1 Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical, Cincinnati, Ohio, USA.
2 Department of Otolaryngology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Otolaryngol Head Neck Surg. 2018 Mar;158(3):559-565. doi: 10.1177/0194599817740332. Epub 2017 Nov 7.
Objectives To determine the effectiveness of pediatric drug-induced sleep endoscopy (DISE)-directed surgery for children with infant obstructive sleep apnea (OSA) or OSA after adenotonsillectomy. Study Design Case series with chart review. Setting Tertiary care pediatric hospital. Subjects and Methods We included 56 children undergoing DISE from October 2013 to September 2015 who underwent subsequent surgery to address OSA. The primary outcome was successful response to DISE-directed surgery based on the postoperative obstructive Apnea-Hypopnea Index (oAHI). Wilcoxon matched-pairs signed-ranks tests were used to compare polysomnography variables before and after surgery, and regression was used to model response to surgery. Results We evaluated 56 patients with a mean age of 5.9 ± 5.5 years (range, 0.1-17.4) and mean body mass index of 21.2 ± 7.9 kg/m (percentile, 77 ± 30). The most commonly performed surgical procedures were adenoidectomy (48%, n = 27), supraglottoplasty (38%, n = 21), tonsillectomy (27%, n = 15), lingual tonsillectomy (13%, n = 7), nasal surgery (11%, n = 6), pharyngoplasty (7%, n = 4), and partial midline glossectomy (7%, n = 4). Mean oAHI improved from 14.9 ± 13.5 to 10.3 ± 16.2 events/hour, with 54% (30 of 56) of children with oAHI <5 and 16.1% (9 of 56) with oAHI <1. There was a significant improvement in oAHI ( P = .001) and saturation nadir ( P < .001) but not in time with end tidal carbon dioxide >50 mm Hg ( P = .14). Multivariable modeling, controlling for age, race, body mass index, sex, and baseline polysomnography variables, revealed that white race predicted success of DISE-directed surgery. Conclusion Fifty-four percent of children with infant OSA or persistent OSA after adenotonsillectomy had oAHI <5 events per hour after DISE-directed surgery. Only white race was predictive of oAHI <5 events per hour.
确定小儿药物诱导睡眠内镜（DISE）指导下手术治疗婴儿阻塞性睡眠呼吸暂停（OSA）或腺样体扁桃体切除术后 OSA 的疗效。
病例系列，病历回顾。
三级儿童医院。
我们纳入了 2013 年 10 月至 2015 年 9 月期间因 OSA 接受 DISE 并随后接受手术治疗的 56 名儿童。主要结局指标为根据术后阻塞性呼吸暂停低通气指数（oAHI）判断 DISE 指导下手术的成功反应。Wilcoxon 配对符号秩检验用于比较手术前后的多导睡眠图变量，回归用于建立对手术的反应模型。
我们评估了 56 例平均年龄 5.9±5.5 岁（范围，0.1-17.4）、平均体重指数 21.2±7.9kg/m2（百分位数，77±30）的患者。最常进行的手术为腺样体切除术（48%，n=27）、悬雍垂成形术（38%，n=21）、扁桃体切除术（27%，n=15）、舌扁桃体切除术（13%，n=7）、鼻手术（11%，n=6）、咽成形术（7%，n=4）和部分中线舌切除术（7%，n=4）。oAHI 均值从 14.9±13.5 降至 10.3±16.2 次/小时，54%（56 例中有 30 例）的儿童 oAHI＜5，16.1%（56 例中有 9 例）的儿童 oAHI＜1。oAHI（P=0.001）和饱和度最低值（P＜0.001）显著改善，但呼气末二氧化碳＞50mmHg 的时间无显著改善（P=0.14）。多变量模型控制年龄、种族、体重指数、性别和基线多导睡眠图变量后显示，白种人种族预测 DISE 指导下手术的成功率。
婴儿 OSA 或腺样体扁桃体切除术后持续 OSA 患儿中，54%在 DISE 指导下手术后 oAHI＜5 次/小时。只有白种人种族是 oAHI＜5 次/小时的预测因素。
