1 Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
2 University of Toronto, Toronto, Ontario, Canada.
Otolaryngol Head Neck Surg. 2018 Apr;158(4):760-766. doi: 10.1177/0194599817746959. Epub 2017 Dec 12.
Objective To estimate the prevalence of persistent obstructive sleep apnea postadenotonsillectomy in children with complex chronic conditions. Study Design A retrospective cohort study. Setting The Hospital for Sick Children Sleep laboratory. Subjects Children ≤18 years of age who had moderate to severe obstructive sleep apnea and had polysomnography pre- and postadenotonsillectomy. Methods Medical and polysomnographic data were reviewed. The prevalence of persistent obstructive sleep apnea postadenotonsillectomy was determined for the following groups: no complex chronic conditions, single-system complex chronic conditions, and multisystem complex chronic conditions. Results We reviewed data of 133 (84 male) children. Their mean (standard deviation) age was 5.5 (3.8) years. The persistent obstructive sleep apnea rate postadenotonsillectomy was highest in children with multisystem complex chronic conditions (57%), intermediate in children with single-system complex chronic conditions (29%), and lowest in children without complex chronic conditions (15%), P = .0004. The odds (confidence interval) of having persistent obstructive sleep apnea postadenotonsillectomy was 7.42 (2.16-25.51) times higher in children with multisystem complex chronic conditions vs no complex chronic conditions and 3.35 (1.16-9.64) times higher in children with multisystem complex chronic conditions vs single-system complex chronic conditions. Conclusions Although adenotonsillectomy is considered first-line therapy in healthy children older than 2 years for the treatment of obstructive sleep apnea, there is a significantly greater risk of persistent obstructive sleep apnea postadenotonsillectomy in children with complex chronic conditions. Therefore, other surgical procedures or nonsurgical management may need to be considered as first-line treatment for this cohort.
评估患有复杂慢性疾病的儿童在腺样体扁桃体切除术后持续性阻塞性睡眠呼吸暂停的发生率。
回顾性队列研究。
SickKids 睡眠实验室。
患有中重度阻塞性睡眠呼吸暂停且在腺样体扁桃体切除术前和术后均进行过多导睡眠图检查的≤18 岁儿童。
回顾了患者的医疗和多导睡眠图数据。确定了以下各组在腺样体扁桃体切除术后持续性阻塞性睡眠呼吸暂停的发生率：无复杂慢性疾病、单系统复杂慢性疾病和多系统复杂慢性疾病。
我们回顾了 133 名（84 名男性）儿童的数据。他们的平均（标准差）年龄为 5.5（3.8）岁。腺样体扁桃体切除术后持续性阻塞性睡眠呼吸暂停的发生率在有多系统复杂慢性疾病的儿童中最高（57%），在有单系统复杂慢性疾病的儿童中居中（29%），在无复杂慢性疾病的儿童中最低（15%），P=0.0004。与无复杂慢性疾病的儿童相比，有多系统复杂慢性疾病的儿童在腺样体扁桃体切除术后发生持续性阻塞性睡眠呼吸暂停的可能性为 7.42（2.16-25.51）倍，与单系统复杂慢性疾病的儿童相比，有多系统复杂慢性疾病的儿童的可能性为 3.35（1.16-9.64）倍。
尽管对于 2 岁以上健康儿童的阻塞性睡眠呼吸暂停，腺样体扁桃体切除术被认为是一线治疗方法，但患有复杂慢性疾病的儿童在腺样体扁桃体切除术后发生持续性阻塞性睡眠呼吸暂停的风险显著更高。因此，可能需要考虑其他手术程序或非手术治疗作为该队列的一线治疗方法。
