Nation Javan, Brigger Matthew
1 Otolaryngology/Head and Neck Surgery, Rady Children's Hospital San Diego/University of California, San Diego, San Diego, California, USA.
Otolaryngol Head Neck Surg. 2017 Sep;157(3):401-408. doi: 10.1177/0194599817703921. Epub 2017 May 9.
Objective Determine the efficacy of adenotonsillectomy in children with Down syndrome. Data Sources Databases included PubMed, EMBASE, CINAHL, and Google Scholar. The search was inclusive of all references available through January 5, 2017. Review Methods A systematic review of the medical literature addressing adenotonsillectomy in treating obstructive sleep apnea in children with Down syndrome was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data were pooled using a random-effects model where possible. The quality of studies was graded using the Methodological Index for Nonrandomized Studies criteria. Results Of the 957 articles screened, 5 met inclusion for the qualitative analysis and 3 met criteria for the quantitative analysis. The findings of the qualitative analysis were that adenotonsillectomy has a positive effect on children with Down syndrome but in many cases is noncurative, up to 75% need postoperative breathing support, there is a high rate of immediate postoperative airway needs, and there is no change in sleep efficiency or architecture. The articles consistently reported moderate success in improving polysomnographic parameters, and limited pooling of the data demonstrated a mean decrease of the apnea-hypopnea index by 51% (95% confidence interval [CI], 46%-55%). Conclusion A 51% reduction in the preoperative apnea-hypopnea index can be expected with the intervention of adenotonsillectomy alone in children with Down syndrome. This information is useful for counseling and managing patient and family expectations. It also serves as a reminder to clinicians to obtain a postoperative sleep study, as many of these patients will need nighttime airway support or secondary sleep surgery.
目的 确定腺样体扁桃体切除术对唐氏综合征患儿的疗效。 数据来源 数据库包括PubMed、EMBASE、CINAHL和谷歌学术。检索涵盖截至2017年1月5日的所有可用参考文献。 综述方法 按照系统评价和Meta分析的首选报告项目，对关于腺样体扁桃体切除术治疗唐氏综合征患儿阻塞性睡眠呼吸暂停的医学文献进行系统评价。尽可能使用随机效应模型汇总数据。采用非随机研究方法学指数标准对研究质量进行分级。 结果 在筛选的957篇文章中，5篇符合定性分析的纳入标准，3篇符合定量分析的标准。定性分析的结果是，腺样体扁桃体切除术对唐氏综合征患儿有积极作用，但在许多情况下不能治愈，高达75%的患儿术后需要呼吸支持，术后立即出现气道问题的发生率很高，睡眠效率或结构没有变化。文章一致报道在改善多导睡眠图参数方面取得了中等程度的成功，有限的数据汇总显示呼吸暂停低通气指数平均下降了51%（95%置信区间[CI]，46%-55%）。 结论 仅对唐氏综合征患儿进行腺样体扁桃体切除术干预，预计术前呼吸暂停低通气指数可降低51%。这些信息有助于为患者及其家属提供咨询和管理期望。这也提醒临床医生进行术后睡眠研究，因为许多此类患者需要夜间气道支持或二次睡眠手术。
