Yin G P, Ye J Y, Xu J K, Cao X, Zhao C M, Zhang Y H
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 May 7;54(5):367-372. doi: 10.3760/cma.j.issn.1673-0860.2019.05.010.
To determine the objective effects of adenotonsillectomy on pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) through analyzing the polysomnography (PSG) results between pre and post-operation. A total of 56 pediatric OSAHS patients were included who underwent adenoidectomy or/and tonsillectomy and completed PSG follow-up from January 1, 2017 to March 31, 2018. All the pediatric patients who underwent adenoidectomy or/and tonsillectomy during the research period were arranged to take a preoperative PSG study. Patients who were diagnosed OSAHS would be encouraged to complete a follow-up PSG study ranged from1 to 3 months after surgery. The parameters of respiration and sleep architecture of PSG were compared and analyzed. The paired student test was used to compare preoperative and postoperative mean values. The unpaired student test was used to compare quantitative variables among different groups. The rank sum test was used if the data were abnormal distribution. Totally 238 patients completed preoperative PSG study, 62 patients were diagnosed as pediatric OSAHS, 56 eligible patients finished post-operative PSG. Hypopnea was the majority in all type of respiratory events in 56.45% (35/62) subjects, while central apnea as the majority in 29.03% (18/62) subjects who can also get significant CAI decrease after surgery. However, obstructive apnea as the majority only exist in 14.52% (9/62) subjects. The short-term cure rate of pediatric OSAHS was 85.71% (48/56). The postoperative AHI, MAI, CAI, HI, ODI, LoSpO(2), percentage of stage I sleep and arousal index were significantly decreased, however, the OAI was no statistical decrease. The percentage of stage Ⅱ and rapid eye movement (REM) sleep were significantly increased, while no significant change in percentage of slow wave sleep and sleep efficiency(2.32, 0.017). Pediatric OSAHS manifest different characteristics of respiratory events from that of adults. Adenotonsillectomy can significant decrease respiratory events and improve sleep architecture, however, there are still some patients who can't be completely relieved with adenotonsillectomy.
通过分析小儿阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者手术前后的多导睡眠图(PSG)结果,来确定腺样体扁桃体切除术对该疾病的客观疗效。纳入2017年1月1日至2018年3月31日期间接受腺样体切除术或/和扁桃体切除术并完成PSG随访的56例小儿OSAHS患者。研究期间所有接受腺样体切除术或/和扁桃体切除术的小儿患者均安排进行术前PSG检查。确诊为OSAHS的患者将被鼓励在术后1至3个月完成随访PSG检查。对PSG的呼吸和睡眠结构参数进行比较和分析。采用配对t检验比较术前和术后的平均值。采用非配对t检验比较不同组间的定量变量。若数据分布异常,则采用秩和检验。共有238例患者完成术前PSG检查,62例被诊断为小儿OSAHS,56例符合条件的患者完成术后PSG检查。在所有类型的呼吸事件中,56.45%(35/62)的受试者以低通气为主,而29.03%(18/62)的受试者以中枢性呼吸暂停为主,这些患者术后CAI也有显著下降。然而,仅14.52%(9/62)的受试者以阻塞性呼吸暂停为主。小儿OSAHS的短期治愈率为85.71%(48/56)。术后AHI、MAI、CAI、HI、ODI、最低血氧饱和度、I期睡眠百分比和觉醒指数均显著下降,然而,OAI无统计学下降。Ⅱ期和快速眼动(REM)睡眠百分比显著增加,而慢波睡眠百分比和睡眠效率无显著变化(2.32,0.017)。小儿OSAHS的呼吸事件特征与成人不同。腺样体扁桃体切除术可显著减少呼吸事件并改善睡眠结构,然而,仍有一些患者不能通过腺样体扁桃体切除术完全缓解。