Martinot Jean-Benoît, Le-Dong N Nam, Denison Stéphane, Guénard Hervé Jean-Pierre, Borel Jean-Christian, Silkoff Philip E, Pepin Jean-Louis, Gozal David
CHU UCL Namur, Namur, Belgium.
RespiSom Private Research Medical Center, Namur, Belgium.
Laryngoscope. 2018 May;128(5):1230-1237. doi: 10.1002/lary.26830. Epub 2017 Aug 22.
Adenotonsillectomy (AT) markedly improves but does not necessarily normalize polysomnographic findings in children with adenotonsillar hypertrophy and related sleep-disordered breathing (SDB). Adenotonsillectomy efficacy should be evaluated by follow-up polysomnography (PSG), but this method may underestimate persistent respiratory effort (RE). Mandibular movement (MMas) monitoring is an innovative measurement that readily identifies RE during upper airway obstruction. We hypothesized that MMas indices would decrease in parallel of PSG indices and that children with persistent RE more reliably could be identified with MMas.
Twenty-five children (3-12 years of age) with SDB were enrolled in this individual prospective-cohort study. Polysomnography was supplemented with a midsagittal movement magnetic sensor that measured MMas during each respiratory cycle before and > 3 months after AT.
Adenotonsillectomy significantly improved PSG indices, except for RE-related arousals (RERA). Mandibular movement index changes after AT significantly were correlated with corresponding decreases in sleep apnea-hypopnea index (AHI) and O desaturation index (ODI) (Spearman's rho = 0.978 and 0.922, respectively), whereas changes in MMas duration significantly were associated with both RERA duration (rho = 0.475, P = 0.017) and index (rho = 0.564, P = 0.003). Conditional multivariate analysis showed that both AHI and RERA significantly contributed to the variance of MMas index after AT (P = 0.0003 and 0.0005, respectively), whereas MMas duration consistently was related to the duration of RERA regardless of AT.
Adenotonsillectomy significantly reduced AHI. However, persistent RERA were apparent in a significant proportion of children, and this was reflected by the remaining abnormal MMas pattern. Follow-up of children after AT can be recommended and readily achieved by monitoring MMas to identify persistent RE.
腺样体扁桃体切除术（AT）可显著改善腺样体扁桃体肥大及相关睡眠呼吸障碍（SDB）患儿的多导睡眠图检查结果，但不一定使其恢复正常。腺样体扁桃体切除术的疗效应通过随访多导睡眠图（PSG）进行评估，但该方法可能低估持续呼吸努力（RE）。下颌运动（MMas）监测是一种创新测量方法，可在上气道阻塞期间轻松识别RE。我们假设MMas指标将与PSG指标平行下降，并且通过MMas能够更可靠地识别出存在持续RE的儿童。
25名患有SDB的儿童（3至12岁）纳入了这项个体前瞻性队列研究。多导睡眠图检查补充了一个矢状面运动磁传感器，该传感器在AT术前及术后3个月以上的每个呼吸周期测量MMas。
腺样体扁桃体切除术显著改善了PSG指标，但与呼吸努力相关的觉醒（RERA）除外。AT术后下颌运动指数变化与睡眠呼吸暂停低通气指数（AHI）和氧饱和度下降指数（ODI）的相应降低显著相关（Spearman相关系数分别为0.978和0.922），而MMas持续时间的变化与RERA持续时间（相关系数 = 0.475，P = 0.017）和指数（相关系数 = 0.564，P = 0.003）均显著相关。条件多变量分析表明，AHI和RERA均对AT术后MMas指数的方差有显著贡献（分别为P = 0.0003和0.0005），而无论是否进行AT，MMas持续时间始终与RERA持续时间相关。
腺样体扁桃体切除术显著降低了AHI。然而，相当一部分儿童存在明显的持续性RERA，这通过剩余的异常MMas模式得以体现。建议对AT术后的儿童进行随访，通过监测MMas来识别持续RE可轻松实现这一点。
4。《喉镜》，2018年，第128卷，第1230 - 1237页。
