Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
Int J Pediatr Otorhinolaryngol. 2020 Dec;139:110482. doi: 10.1016/j.ijporl.2020.110482. Epub 2020 Nov 4.
Paediatrics obstructive sleep apnoea have been discussed to a great degree over the recent years and remains a conundrum till date. The advent of instrumentation has aided upper airway evaluation in determining the site and degree of upper airway collapse for targeted and effective surgical planning. The literature was reviewed to determine the outcome of Drug Induced Sleep Endoscopy (DISE) directed surgery in children with obstructive sleep apnoea.
A literature search was conducted for the period from January 2000 to December 2019 by using a number of medical literature data bases including Scopus, PubMed and Embase. The following search words were used either individually or in combination: drug-induced sleep endoscopy, sleep endoscopy directed surgery, paediatrics sleep apnoea. The search was conducted over a month period (December 2019). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were followed when possible.
Seven clinical research articles were selected based on our objective and selection criteria. Seven studies were of level III evidence: retrospective, case-control and prospective series. Altogether, there were 996 patients with male predominance; 61%. Over 10% of patients (133 patients) were found to have comorbidities or were syndromic. The mean age of patient was 6 years and majority (87.6%) of our patients were found to be surgically naïve, that is, no previous surgical procedures were performed for OSA. Surgical decision was changed in 295 patients (30%) following DISE. Post intervention outcomes were objectively revealed in 4 studies. Most of our patients underwent a multilevel surgery based on DISE (86%). Complications were documented in 3 studies.
Analysis of the results indicated that DISE directed surgery was an effective, safe therapeutic approach to treating paediatrics obstructive sleep apnoea. DISE directed surgery has shown to have changed surgical management in most studies.
近年来，儿科阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）已得到广泛讨论，但至今仍是一个难题。仪器的出现有助于对上气道进行评估，以确定上气道塌陷的部位和程度，从而进行有针对性和有效的手术规划。本文对药物诱导睡眠内镜（Drug Induced Sleep Endoscopy，DISE）指导下手术治疗儿童阻塞性睡眠呼吸暂停的结果进行了文献回顾。
使用包括 Scopus、PubMed 和 Embase 在内的多个医学文献数据库，对 2000 年 1 月至 2019 年 12 月期间的文献进行了搜索。使用了以下搜索词：药物诱导睡眠内镜、睡眠内镜指导手术、儿科睡眠呼吸暂停。搜索持续了一个月（2019 年 12 月）。尽可能遵循系统评价和荟萃分析的 Preferred Reporting Items 指南和 Cochrane 干预系统评价手册。
根据我们的目标和选择标准，共选择了 7 篇临床研究文章。7 项研究为 III 级证据：回顾性、病例对照和前瞻性系列研究。共有 996 例患者，男性居多，占 61%；超过 10%的患者（133 例）存在合并症或综合征。患者的平均年龄为 6 岁，87.6%的患者未接受过手术，即未因 OSA 进行过任何手术。295 例患者（30%）根据 DISE 改变了手术决策。4 项研究客观地揭示了干预后的结果。根据 DISE，大多数患者（86%）接受了多水平手术。3 项研究记录了并发症。
对结果的分析表明，DISE 指导下的手术是治疗儿童阻塞性睡眠呼吸暂停的一种有效、安全的治疗方法。在大多数研究中，DISE 指导下的手术改变了手术管理。
