Lim Jerome, McKean Michael C
Ear, Nose and Throat Department , Medway Maritime Hospital, Windmill Road, Gillingham , Kent, UK, ME7 5NY.
Cochrane Database Syst Rev. 2009 Apr 15(2):CD003136. doi: 10.1002/14651858.CD003136.pub2.
Current treatment of sleep apnoea in children consists of largely surgical based treatments. Adenotonsillectomy is the most commonly used intervention to treat sleep apnoea in children.
To determine the efficacy of adenotonsillectomy in the treatment of obstructive sleep apnoea in children.
The Cochrane Airways Group Specialised Register was searched with pre-specified terms. Searches were current as of August 2008.
Randomised trials recruiting children with a diagnosis of obstructive sleep apnoea.
Two reviewers examined the search results and collected data from the studies in terms of their characteristics before deciding which ones would be included in the review.
One study met the review entry criteria. This study addressed the relative merits of two surgical techniques in treating OSA in children (temperature controlled radiofrequency tonsillectomy and adenoidectomy, and complete tonsillectomy and adenoidectomy). No significant difference was apparent for either symptoms or respiratory disturbance index. More children in the TCFR&A group were able to return to normal diet at 7 days compared with complete T&A. No significant complications were observed in the study.
AUTHORS' CONCLUSIONS: One small study failed to find a difference between two surgical techniques, although return to normal diet was more frequent in the group treated by temperature controlled radiofrequency tonsillectomy and adenoidectomy. At present there is still debate as to the criteria required to diagnose significant obstructive sleep apnoea in children. Also the natural history of the condition has not been fully delineated. There is an absence of randomised controlled trials investigating the efficacy of treatment of confirmed obstructive sleep apnoea with adenotonsillectomy in children. Research is required before recommendations for the treatment of obstructive sleep apnoea in children can be formulated. The quality of research in this area could be improved with the use of sleep studies at baseline to determine the extent of severity of sleep apnoea in children who are recruited to studies in this area. Long-term follow up is also required in order to explore the effect of adenotonsillectomy on paediatric sleep apnoea.
目前儿童睡眠呼吸暂停的治疗主要以手术治疗为主。腺样体扁桃体切除术是治疗儿童睡眠呼吸暂停最常用的干预措施。
确定腺样体扁桃体切除术治疗儿童阻塞性睡眠呼吸暂停的疗效。
使用预先设定的检索词检索Cochrane气道组专业注册库。检索截至2008年8月。
招募诊断为阻塞性睡眠呼吸暂停儿童的随机试验。
两名综述作者检查检索结果，并根据研究特征收集数据，然后决定哪些研究纳入综述。
一项研究符合综述纳入标准。该研究探讨了两种手术技术治疗儿童阻塞性睡眠呼吸暂停（温控射频扁桃体切除术加腺样体切除术与完全扁桃体切除术加腺样体切除术）的相对优缺点。症状或呼吸紊乱指数方面均无明显差异。与完全扁桃体切除术加腺样体切除术相比，温控射频扁桃体切除术加腺样体切除术组更多儿童在7天时能够恢复正常饮食。该研究未观察到明显并发症。
一项小型研究未发现两种手术技术之间存在差异，尽管温控射频扁桃体切除术加腺样体切除术组恢复正常饮食更为常见。目前，对于诊断儿童显著阻塞性睡眠呼吸暂停所需的标准仍存在争议。此外，该疾病的自然病程尚未完全阐明。缺乏关于腺样体扁桃体切除术治疗儿童确诊阻塞性睡眠呼吸暂停疗效的随机对照试验。在制定儿童阻塞性睡眠呼吸暂停治疗建议之前需要进行研究。通过在基线时使用睡眠研究来确定纳入该领域研究的儿童睡眠呼吸暂停严重程度，可提高该领域的研究质量。还需要进行长期随访，以探讨腺样体扁桃体切除术对儿童睡眠呼吸暂停的影响。
