Hasukić Begzada, Brkić Fuad, Kapidzić Adnan, Skokić Fahrija
Klinika za otorinolaringologiju cerviko i maksilofacijalnu hirurgiju, UKC Tuzla.
Med Arh. 2008;62(1):30-3.
Obstructive sleep apnea (OSA) caused by enlarged tonsils and adenoids is common in pediatric population. The prevalence of pediatric obstructive sleep apnea syndrome has been estimated to be between 1% and 3% in preschool and school-aged children. The aim of this study was to examine quality of life in children before and after adenotonsillectomy.
This study was prospective and it was carried out in the period from mid-November 2005 to end-June 2006. Specific exclusion criteria were: no existing of OSA, neuromuscular disorders, constitutional maxillofacial anomalies, septal deviation, mental retardation, obesity (BMI > 30). Anamnesis was taken from parents or caregiver, each child was examined from ENT specialist, Pediatar and Anestesiolog. The adenoid size was estimated by palpation or/and X-ray examination of nasopharynx. The tonsils size was estimated by Brodsky scala. OSA-18 quality of life survey was used to estimate improvement of quality of life after adenotonsillectomy. The children that had asserted symptoms of OSA by OSA-18 quality of life survey, were analyzed by this survey 5 weeks after surgery. The results before and after surgery were compared. The adenotonsillectomy was done with standard operation technique at our ENT department (cold dissection using termocauter), and comprehends removal palatinal tonsils and adenoids, that are removed by adenotom with uniform anestesiology protocol.
At 13 patients (43.3%) undergone adenotonsillectomy, OSA had a small impact on quality of life, at 11 (36.7) patients had a moderate impact and at 6 (20%) patients had large impact. Statistical significant improvement of quality of life after adenotonsillectomy was found in all domains using OSA-18-QOL survey: sleep disturbance (P < 0.0001), physical suffering (P < 0.0001), emotional distress (P < 0.0001), daytime problems (P = 0.0081) and caregiver concerns (P < 0.0001). The mean OSA-18-QOL total change score showed significant improvement of quality of life in patients suffering from OSA who undergone adenotonsillectomy.
Adenotonsillectomy improves quality of life in children suffering from OSA caused by adenotonsillar hypertrophy.
由扁桃体和腺样体肥大引起的阻塞性睡眠呼吸暂停（OSA）在儿童群体中很常见。据估计，学龄前和学龄儿童中儿童阻塞性睡眠呼吸暂停综合征的患病率在1%至3%之间。本研究的目的是检查腺样体扁桃体切除术前和术后儿童的生活质量。
本研究为前瞻性研究，于2005年11月中旬至2006年6月底进行。具体排除标准为：不存在OSA、神经肌肉疾病、先天性颌面畸形、鼻中隔偏曲、智力低下、肥胖（BMI>30）。向家长或照顾者询问病史，每位儿童均由耳鼻喉科专家、儿科医生和麻醉科医生进行检查。通过触诊或/和鼻咽部X线检查评估腺样体大小。扁桃体大小通过布罗德斯基量表评估。使用OSA - 18生活质量调查问卷评估腺样体扁桃体切除术后生活质量的改善情况。通过OSA - 18生活质量调查问卷确认有OSA症状的儿童，在术后5周通过该问卷进行分析。比较手术前后的结果。腺样体扁桃体切除术在我们的耳鼻喉科采用标准手术技术进行（使用热灼器进行冷剥离），包括切除腭扁桃体和腺样体，腺样体通过腺样体切除术切除，并采用统一的麻醉方案。
在接受腺样体扁桃体切除术的13名患者（43.3%）中，OSA对生活质量影响较小；11名患者（36.7%）有中度影响；6名患者（20%）有较大影响。使用OSA - 18 - QOL调查问卷发现，腺样体扁桃体切除术后生活质量在所有领域均有统计学意义的改善：睡眠障碍（P < 0.0001）、身体痛苦（P < 0.0001）、情绪困扰（P < 0.0001）白天问题（P = 0.0081）和照顾者担忧（P < 0.0001）。OSA - 18 - QOL总变化得分均值显示，接受腺样体扁桃体切除术的OSA患者生活质量有显著改善。
腺样体扁桃体切除术可改善因腺样体扁桃体肥大导致OSA的儿童的生活质量。
