Aksu Hatice, Günel Ceren, Özgür Börte Gürbüz, Toka Ali, Başak Sema
Department of Child and Adolescent Psychiatry, Adnan Menderes University, Aydın, Turkey.
Department of ENT, Adnan Menderes University, Aydın, Turkey.
Int J Pediatr Otorhinolaryngol. 2015 Jul;79(7):1030-3. doi: 10.1016/j.ijporl.2015.04.018. Epub 2015 Apr 18.
In children, the most common reason of upper airway obstruction (UAO) is adenotonsillar hypertrophy. In literature, the adverse effects of UAO and obstructive sleep apnea syndrome on behavior and attention in children have been reported in several articles. However, the methods used for the evaluation of behavioral disorders have not been standardized in those studies. The aim of this study was to investigate the behavioral and attention characteristics of children before and after adenoidectomy/adenotonsillectomy using an internationally valid method.
A total of 41 patients, between 6 and 11 years of age and having a medical history of UAO for at least one year for which adenotonsillectomy procedure was indicated, were enrolled in the study. The patients were evaluated for signs of attention/behavioral disorders by a child-adolescent psychiatrist and Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children: Present and Lifetime Version (K-SADS-PL) and The Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S), before and at the 6th month following the operation.
In the preoperative period, a psychiatric disorder was identified by K-SADS-PL in 41.4% (n =1 7) of patients. Of these, 11 patients had attention deficit hyperactivity disorder (ADHD), 6 had enuresis nocturna, and 2 had separation anxiety disorder. Pre- and postoperative mean scores in T-DSM-IV-S parent scale were 31.3 ± 8.5 and 20.2 ± 10.3, respectively, and this difference was statistically significant (p < 0.001).
The relationship of UAO and attention/behavioral disorders should be taken into consideration by child-adolescent psychiatrists together with ENT specialists and a multidisciplinary approach is important for the treatment team.
在儿童中，上气道梗阻（UAO）最常见的原因是腺样体扁桃体肥大。在文献中，已有多篇文章报道了UAO和阻塞性睡眠呼吸暂停综合征对儿童行为和注意力的不良影响。然而，这些研究中用于评估行为障碍的方法尚未标准化。本研究的目的是使用一种国际通用的方法，调查腺样体切除术/腺样体扁桃体切除术前和术后儿童的行为和注意力特征。
本研究共纳入41例年龄在6至11岁之间、有至少一年UAO病史且需行腺样体扁桃体切除术的患者。由儿童青少年精神科医生使用儿童情感障碍和精神分裂症量表：学龄儿童版（K-SADS-PL）以及基于图尔盖DSM-IV的儿童和青少年破坏性行为障碍筛查与评定量表（T-DSM-IV-S），在术前及术后第6个月对患者的注意力/行为障碍体征进行评估。
在术前阶段，K-SADS-PL确定41.4%（n = 17）的患者存在精神障碍。其中，11例患者患有注意力缺陷多动障碍（ADHD），6例患有夜间遗尿症，2例患有分离焦虑症。T-DSM-IV-S家长量表的术前和术后平均得分分别为31.3±8.5和20.2±10.3，差异具有统计学意义（p < 0.001）。
儿童青少年精神科医生应与耳鼻喉科专家共同考虑UAO与注意力/行为障碍之间的关系，多学科方法对治疗团队很重要。
