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。

Impact of adenotonsillectomy on quality of life in children with sleep disordered breathing

Objective:To compare improvement in quality of life after adenotonsillectomy in children with similar demographics but with either obstructive sleep apnea hypopnea syndrome(OSAHS) or with milder forms of sleep-disordered breathing(SDB).To evaluate the relationship between polysomnogram(PSG) results and disease-specific quality of life for children with obstructive sleep apnea 18 item survey(OSA-18).Method:Children with SDB who were suspected of having OSAHS were enrolled.All study participants underwent overnight PSG using standardized techniques.The effectiveness of adenotonsillectomy for the relief of SDB was evaluated by using the OSA-18.Follow-up was assessed at 6-9 months.Preoperative and postoperative OSA-18 scores for each group of children(OSAHS and mild SDB) were compared.Result:The study population inculded 51 children with SDB,and 28 of them met PSG criteria for OSAHS,the other 23 of them without OSAHS.The clinical data in the two groups were similar.OSA-18 scores were not significantly different between children with and without OSAHS.The total OSA-18 scores and the scores for all domains showed significant improvement after surgery for both groups of children(P<0.01).A comparison of mean difference in total and domain scores for the two groups of children was not significant(P>0.05).The domains of sleep disturbance,physical suffering and caregiver concerns showed significant association with PSG parameters(P<0.01).But no strong association was identified for OSA-18 total scores and other two domains(P>0.05).Conclusion:Both groups of children showed a dramatic improvement in quality of life after adenotonsillectomy and the degree of improvement was similar.Fortunately,surgical therapy with adenotonsillectomy was associated with marked improvement in quality of life for children with either OSAHS or mild SDB.However,the association between PSG findings and OSA-18 scores was only moderate.