Department of Pediatrics, University Hospital Antwerp, Antwerp, Belgium.
Technology, Biomedical Physics, FluidDA, Kontich, Belgium.
J Clin Sleep Med. 2018 Apr 15;14(4):651-659. doi: 10.5664/jcsm.7064.
The complexity of the pathogenesis of obstructive sleep apnea (OSA) in children with Down syndrome (DS) is illustrated by a prevalence of residual OSA after adenotonsillectomy. The aim of this study was to investigate whether upper airway imaging combined with computation fluid dynamics could characterize treatment outcome after adenotonsillectomy in these children.
Children with DS and OSA were prospectively included. All children underwent an evaluation of the upper airway and an ultra-low dose computed tomography scan of the upper airway before adenotonsillectomy. The upper airway tract was extracted from the scan and combined with computational fluid dynamics. Results were evaluated using control polysomnography after adenotonsillectomy.
Thirty-three children were included: 18 boys, age 4.3 ± 2.3 years, median body mass index z-score 0.6 (-2.9 to 3.0), and median obstructive apnea-hypopnea index was 15.7 (3-70) events/h. The minimal upper airway cross-sectional area was significantly smaller in children with more severe OSA ( = .03). Nineteen children underwent a second polysomnography after adenotonsillectomy. Seventy-nine percent had persistent OSA (obstructive apneahypopnea index > 2 events/h). A greater than 50% decrease in obstructive apnea-hypopnea index was observed in 79% and these children had a significantly higher volume of the regions below the tonsils.
This is the first study to characterize treatment outcome in children with DS and OSA using computed tomography upper airway imaging. At baseline, children with more severe OSA had a smaller upper airway. Children with a less favorable response to adenotonsillectomy had a smaller volume of regions below the tonsils, which could be due to enlargement of the lingual tonsils, glossoptosis, or macroglossia.
A commentary on this article appears in this issue on page 501.
唐氏综合征（DS）患儿阻塞性睡眠呼吸暂停（OSA）的发病机制较为复杂，即使接受了腺样体扁桃体切除术，仍有部分患儿存在残余 OSA。本研究旨在探讨上气道影像学联合计算流体动力学是否可以对这些患儿腺样体扁桃体切除术后的治疗效果进行评估。
前瞻性纳入 DS 合并 OSA 的患儿。所有患儿均在腺样体扁桃体切除术前行上气道评估和超低剂量上气道 CT 扫描。从扫描中提取上气道，并结合计算流体动力学。术后采用控制多导睡眠图进行评估。
共纳入 33 例患儿，男 18 例，年龄 4.3±2.3 岁，中位数体质指数 z 评分 0.6（-2.9 至 3.0），中位数阻塞性呼吸暂停低通气指数为 15.7（3 至 70）事件/h。上气道最小横截面积在 OSA 更严重的患儿中显著更小（P=.03）。19 例患儿在腺样体扁桃体切除术后接受了第二次多导睡眠图检查。79%的患儿仍存在持续性 OSA（阻塞性呼吸暂停低通气指数>2 事件/h）。79%的患儿阻塞性呼吸暂停低通气指数降低了>50%，这些患儿的扁桃体下方区域体积明显更小。
这是第一项使用 CT 上气道成像来评估 DS 合并 OSA 患儿治疗效果的研究。在基线时，OSA 更严重的患儿上气道更小。对腺样体扁桃体切除术反应不佳的患儿扁桃体下方区域体积更小，这可能是由于舌扁桃体增大、软腭下垂或巨舌所致。
本文评论见本期第 501 页。
