Division of Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Sleep. 2013 Jun 1;36(6):841-7. doi: 10.5665/sleep.2708.
The reasons why adenotonsillectomy (AT) is less effective treating obese children with obstructive sleep apnea syndrome (OSAS) are not understood. Thus, the aim of the study was to evaluate how anatomical factors contributing to airway obstruction are affected by AT in these children.
Twenty-seven obese children with OSAS (age 13.0 ± 2.3 y, body mass index Z-score 2.5 ± 0.3) underwent polysomnography and magnetic resonance imaging of the head during wakefulness before and after AT. Volumetric analysis of the upper airway and surrounding tissues was performed using commercial software (AMIRA®).
Patients were followed for 6.1 ± 3.6 mo after AT. AT improved mean obstructive apnea-hypopnea index (AHI) from 23.7 ± 21.4 to 5.6 ± 8.7 (P < 0.001). Resolution of OSAS was noted in 44% (12 of 27), but only in 22% (4 of 18) of those with severe OSAS (AHI > 10). AT increased the volume of the nasopharynx and oropharynx (2.9 ± 1.3 versus 4.4 ± 0.9 cm(3), P < 0.001, and 3.2 ± 1.2 versus 4.3 ± 2.0 cm(3), P < 0.01, respectively), reduced tonsils (11.3 ± 4.3 versus 1.3 ± 1.4 cm(3), P < 0.001), but had no effect on the adenoid, lingual tonsil, or retropharyngeal nodes. A small significant increase in the volume of the soft palate and tongue was also noted (7.3 ± 2.5 versus 8.0 ± 1.9 cm(3), P = 0.02, and 88.2 ± 18.3 versus 89.3 ± 24.4 cm(3), P = 0.005, respectively).
This is the first report to quantify volumetric changes in the upper airway in obese children with OSAS after adenotonsillectomy showing significant residual adenoid tissue and an increase in the volume of the tongue and soft palate. These findings could explain the low success rate of AT reported in obese children with OSAS and are important considerations for clinicians treating these children.
腺扁桃体切除术（adenotonsillectomy，AT）治疗肥胖阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）儿童效果较差的原因尚不清楚。因此，本研究旨在评估 AT 治疗后这些儿童气道阻塞的解剖学相关因素如何变化。
27 例肥胖 OSAS 患儿（年龄 13.0 ± 2.3 岁，体重指数 Z 评分 2.5 ± 0.3）在清醒状态下接受多导睡眠监测和头部磁共振成像，分别于 AT 前后进行。使用商业软件（AMIRA®）对气道及周围组织进行容积分析。
27 例患儿 AT 后平均随访 6.1 ± 3.6 个月。AT 后，平均阻塞性呼吸暂停低通气指数（obstructive apnea-hypopnea index，AHI）从 23.7 ± 21.4 降至 5.6 ± 8.7（P＜0.001）。27 例患儿中，44%（12/27）OSAS 得到缓解，但重度 OSAS 患儿（AHI＞10）仅 22%（4/18）得到缓解。AT 使鼻咽腔和口咽腔容积增加（2.9 ± 1.3 与 4.4 ± 0.9 cm3，P＜0.001；3.2 ± 1.2 与 4.3 ± 2.0 cm3，P＜0.01），扁桃体缩小（11.3 ± 4.3 与 1.3 ± 1.4 cm3，P＜0.001），但对腺样体、舌扁桃体和咽后淋巴结无影响。软腭和舌的容积也有小但显著的增加（7.3 ± 2.5 与 8.0 ± 1.9 cm3，P=0.02；88.2 ± 18.3 与 89.3 ± 24.4 cm3，P=0.005）。
本研究首次报道了肥胖 OSAS 患儿 AT 后上气道容积的变化，发现腺样体组织残留和舌及软腭容积增加。这些发现可以解释肥胖 OSAS 患儿 AT 成功率低的原因，也是临床医生治疗此类患儿的重要考虑因素。
