Lee Li-Ang, Li Hsueh-Yu, Lin Yu-Sheng, Fang Tuan-Jen, Huang Yu-Shu, Hsu Jen-Fu, Wu Che-Ming, Huang Chung-Guei
School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Otolaryngology, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China
School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Otolaryngology, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Otolaryngol Head Neck Surg. 2015 Mar;152(3):553-60. doi: 10.1177/0194599814561203. Epub 2014 Dec 17.
To report improvements in childhood obstructive sleep apnea (OSA) and hypertension after adenotonsillectomy.
Case series with planned data collection.
Tertiary referral center.
Fifty consecutive patients (36 boys and 14 girls; median age, 7.0 years) who underwent plasma knife-assisted total tonsillectomy and adenoidectomy for OSA between January 2010 and March 2013 were assessed with the body mass index z score, apnea-hypopnea index (AHI), systolic blood pressure (BP), and diastolic BP at baseline and at ≥6 months postoperatively. Changes in these parameters were statistically analyzed using nonparametric tests with the bootstrap approach.
The median follow-up period was 9.6 months. Postoperatively, the median AHI significantly reduced from 9.8 to 1.6 (P<.001). Although the median systolic BP and diastolic BP insignificantly changed in the overall group, both were significantly reduced in children with preoperative hypertension (systolic: from 119.0 to 113.0 [P=.038]; diastolic: from 79.0 to 68.0 [P=.005]). Accordingly, the hypertension rate significantly reduced from 34% to 14% (P=.006). However, the change in OSA severity was not well correlated with the change in hypertension severity. In multiple logistic regression analysis with forward selection, a combination of preoperative hypertension and severe OSA was a significant predictor of postoperative hypertension (relative risk, 15.4; 95% confidence interval, 3.7-64.3; P<.001).
The decreased hypertension rate indicates that a reduction of the AHI is not all that matters after adenotonsillectomy in childhood OSA. However, patients with preoperative severe OSA and hypertension need careful management of their elevated BP despite surgical treatment.
报告腺扁桃体切除术后儿童阻塞性睡眠呼吸暂停（OSA）和高血压的改善情况。
有计划数据收集的病例系列。
三级转诊中心。
对2010年1月至2013年3月间因OSA接受等离子刀辅助全扁桃体切除术和腺样体切除术的50例连续患者（36例男孩和14例女孩；中位年龄7.0岁），在基线及术后≥6个月时采用体重指数z评分、呼吸暂停低通气指数（AHI）、收缩压（BP）和舒张压进行评估。使用非参数检验和自助法对这些参数的变化进行统计学分析。
中位随访期为9.6个月。术后，中位AHI从9.8显著降至1.6（P<0.001）。虽然总体组中位收缩压和舒张压变化不显著，但术前高血压儿童的收缩压和舒张压均显著降低（收缩压：从119.0降至113.0 [P = 0.038]；舒张压：从79.0降至68.0 [P = 0.005]）。因此，高血压发生率从34%显著降至14%（P = 0.006）。然而，OSA严重程度的变化与高血压严重程度的变化相关性不佳。在向前选择的多因素逻辑回归分析中，术前高血压和重度OSA的组合是术后高血压的显著预测因素（相对风险，15.4；95%置信区间，3.7 - 64.3；P<0.001）。
高血压发生率降低表明，儿童OSA行腺扁桃体切除术后，AHI降低并非唯一重要的事情。然而，术前有重度OSA和高血压的患者，尽管接受了手术治疗，仍需对其升高的血压进行仔细管理。
