Slaats Monique, Vos Wim, Van Holsbeke Cedric, De Backer Jan, Loterman Dieter, De Backer Wilfried, Boudewyns An, Verhulst Stijn
Department of Paediatrics, Antwerp University Hospital, Edegem, Belgium.
Laboratory of Experimental Medicine and Paediatrics (LEMP), University of Antwerp, Universiteitsplein 1, Antwerp, Belgium.
Pediatr Pulmonol. 2017 Jun;52(6):799-805. doi: 10.1002/ppul.23684. Epub 2017 Mar 7.
The aim of this study was to investigate whether functional respiratory imaging (FRI) or clinical examination could predict treatment outcome for obstructive sleep apnea (OSA) in normal-weight, non-syndromic children.
Normal weight children diagnosed with OSA by polysomnography were prospectively included. All children got a thorough evaluation and an ultra-low dose computed tomography scan of the upper airway (UA). A 3-D reconstruction was built combined with computational fluid dynamics for FRI. Decisions on the need and type of surgery were based upon findings during drug-induced sleep endoscopy. A second polysomnography was performed 3-12 months after surgery.
Ninety-one children were included: 62 boys, 5.0 ± 2.7 years, and BMI z-score of -0.1 ± 1.2. Children with more severe OSA had a smaller volume of the overlap region between the adenoids and tonsils. Nineteen out of 60 patients had persistent OSA (oAHI >2/h). A lower conductance in the UA and a higher tonsil score predicted successful treatment.
A less constricted airway, as characterized by both FRI and a lower tonsil score, was associated with a less favorable response to (adeno) tonsillectomy. Further studies after treatment using FRI and DISE are warranted to further characterize the UA of these subjects.
本研究旨在调查功能呼吸成像（FRI）或临床检查能否预测正常体重、非综合征性儿童阻塞性睡眠呼吸暂停（OSA）的治疗结果。
前瞻性纳入经多导睡眠图诊断为OSA的正常体重儿童。所有儿童均接受了全面评估以及上气道（UA）的超低剂量计算机断层扫描。结合计算流体动力学构建了用于FRI的三维重建。手术需求和类型的决策基于药物诱导睡眠内镜检查的结果。术后3至12个月进行了第二次多导睡眠图检查。
纳入91名儿童：62名男孩，年龄5.0±2.7岁，BMI z评分为-0.1±1.2。OSA更严重的儿童腺样体和扁桃体之间重叠区域的体积较小。60名患者中有19名持续存在OSA（阻塞性呼吸暂停低通气指数>2次/小时）。UA较低的传导性和较高的扁桃体评分预测治疗成功。
FRI和较低的扁桃体评分所表征的气道狭窄程度较轻与（腺样体）扁桃体切除术后反应较差相关。有必要在治疗后使用FRI和药物诱导睡眠内镜检查进行进一步研究，以进一步表征这些受试者的上气道情况。
