Mitchell Ron B, Boss Emily F
Department of Otolaryngology-Head and Neck Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Dev Neuropsychol. 2009;34(5):650-61. doi: 10.1080/87565640903133657.
To evaluate the impact of adenotonsillectomy (T&A) on quality-of-life (QOL) and behavior in obese versus normal-weight children with Obstructive Sleep Apnea (OSA).
Prospective, non-randomized, controlled study.
Children with an apnea-hypopnea index (AHI) >or=2 were studied. Polysomnography was performed before and after T&A. An age- and gender-specific body mass index (BMI-for-age) percentile was determined preoperatively. Children who were obese (>95th percentile) were compared to normal-weight children (BMI-for-age > 5th-85th percentile). Caregivers completed the OSA-18 QOL survey and the Behavioral Assessment Survey for Children (BASC) before surgery and 3-6 months postoperatively. Pre- and postoperative scores were compared using paired t-tests, and the impact of covariants was analyzed using ANOVA.
The study population consisted of 89 children, 40 of whom were obese (45%). Postoperative scores for AHI, OSA-18 total and domain scores, and BASC scales and composites were significantly lower (improved) compared to pre-operative values in all children (p < .001). All mean OSA-18 and BASC scores were higher (indicating worse quality-of-life and behavior) pre- and postoperatively in obese than in normal-weight children. Postoperatively, the majority of OSA-18 total scores and domain scores were significantly higher in obese children. A comparison of the total OSA-18 scores between children with a postoperative AHI < 2 and AHI >or= 2 in obese children and a similar comparison in normal-weight children was not statistically significant. There was no significant difference for BASC scores pre- and postoperatively between obese and normal-weight children. The pre- and postoperative scores for the AHI had a poor correlation with the pre- and postoperative Behavioral Symptoms Index (BSI) and total OSA-18 scores (r = .09), respectively.
Following T&A all children have improvements in AHI, QOL, and behavior. Obese children are more likely to have persistent OSA and poor QOL scores after T&A. Behavior improves postoperatively to a similar extent in all children regardless of obesity.
评估腺样体扁桃体切除术（T&A）对肥胖与正常体重的阻塞性睡眠呼吸暂停（OSA）儿童生活质量（QOL）和行为的影响。
前瞻性、非随机对照研究。
对呼吸暂停低通气指数（AHI）≥2的儿童进行研究。在T&A手术前后进行多导睡眠图检查。术前确定年龄和性别特异性体重指数（年龄别BMI）百分位数。将肥胖儿童（>第95百分位数）与正常体重儿童（年龄别BMI>第5 - 85百分位数）进行比较。照顾者在手术前和术后3 - 6个月完成OSA - 18生活质量调查问卷和儿童行为评估量表（BASC）。术前和术后得分采用配对t检验进行比较，并使用方差分析分析协变量的影响。
研究人群包括89名儿童，其中40名肥胖（45%）。所有儿童术后AHI、OSA - 18总分及各领域得分、BASC量表及综合得分均显著低于术前值（改善）（p <.001）。肥胖儿童术前和术后所有平均OSA - 18和BASC得分均高于正常体重儿童（表明生活质量和行为更差）。术后，肥胖儿童的大多数OSA - 18总分及各领域得分显著更高。肥胖儿童术后AHI < 2与AHI≥2的儿童之间以及正常体重儿童的类似比较中，OSA - 18总分差异无统计学意义。肥胖和正常体重儿童术后BASC得分差异无统计学意义。AHI术前和术后得分分别与术前和术后行为症状指数（BSI）及OSA - 18总分的相关性较差（r =.09）。
T&A手术后所有儿童的AHI、生活质量和行为均有改善。肥胖儿童在T&A手术后更有可能持续存在OSA且生活质量得分较差。无论肥胖与否，所有儿童术后行为改善程度相似。
