Pabla L, Duffin J, Flood L, Blackmore K
ENT Department,James Cook University Hospital,Middlesbrough,UK.
J Laryngol Otol. 2018 Apr;132(4):284-292. doi: 10.1017/S0022215118000208. Epub 2018 Feb 14.
Paediatric obstructive sleep apnoea is a common clinical condition managed by most ENT clinicians. However, despite the plethora of publications on the subject, there is wide variability, in the literature and in practice, on key aspects such as diagnostic criteria, the impact of co-morbidities and the indications for surgical correction.
A systematic review is presented, addressing four key questions from the available literature: (1) what is the evidence base for any definition of paediatric obstructive sleep apnoea?; (2) does it cause serious systemic illness?; (3) what co-morbidities influence the severity of paediatric obstructive sleep apnoea?; and (4) is there a medical answer?
There is a considerable lack of evidence regarding most of these fundamental questions. Notably, screening measures show low specificity and can be insensitive to mild obstructive sleep apnoea. There is a surprising lack of clarity in the definition (let alone estimate of severity) of sleep-disordered breathing, relying on what may be arbitrary test thresholds. Areas of potential research might include investigation of the mechanisms through which obstructive sleep apnoea causes co-morbidities, whether neurocognitive, behavioural, metabolic or cardiovascular, and the role of non-surgical management.
小儿阻塞性睡眠呼吸暂停是大多数耳鼻喉科临床医生都会处理的常见临床病症。然而，尽管关于该主题的出版物众多，但在诊断标准、合并症的影响以及手术矫正指征等关键方面，文献和实践中仍存在很大差异。
本文进行了一项系统综述，针对现有文献中的四个关键问题展开探讨：（1）小儿阻塞性睡眠呼吸暂停的任何定义的证据基础是什么？；（2）它会导致严重的全身性疾病吗？；（3）哪些合并症会影响小儿阻塞性睡眠呼吸暂停的严重程度？；（4）是否有医学解决方案？
对于这些基本问题中的大多数，证据相当匮乏。值得注意的是，筛查措施显示出低特异性，并且可能对轻度阻塞性睡眠呼吸暂停不敏感。睡眠呼吸障碍的定义（更不用说严重程度的评估）令人惊讶地缺乏清晰度，这依赖于可能是任意的测试阈值。潜在的研究领域可能包括调查阻塞性睡眠呼吸暂停导致合并症的机制，无论是神经认知、行为、代谢还是心血管方面的机制，以及非手术治疗的作用。
