compliance in children with obstructive sleep apnea syndrome: assessed by a simplified approach

INTRODUCTION: The frequency of diagnoses of obstructive sleep apnea syndrome (OSAS) in children is increasing and more and more adenotonsillectomies (A&T) are being performed on severely ill children who have a higher perioperatory risk. The objective of the present study was to describe preoperative compliance in the use of continuous positive airway pressure (CPAP) in children with OSAS, when this treatment was prescribed as a means of preventing complications. PATIENTS AND METHODS: We describe data from children with severe OSAS caused by hypertrophy of the adenoids and tonsils, but with no craniofacial abnormalities. CPAP pressure was adjusted either during diurnal polysomnography with sleep deprivation or by self-adjusting devices. Follow-up was conducted through weekly interviews and the downloading of data recorded by the equipment. RESULTS: 48 children were included; 73% of them used a CPAP machine > or =3h per night, and 31% used it for > or =6h per night. The variables associated with good equipment compliance included higher BMI, higher pressure levels in the devices, and a higher number of episodes of apneas and hypopneas. Children who weighed > or =30kg used CPAP for > or =3h per night more often (OR 16, 95% CI 1.9-137). Compliance levels with fixed and self-adjusting CPAP were similar, and side effects in both cases were slight and limited to those caused by the pressure of the masks on patients' skin. One case of excessive bleeding was the only complication reported during A&T. CONCLUSIONS: The mean preoperative use of CPAP equipment by children with severe OSAS was 4.5+/-2.6h. Seventy-three percent of subjects used the equipment for >/=3h.     

阻塞性睡眠呼吸暂停综合征患儿T细胞亚群水平及相关指标的分析

目的 :检测阻塞性睡眠呼吸暂停综合征 (OSAS)患儿外周血T细胞亚群的变化 ,探讨OSAS对其细胞免疫功能的影响。方法 :应用APAAP桥联酶标法测定OSAS组和正常对照组外周血淋巴细胞表型 ,并将结果与睡眠检测指标进行相关性分析。结果 :OSAS组与正常对照组比较 ,CD4 、CD8 、CD4 /CD8 差异均有统计学意义 (均P <0 .0 1) ;CD4 、CD8 、CD4 /CD8 与呼吸暂停指数无相关性 ;与最低血氧饱和度 (LSaO2 )和病程有相关性 ,LSaO2 越低、病程越长 ,对T细胞亚群的影响越大 (P <0 .0 5 )。结论 :OSAS患儿细胞免疫功能低下。     

The role of sleep position in obstructive sleep apnea syndrome

We analyzed the role of sleep position in obstructive sleep apnea syndrome (OSAS). The polysomnograms of 120 patients with sleep apnea syndrome were analyzed. We associated the apnea hypopnea index (AHI) of the supine position with the AHI of the other positions. Patients were stratified in a group of positional patients (PP) (AHI supine ≥ 2 × AHI other positions) and a group of non-positional patients (NPP). In 55.8% of our patients, OSAS was position dependent. PP patients were significantly (6.7 years) younger. BMI and AHI were higher in the NPP group, but the difference was not significant. Level of obstruction in the upper airway (retropalatinal vs retrolingual vs both levels) as assessed by sleep endoscopy was not significantly different between the two groups. Total sleep time (TST) was equal in both groups, but the average time in supine position was 37 min longer in the PP group. This study confirms the finding that in more than 50% of patients, OSAS is position dependent. Apart from age, no patient characteristics were found indicating the position dependency. Overall AHI does not identify positional OSAS.