儿童腺样体扁桃体切除术后的生活质量和阻塞性睡眠呼吸暂停症状。
Quality of life and obstructive sleep apnea symptoms after pediatric adenotonsillectomy.
机构信息
Department of Otolaryngology-Head and Neck Surgery and Sleep Disorders Center,
Departments of Otolaryngology and Pediatrics, Utah Southwestern and Children's Medical Center, Dallas, Texas;
出版信息
Pediatrics. 2015 Feb;135(2):e477-86. doi: 10.1542/peds.2014-0620. Epub 2015 Jan 19.
BACKGROUND AND OBJECTIVES
Data from a randomized, controlled study of adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) were used to test the hypothesis that children undergoing surgery had greater quality of life (QoL) and symptom improvement than control subjects. The objectives were to compare changes in validated QoL and symptom measurements among children randomized to undergo adenotonsillectomy or watchful waiting; to determine whether race, weight, or baseline OSAS severity influenced changes in QoL and symptoms; and to evaluate associations between changes in QoL or symptoms and OSAS severity.
METHODS
Children aged 5 to 9.9 years with OSAS (N = 453) were randomly assigned to undergo adenotonsillectomy or watchful waiting with supportive care. Polysomnography, the Pediatric Quality of Life inventory, the Sleep-Related Breathing Scale of the Pediatric Sleep Questionnaire, the 18-item Obstructive Sleep Apnea QoL instrument, and the modified Epworth Sleepiness Scale were completed at baseline and 7 months. Changes in the QoL and symptom surveys were compared between arms. Effect modification according to race and obesity and associations between changes in polysomnographic measures and QoL or symptoms were examined.
RESULTS
Greater improvements in most QoL and symptom severity measurements were observed in children randomized to undergo adenotonsillectomy, including the parent-completed Pediatric Quality of Life inventory (effect size [ES]: 0.37), the 18-item Obstructive Sleep Apnea QoL instrument (ES: -0.93), the modified Epworth Sleepiness Scale score (ES: -0.42), and the Sleep-Related Breathing Scale of the Pediatric Sleep Questionnaire (ES: -1.35). Effect modification was not observed by obesity or baseline severity but was noted for race in some symptom measures. Improvements in OSAS severity explained only a small portion of the observed changes.
CONCLUSIONS
Adenotonsillectomy compared with watchful waiting resulted in significantly more improvements in parent-rated generic and OSAS-specific QoL measures and OSAS symptoms.
背景与目的
本研究使用一项随机对照研究的腺扁桃体切除术治疗阻塞性睡眠呼吸暂停综合征（OSAS）的数据来验证以下假说，即接受手术的儿童比对照组有更好的生活质量（QoL）和症状改善。研究目的是比较随机分配接受腺样体扁桃体切除术或观察等待的儿童在经过验证的 QoL 和症状测量方面的变化；确定种族、体重或基线 OSAS 严重程度是否影响 QoL 和症状的变化；并评估 QoL 或症状变化与 OSAS 严重程度之间的相关性。
方法
本研究纳入了年龄在 5 至 9.9 岁的患有 OSAS 的儿童（N = 453），随机分配接受腺样体扁桃体切除术或观察等待并接受支持性护理。在基线和 7 个月时，完成了多导睡眠图、儿童生活质量问卷、儿科睡眠问卷的睡眠相关呼吸量表、18 项阻塞性睡眠呼吸暂停 QoL 量表和改良 Epworth 嗜睡量表的评估。比较两组间 QoL 和症状量表的变化。根据种族和肥胖情况进行效应修饰，并检查多导睡眠图测量与 QoL 或症状变化之间的关联。
结果
与接受观察等待的儿童相比，接受腺样体扁桃体切除术的儿童在大多数 QoL 和症状严重程度测量上有更大的改善，包括父母完成的儿童生活质量问卷（效应大小 [ES]：0.37）、18 项阻塞性睡眠呼吸暂停 QoL 量表（ES：-0.93）、改良 Epworth 嗜睡量表评分（ES：-0.42）和儿科睡眠问卷的睡眠相关呼吸量表（ES：-1.35）。肥胖或基线严重程度并未观察到效应修饰，但在某些症状测量中观察到了种族的影响。OSAS 严重程度的改善仅能解释观察到的变化的一小部分。
结论
与观察等待相比，腺样体扁桃体切除术可显著改善父母评估的一般和 OSAS 特异性 QoL 指标以及 OSAS 症状。
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