Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan, Taiwan ; Department of Clinical Psychology College of Medicine, FU JEN Catholic University, Taipei, Taiwan.
Stanford University Sleep Medicine Division, Stanford, CA ; Department of Clinical Psychology College of Medicine, FU JEN Catholic University, Taipei, Taiwan.
Sleep. 2014 Jan 1;37(1):71-6. doi: 10.5665/sleep.3310.
To evaluate the efficacy of adenotonsillectomy (AT) in the treatment of children with obstructive sleep apnea (OSA) in a 3-y prospective, longitudinal study with analysis of risk factors of recurrence of OSA.
An investigation of children (6 to 12 y old) with OSA documented at entry and followed posttreatment at 6, 12, 24, and 36 mo with examination, questionnaires, and polysomnography. Multivariate generalized linear modeling and hierarchical linear models analysis were used to determine contributors to suboptimal long-term resolution of OSA, and Generalized Linear Models were used for analysis of risk factors of recurrence.
Of the 135 children, 88 terminated the study at 36 months post-AT. These 88 children (boys = 72, mean age = 8.9 ± 2.7 yersus boys 8.9 ± 2.04 y, girls: 8.8 ± 2.07 y; body mass index [BMI] = 19.5 ± 4.6 kg/m(2)) had a preoperative mean apnea-hypopnea index (AHI0) of 13.54 ± 7.23 and a mean postoperative AHI at 6 mo (AHI6) of 3.47 ± 8.41 events/h (with AHI6 > 1 = 53.4% of 88 children). A progressive increase in AHI was noted with a mean AHI36 = 6.48 ± 5.57 events/h and AHI36 > 1 = 68% of the studied group. Change in AHI was associated with changes in the OSA-18 questionnaire. The residual pediatric OSA after AT was significantly associated with BMI, AHI, enuresis, and allergic rhinitis before surgery. From 6 to 36 mo after AT, recurrence of pediatric OSA was significantly associated with enuresis, age (for the 24- to 36-mo period), postsurgery AHI6 (severity), and the rate of change in BMI and body weight.
Adenotonsillectomy leads to significant improvement in apnea-hypopnea index, though generally with incomplete resolution, but a worsening over time was observed in 68% of our cases.
通过一项为期 3 年的前瞻性纵向研究，对行扁桃体腺样体切除术（adenotonsillectomy，AT）的儿童阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）进行疗效评估，并分析 OSA 复发的危险因素。
对患有 OSA 的儿童（6 至 12 岁）进行调查，在术前记录，在术后 6、12、24 和 36 个月时通过检查、问卷调查和多导睡眠图进行随访。采用多变量广义线性建模和分层线性模型分析来确定导致 OSA 长期缓解效果不佳的因素，并采用广义线性模型分析复发的危险因素。
135 例患儿中，88 例在 AT 后 36 个月时完成研究。这 88 例患儿（男 72 例，平均年龄 8.9 ± 2.7 岁；女 8.8 ± 2.07 岁；体重指数 [body mass index，BMI] = 19.5 ± 4.6 kg/m²）术前平均呼吸暂停低通气指数（apnea-hypopnea index，AHI0）为 13.54 ± 7.23，术后 6 个月平均 AHI（AHI6）为 3.47 ± 8.41 次/小时（AHI6>1 者占 88 例的 53.4%）。研究组中，随着时间推移，AHI 逐渐增加，术后 36 个月时平均 AHI36 为 6.48 ± 5.57 次/小时，AHI36>1 者占 68%。AHI 的变化与 OSA-18 问卷的变化相关。AT 后残留的小儿 OSA 与术前 BMI、AHI、遗尿和过敏性鼻炎显著相关。从 AT 后 6 个月到 36 个月，小儿 OSA 的复发与遗尿、年龄（24 至 36 个月期间）、术后 AHI6（严重程度）以及 BMI 和体重变化率显著相关。
扁桃体腺样体切除术可显著改善呼吸暂停低通气指数，但总体上缓解不完全，且我们的研究中有 68%的病例在术后随时间推移逐渐恶化。
