Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, United States of America.
Department of Pediatrics, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medicine College of Jinan University, Shenzhen, Guangdong, China.
Am J Otolaryngol. 2020 Jul-Aug;41(4):102566. doi: 10.1016/j.amjoto.2020.102566. Epub 2020 May 27.
To examine surgery performed for obstructive sleep apnea (OSA) in children with syndromic or neurologic comorbidities.
Medical records of 375 children with OSA were retrospectively reviewed, including 142 patients with trisomy 21, 105 with cerebral palsy, 53 with muscular dystrophy, 32 with spinal muscular atrophy, 18 with mucopolysaccharidoses, 14 with achondroplasia, and 11 with Prader-Willi.
Apnea-hypopnea index (AHI), complications, length of postoperative stay, and endoscopic findings.
228 patients received 297 surgical interventions, with the remainder undergoing observation or positive pressure ventilation. Adenoidectomy was the most common procedure performed (92.1% of patients), followed by tonsillectomy (91.6%). Average AHI decreased following tonsillectomy, from 12.4 to 5.7 (p = 0.002). The most common DISE finding was the tongue base causing epiglottic retroflexion. Lingual tonsillectomy also resulted in an insignificant decrease in the AHI.
Adenotonsillectomy, when there is hypertrophy, remains the mainstay of management of syndromic and neurologically-impaired children with OSA. However, additional interventions are often required, due to incomplete resolution of the OSA. DISE is valuable in identifying remaining sites of obstruction and guiding future management.
研究伴有综合征或神经合并症的儿童阻塞性睡眠呼吸暂停（OSA）手术治疗。
回顾性分析 375 例 OSA 患儿的病历资料，其中 21 三体综合征 142 例、脑瘫 105 例、肌营养不良 53 例、脊髓性肌萎缩 32 例、黏多糖贮积症 18 例、软骨发育不全 14 例、普拉德-威利综合征 11 例。
呼吸暂停低通气指数（AHI）、并发症、术后住院时间和内镜检查结果。
228 例患儿接受了 297 次手术干预，其余患儿接受了观察或正压通气。腺样体切除术（92.1%）最常见，其次是扁桃体切除术（91.6%）。扁桃体切除术后 AHI 平均下降，从 12.4 降至 5.7（p=0.002）。最常见的直接喉镜检查发现是舌根导致会厌后倾。舌扁桃体切除术也会导致 AHI 轻微下降。
当存在肥大时，腺样体切除术仍然是治疗伴有综合征或神经障碍的 OSA 儿童的主要方法。然而，由于 OSA 不完全缓解，通常需要额外的干预措施。直接喉镜检查对于确定残余梗阻部位和指导后续治疗具有重要价值。
