Tang Alice, Benke James R, Cohen Aliza P, Ishman Stacey L
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Otolaryngol Head Neck Surg. 2015 Aug;153(2):281-5. doi: 10.1177/0194599815583459. Epub 2015 May 4.
To determine if pediatric obstructive sleep apnea (OSA) improves after adenotonsillectomy (AT) regardless of tonsil size.
Case series with chart review.
Pediatric Otolaryngology Department, Johns Hopkins Hospital.
Seventy children 1 to 18 years of age who underwent polysomnography (PSG) before and after AT.
Tonsil size was evaluated using the Brodsky grading scale.
Children were stratified by tonsil size as 2+ (n = 20), 3+ (n = 36), and 4+ (n = 14). There was a significant improvement in obstructive apnea-hypopnea index (oAHI), apnea index (AI), and saturation nadir across all 3 groups after AT. Preoperative oAHI, AI, and hypopnea index (HI) were similar regardless of tonsil size (P > .05). Overall, oAHI improved from a median of 11.8 ± 21.7 to 2.0 ± 6.1 events/h, with 40% (28/70) of children having complete resolution. The oAHI (P < .0001-0.02), AI (P < .0001-0.017), HI (P < .0001-0.058), and saturation nadir (P < .0001-0.017) significantly improved for the 2+, 3+, and 4+ groups. Only the HI (P = .058) in the 2+ group did not. The median oAHI improvement was 3.4 ± 26.4 events/h in the 2+ group, 8.3 ± 16.6 events/h in the 3+ group, and 12.3 ± 19.5 events/h in the 4+ group, with 25% (5/20), 50% (18/36), and 36% (5/14), respectively, having complete resolution. There was no correlation between OSA severity and tonsil or adenoid size (P > .32).
Tonsil size did not correlate with OSA severity. While a larger proportion of patients classified as 3+ and 4+ had complete resolution after surgery, significant improvement was seen in AI and saturation nadir even in those classified as 2+.
确定小儿阻塞性睡眠呼吸暂停（OSA）在腺样体扁桃体切除术（AT）后是否有所改善，而不考虑扁桃体大小。
病历回顾病例系列研究。
约翰霍普金斯医院儿科耳鼻喉科。
70名1至18岁在AT前后接受多导睡眠图（PSG）检查的儿童。
使用布罗德斯基分级量表评估扁桃体大小。
根据扁桃体大小将儿童分为2+组（n = 20）、3+组（n = 36）和4+组（n = 14）。AT后所有3组的阻塞性呼吸暂停低通气指数（oAHI）、呼吸暂停指数（AI）和最低血氧饱和度均有显著改善。无论扁桃体大小，术前oAHI、AI和低通气指数（HI）均相似（P >.05）。总体而言，oAHI从中位数11.8±21.7次/小时改善至2.0±6.1次/小时，40%（28/70）的儿童完全缓解。2+组、3+组和4+组的oAHI（P <.0001 - 0.02）、AI（P <.0001 - 0.017）、HI（P <.0001 - 0.058）和最低血氧饱和度（P <.0001 - 0.017）均显著改善。只有2+组的HI（P =.058）未改善。2+组oAHI改善的中位数为3.4±26.4次/小时，3+组为8.3±16.6次/小时，4+组为12.3±19.5次/小时，完全缓解率分别为25%（5/20）、50%（18/36）和36%（5/14）。OSA严重程度与扁桃体或腺样体大小之间无相关性（P >.32）。
扁桃体大小与OSA严重程度无关。虽然分类为3+和4+的患者术后完全缓解的比例更高，但即使是分类为2+的患者，其AI和最低血氧饱和度也有显著改善。
