Park J S, Chan D K, Parikh S R, Meyer A K, Rosbe K W
University of California, San Francisco, Pediatric Otolaryngology, 550 16th Street, San Francisco, CA 94158, USA.
Seattle Children's Hospital, Pediatric Otolaryngology, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Int J Pediatr Otorhinolaryngol. 2016 Nov;90:99-106. doi: 10.1016/j.ijporl.2016.09.004. Epub 2016 Sep 6.
To study the efficacy of surgical management for obstructive sleep apnea (OSA) syndrome in children with hypotonia, and to identify common anatomic sites of airway obstruction.
Retrospective chart review of polysomnographic parameters and quality of life instrument scores for seventy eight children with hypotonia who underwent surgical intervention for sleep-disordered breathing at two tertiary children's hospitals, and analysis of drug-induced sleep endoscopy data using a previously validated scoring system.
Children undergoing surgical intervention had baseline severe OSA with a statistically significant improvement in apnea-hypopnea index from 23.6 to 11.1 after surgery, but persistent severe OSA. OSA-18 sleep-related quality of life measurement and overall quality of life score showed statistically and clinically significant improvements, from 72.0 to 43.4 and from 5.3 to 7.6 respectively. Sleep endoscopy showed an average obstructive score of 7.2/15 (n = 39), with multi-level obstruction in 49% of children. Greater than 50% obstruction was observed at the tongue base in 64% of patients, velum in 46%, lateral pharyngeal wall in 38%, supraglottis in 38%, and adenoid in 23%.
OSA syndrome is challenging to treat in hypotonic children. Severe residual OSA is common after surgical intervention, but improvement in quality of life is clinically and statistically significant. The tongue base is the most common site of persistent airway obstruction. Drug-induced sleep endoscopy can identify sites of airway obstruction and may aid in surgical planning for high-risk patients.
研究手术治疗对肌张力减退儿童阻塞性睡眠呼吸暂停（OSA）综合征的疗效，并确定气道阻塞的常见解剖部位。
回顾性分析两家三级儿童医院78例因睡眠呼吸障碍接受手术干预的肌张力减退儿童的多导睡眠图参数和生活质量仪器评分，并使用先前验证的评分系统分析药物诱导睡眠内镜检查数据。
接受手术干预的儿童基线时存在严重OSA，术后呼吸暂停低通气指数从23.6显著改善至11.1，但仍存在持续性严重OSA。OSA-18睡眠相关生活质量测量和总体生活质量评分在统计学和临床上均有显著改善，分别从72.0降至43.4和从5.3升至7.6。睡眠内镜检查显示平均阻塞评分为7.2/15（n = 39），49%的儿童存在多平面阻塞。64%的患者在舌根处观察到超过50%的阻塞，软腭处为46%，咽侧壁为38%，声门上为38%，腺样体为23%。
肌张力减退儿童的OSA综合征治疗具有挑战性。手术干预后严重残留OSA很常见，但生活质量在临床和统计学上均有显著改善。舌根是持续性气道阻塞最常见的部位。药物诱导睡眠内镜检查可识别气道阻塞部位，并可能有助于高危患者的手术规划。
