Praud Jean-Paul, Dorion Dominique
Respiratory Medicine Division, Department of Pediatrics, Université de Sherbrooke, Québec, Canada.
Pediatr Pulmonol. 2008 Sep;43(9):837-43. doi: 10.1002/ppul.20888.
Traditionally, adenotonsillectomy (AT) has long been the treatment of choice for obstructive sleep disordered breathing (SDB) in children. AT is usually considered a safe procedure, which cures 80% of children with SDB. Accumulated data have however challenged this overly simplistic view. Indeed, AT is invariably associated with significant morbidity, post-operative pain, and a mortality rate which, though low, cannot be ignored. In addition, aside from a recurrence of SDB at adolescence in an unknown percentage of cases, some recent results suggest that complete SDB cure is not achieved in as much as 75% of cases after AT. Interestingly, several treatment options have been recently proposed for replacing or complementing AT. Continuous positive airway pressure (CPAP) is now suggested in children with remaining SDB after AT; however, compliance and suitability of equipment remain important hurdles, especially in small children and infants. Anti-inflammatory treatments, including nasal glucocorticoids and/or the anti-leukotriene montelukast, appear to hold great promise. Finally, orthodontic treatments are an appealing option, with recent results in children suggesting that it is possible to improve or perhaps even cure SDB in a durable manner by enlarging the nasal passages and/or the oropharyngeal airspace. In conclusion, while we are currently in the midst of an exciting time with several new treatments being developed for childhood SDB, randomized controlled trials are urgently needed to delineate their indications. In the meantime, it appears that systematic detection of orthodontic anomalies and better collaboration with maxillofacial specialists, including orthodontists and/or dentists, is needed for deciding the best treatment options for childhood SDB.
传统上，腺样体扁桃体切除术（AT）长期以来一直是治疗儿童阻塞性睡眠呼吸障碍（SDB）的首选方法。AT通常被认为是一种安全的手术，能治愈80%的SDB患儿。然而，积累的数据对这种过于简单化的观点提出了挑战。事实上，AT总是伴随着显著的发病率、术后疼痛以及死亡率，尽管死亡率很低，但也不容忽视。此外，除了在未知比例的病例中SDB在青春期复发外，一些最新结果表明，AT术后多达75%的病例并未实现SDB的完全治愈。有趣的是，最近有人提出了几种替代或补充AT的治疗选择。对于AT后仍有SDB的儿童，现在建议使用持续气道正压通气（CPAP）；然而，设备的依从性和适用性仍然是重要障碍，尤其是在幼儿和婴儿中。包括鼻用糖皮质激素和/或抗白三烯药物孟鲁司特在内的抗炎治疗似乎很有前景。最后，正畸治疗是一个有吸引力的选择，最近在儿童中的研究结果表明，通过扩大鼻腔通道和/或口咽气道空间，有可能以持久的方式改善甚至治愈SDB。总之，虽然目前我们正处于一个激动人心的时期，有几种针对儿童SDB的新治疗方法正在研发中，但迫切需要进行随机对照试验来明确它们的适应症。与此同时，似乎需要系统地检测正畸异常，并与包括正畸医生和/或牙医在内的颌面专家更好地合作，以确定儿童SDB的最佳治疗方案。
