Galluzzi Francesca, Pignataro Lorenzo, Gaini Renato Maria, Garavello Werner
Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy.
Department of Otorhinolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Sleep Med. 2015 Mar;16(3):331-5. doi: 10.1016/j.sleep.2014.10.017. Epub 2015 Jan 20.
Tonsillectomy and adenoidectomy (T&A) is currently recommended in children with Obstructive Sleep Apnea (OSA). However, the condition persists after surgery in about one third of cases. It has been suggested that Drug Induced Sleep Endoscopy (DISE) may be of help for planning a more targeted and effective surgical treatment but evidence is yet weak. The aim of this review is to draw recommendation on the use of DISE in children with OSA. More specifically, we aimed at determine the proportion of cases whose treatment may be influenced by DISE findings. A comprehensive search of articles published from February 1983 to January 2014 listed in the PubMed/MEDLINE databases was performed. The search terms used were: "endoscopy" or "nasoendoscopy" or "DISE" and "obstructive sleep apnea" and "children" or "child" or "pediatric." The main outcome was the rate of naive children with hypertrophic tonsils and/or adenoids. The assumptions are that clinical diagnosis of hypertrophic tonsils and/or adenoids is reliable and does not require DISE, and that exclusive T&A may solve OSA in the vast majority of cases even in the presence of other concomitant sites of obstruction. Five studies were ultimately selected and all were case series. The median (range) number of studied children was 39 (15-82). Mean age varied from 3.2 to 7.8 years. The combined estimate rate of OSA consequent to hypertrophic tonsils and/or adenoids was 71% (95%CI: 64-77%). In children with Down Syndrome, the combined estimated rate of hypertrophic tonsils and/or adenoids was 62% (95%CI: 44-79%). Our findings show that DISE may be of benefit in a minority of children with OSA since up to two thirds of naive cases presents with hypertrophic tonsils and/or adenoids. Its use should be limited to those whose clinical evaluation is unremarkable or when OSA persists after T&A.
目前，阻塞性睡眠呼吸暂停（OSA）患儿建议进行扁桃体切除术和腺样体切除术（T&A）。然而，约三分之一的病例术后病情仍会持续。有人认为，药物诱导睡眠内镜检查（DISE）可能有助于规划更有针对性和有效的手术治疗，但证据尚不充分。本综述的目的是就DISE在OSA患儿中的应用提出建议。更具体地说，我们旨在确定其治疗可能受DISE检查结果影响的病例比例。我们对PubMed/MEDLINE数据库中1983年2月至2014年1月发表的文章进行了全面检索。使用的检索词为：“内镜检查”或“鼻内镜检查”或“DISE”以及“阻塞性睡眠呼吸暂停”和“儿童”或“小孩”或“儿科”。主要结果是患有肥大扁桃体和/或腺样体的初治儿童比例。假设是肥大扁桃体和/或腺样体的临床诊断可靠，不需要DISE，并且即使存在其他伴随的阻塞部位，单纯的T&A在绝大多数病例中也可解决OSA。最终选择了五项研究，均为病例系列研究。研究儿童的中位数（范围）为39例（15 - 82例）。平均年龄在3.2至7.8岁之间。肥大扁桃体和/或腺样体导致的OSA综合估计率为71%（95%CI：64 - 77%）。在唐氏综合征患儿中，肥大扁桃体和/或腺样体的综合估计率为62%（95%CI：44 - 79%）。我们的研究结果表明，DISE可能仅对少数OSA患儿有益，因为多达三分之二的初治病例存在肥大扁桃体和/或腺样体。其应用应限于临床评估无异常或T&A术后OSA仍持续的患儿。
