Smith Matthew M, Peterson Ed, Yaremchuk Kathleen L
1 Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
2 Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA.
Otolaryngol Head Neck Surg. 2017 Aug;157(2):331-335. doi: 10.1177/0194599817698671. Epub 2017 Mar 28.
Objective To determine if tonsillectomy alone is an effective treatment in improving obstructive sleep apnea in adult subjects with tonsillar hypertrophy and to evaluate the effect of tonsillectomy on patient-reported quality-of-life indices. Study Design Case series with planned data collection. Setting Academic hospital. Subjects and Methods Thirty-four subjects completed enrollment and intervention from January 2011 to January 2016. Subjects completed pre- and postoperative quality-of-life questionnaires, including the Insomnia Severity Index, Epworth Sleepiness Scale, and the Functional Outcomes of Sleep Questionnaire-10. Surgical response to treatment was defined by a >50% decrease in the Apnea-Hypopnea Index and a decrease in the overall Apnea-Hypopnea Index to <20. Wilcoxon matched-pairs signed-rank tests were used to test each variable to assess for a change from pre- to postintervention. Subjects were then split into 3 BMI subgroups, with results also evaluated by Wilcoxon matched-pairs signed-rank tests. Results There was a significant difference discovered between the mean preoperative Apnea-Hypopnea Index of 31.57 and the mean postoperative value of 8.12 ( P < .001). All patient-reported outcomes improved significantly following tonsillectomy. After stratifying all outcome variables (Apnea-Hypopnea Index, Epworth Sleepiness Scale, Insomnia Severity Index, and Functional Outcomes of Sleep Questionnaire-10) by sex, race, and tonsil size, no statistically significant difference was noted among any of these subgroups. There was a 78% surgical response to treatment. Conclusion Tonsillectomy appears to be an effective treatment for obstructive sleep apnea in a select population of adults with tonsillar hypertrophy.
目的 确定单纯扁桃体切除术是否为改善成年扁桃体肥大患者阻塞性睡眠呼吸暂停的有效治疗方法，并评估扁桃体切除术对患者报告的生活质量指标的影响。研究设计 带有计划数据收集的病例系列研究。研究地点 学术医院。对象与方法 2011年1月至2016年1月，34名受试者完成了入组和干预。受试者完成了术前和术后生活质量问卷，包括失眠严重程度指数、爱泼华嗜睡量表和睡眠问卷-10的功能结局。治疗的手术反应定义为呼吸暂停低通气指数降低>50%，且总体呼吸暂停低通气指数降低至<20。采用Wilcoxon配对符号秩检验对每个变量进行检验，以评估干预前后的变化。然后将受试者分为3个体重指数亚组，结果也通过Wilcoxon配对符号秩检验进行评估。结果 术前平均呼吸暂停低通气指数31.57与术后平均8.12之间存在显著差异（P <.001）。扁桃体切除术后，所有患者报告的结局均有显著改善。按性别、种族和扁桃体大小对所有结局变量（呼吸暂停低通气指数、爱泼华嗜睡量表、失眠严重程度指数和睡眠问卷-10的功能结局）进行分层后，这些亚组之间均未发现统计学上的显著差异。治疗的手术反应率为78%。结论 对于特定的成年扁桃体肥大患者群体，扁桃体切除术似乎是治疗阻塞性睡眠呼吸暂停的有效方法。
