Stanford University Sleep Medicine Division, 450 Broadway, Pavillon B, Redwood City, CA 94063, USA.
Sleep Breath. 2011 May;15(2):173-7. doi: 10.1007/s11325-010-0419-3. Epub 2010 Sep 17.
When both narrow maxilla and moderately enlarged tonsils are present in children with obstructive sleep apnea, the decision of which treatment to do first is unclear. A preliminary randomized study was done to perform a power analysis and determine the number of subjects necessary to have an appropriate response. Thirty-one children, 14 boys, diagnosed with OSA based on clinical symptoms and polysomnography (PSG) findings had presence of both narrow maxillary complex and enlarged tonsils. They were scheduled to have both adeno-tonsillectomy and RME for which the order of treatment was randomized: group 1 received surgery followed by orthodontics, while group 2 received orthodontics followed by surgery. Each child was seen by an ENT, an orthodontist, and a sleep medicine specialist. The validated pediatric sleep questionnaire and PSG were done at entry and after each treatment phase at time of PSG. Statistical analyses were ANOVA repeated measures and t tests.
The mean age of the children at entry was 6.5 ± 0.2 years (mean ± SEM). Overall, even if children presented improvement of both clinical symptoms and PSG findings, none of the children presented normal results after treatment 1, at the exception of one case. There was no significant difference in the amount of improvement noted independently of the first treatment approach. Thirty children underwent treatment 2, with an overall significant improvement shown for PSG findings compared to baseline and compared to treatment 1, without any group differences.
This preliminary study emphasizes the need to have more than subjective clinical scales for determination of sequence of treatments.
当儿童患有阻塞性睡眠呼吸暂停症且存在狭窄的上颌骨和中等程度肿大的扁桃体时，哪种治疗方法应优先进行尚不清楚。本研究进行了一项初步的随机研究，以进行功效分析并确定进行适当应答所需的受试者数量。31 名儿童（14 名男孩）根据临床症状和多导睡眠图（PSG）检查结果诊断为 OSA，存在狭窄的上颌复合体和肿大的扁桃体。他们计划同时进行腺样体切除术和 RME，治疗顺序随机化：第 1 组先接受手术再接受正畸治疗，第 2 组先接受正畸治疗再接受手术。每个孩子都由耳鼻喉科医生、正畸医生和睡眠医学专家进行检查。在初始检查和每次治疗阶段结束时（PSG 检查时）进行了经过验证的儿科睡眠问卷和 PSG 检查。统计分析采用重复测量方差分析和 t 检验。
儿童入组时的平均年龄为 6.5±0.2 岁（平均值±SEM）。总体而言，即使儿童的临床症状和 PSG 检查结果都有所改善，但在治疗 1 后，没有一个孩子的结果正常，除了一个例外。无论首选的治疗方法如何，改善程度都没有显著差异。30 名儿童接受了治疗 2，与基线和治疗 1 相比，PSG 检查结果均有显著改善，而两组之间没有差异。
这项初步研究强调，需要有比主观临床量表更客观的方法来确定治疗的顺序。
