Department of Otolaryngology, Shanghai Children's Medical Center Affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China.
PLoS One. 2019 Feb 22;14(2):e0212317. doi: 10.1371/journal.pone.0212317. eCollection 2019.
The study aims to examine drug-induced sleep endoscopy (DISE) in the decision-making process of pediatric obstructive sleep apnea (OSA) patients with small tonsils. This was a retrospective study of children who underwent awake flexible endoscopy, DISE, and adenoidectomy with/without tonsillectomy at the Shanghai Children's Medical Center between 03/2015 and 12/2016. Tonsillectomy was performed for tonsillar obstruction found by DISE. Adenoidectomy was performed for all children. Cardio-pulmonary coupling (CPC) and oximetry were observed before/after surgery. The study included 126 children: 56 (44.4%) with grade 2 tonsils and 70 (55.6%) with grade 1. Mean age was 5.7±3.2 (range, 2.8-10.4) years and mean BMI of 15.7±5.5 kg/m2. Unexpectedly, DISE showed tonsillar obstruction in 57 (45.2%) children, including 44 (78.6%) with grade 2 tonsils and 13 (18.6%) with grade 1. Therefore, DISE-directed tonsillectomy was performed for 57 patients. There was an improvement in respiratory disturbance index (RDI) and oxygen saturation nadir in the DISE (P = 0.0007, P = 0.037) and control (P = 0.001, P = 0.023) groups 6 months after surgery, but RDI improvement was better in the DISE group compared with controls 1 year after surgery (P = 0.042). DISE is a good way to determine the necessity of tonsillectomy in pediatric OSA patients with small tonsils.
本研究旨在探讨药物诱导睡眠内镜（DISE）在小扁桃体儿童阻塞性睡眠呼吸暂停（OSA）患者决策中的作用。这是一项回顾性研究，纳入了 2015 年 3 月至 2016 年 12 月期间在上海儿童医学中心行清醒纤维内镜检查、DISE 和腺样体切除术（伴或不伴扁桃体切除术）的儿童。根据 DISE 发现的扁桃体阻塞情况行扁桃体切除术。所有儿童均行腺样体切除术。观察手术前后心肺偶联（CPC）和血氧饱和度。研究共纳入 126 例儿童：56 例（44.4%）扁桃体 2 度肿大，70 例（55.6%）扁桃体 1 度肿大。平均年龄为 5.7±3.2（范围 2.8-10.4）岁，平均 BMI 为 15.7±5.5kg/m2。出乎意料的是，57 例（45.2%）儿童的 DISE 显示存在扁桃体阻塞，其中 44 例（78.6%）扁桃体 2 度肿大，13 例（18.6%）扁桃体 1 度肿大。因此，57 例患者行 DISE 指导下的扁桃体切除术。DISE 组和对照组术后 6 个月呼吸暂停低通气指数（RDI）和血氧饱和度最低点均有改善（P=0.0007，P=0.037；P=0.001，P=0.023），但 DISE 组较对照组术后 1 年 RDI 改善更明显（P=0.042）。在小扁桃体儿童 OSA 患者中，DISE 是确定是否行扁桃体切除术的良好方法。
