Todd Cameron A, Bareiss Anna K, McCoul Edward D, Rodriguez Kimsey H
1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
2 Department of Otorhinolaryngology-Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.
Otolaryngol Head Neck Surg. 2017 Nov;157(5):767-773. doi: 10.1177/0194599817717480. Epub 2017 Jul 4.
Objective To determine the impact of adenotonsillectomy on the quality of life of pediatric patients with obstructive sleep apnea (OSA) and to identify gaps in the current research. Data Sources The MEDLINE, EMBASE, and Cochrane databases were systematically searched via the Ovid portal on June 18, 2016, for English-language articles. Review Methods Full-text articles were selected that studied boys and girls <18 years of age who underwent adenotonsillectomy for OSA or sleep-disordered breathing and that recorded validated, quantitative quality-of-life outcomes. Studies that lacked such measures, performed adenotonsillectomy for indications other than OSA or sleep-disordered breathing, or grouped adenotonsillectomy with other procedures were excluded. Results Of the 328 articles initially identified, 37 were included for qualitative analysis. The level of evidence was generally low. All studies involving short-term follow-up (≤6 months) showed improvement in quality-of-life scores after adenotonsillectomy as compared with preoperative values. Studies involving long-term follow-up (>6 months) showed mixed results. Modifications to and concurrent procedures with conventional adenotonsillectomy were also identified that showed quality-of-life improvements. Three studies were identified for meta-analysis that compared pre- and postoperative Obstructive Sleep Apnea-18 scores. Short- and long-term follow-up versus preoperative scores showed significant improvement ( P < .001). Short- and long-term scores showed no significant difference. Conclusion This systematic review and meta-analysis demonstrate adenotonsillectomy's effectiveness in improving the quality of life of pediatric patients with OSA. This is well demonstrated in the short term and has strong indications in the long term.
目的 确定腺样体扁桃体切除术对小儿阻塞性睡眠呼吸暂停（OSA）患者生活质量的影响，并找出当前研究中的差距。 数据来源 通过Ovid平台于2016年6月18日系统检索MEDLINE、EMBASE和Cochrane数据库，查找英文文章。 综述方法 选择全文文章，这些文章研究对象为18岁以下因OSA或睡眠呼吸障碍接受腺样体扁桃体切除术的男孩和女孩，并记录了经过验证的定量生活质量结果。排除缺乏此类测量、因OSA或睡眠呼吸障碍以外的适应症进行腺样体扁桃体切除术或将腺样体扁桃体切除术与其他手术分组的研究。 结果 在最初识别的328篇文章中，37篇纳入定性分析。证据水平普遍较低。所有涉及短期随访（≤6个月）的研究均显示，与术前值相比，腺样体扁桃体切除术后生活质量评分有所改善。涉及长期随访（>6个月）的研究结果不一。还发现了对传统腺样体扁桃体切除术的改良和同期手术，这些手术显示生活质量有所改善。确定了三项进行荟萃分析的研究，比较了术前和术后阻塞性睡眠呼吸暂停-18评分。短期和长期随访与术前评分相比显示有显著改善（P<.001）。短期和长期评分无显著差异。 结论 这项系统评价和荟萃分析证明了腺样体扁桃体切除术在改善小儿OSA患者生活质量方面的有效性。这在短期内得到了充分证明，在长期内也有有力的指征。
