Van de Perck E, Van Hoorenbeeck K, Verhulst S, Saldien V, Vanderveken O M, Boudewyns A
Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
Sleep Med. 2021 Mar;79:19-28. doi: 10.1016/j.sleep.2020.12.028. Epub 2020 Dec 30.
OBJECTIVE/BACKGROUND: Surgical interventions for obstructive sleep apnea (OSA) are less effective in obese than in normal-weight children. However, the mechanisms that underpin this relationship are not fully understood. Therefore, this study aimed to explore how body weight influences upper airway collapse and treatment outcome in children with OSA.
We conducted a retrospective analysis of prospectively collected data on polysomnography, drug-induced sleep endoscopy (DISE), and treatment outcome in otherwise healthy children with OSA. Associations between body mass index (BMI) z-score and upper airway collapse during DISE were assessed using logistic regression modelling. Treatment success was defined as obstructive apnea-hypopnea index (oAHI) < 5 events/hour and cure as oAHI < 2 events/hour with obstructive apnea index < 1 event/hour.
A total of 139 children were included [median (Q1─Q3); age 4.5 (3.1─8.4) years; BMI z-score 0.3 (-0.8 to 1.4); oAHI 10.8 (6.8─18.0) events/hour]. Twenty-five of them were overweight and 21 were obese. After adjusting for age and history of upper airway surgery, BMI z-score was significantly correlated with circumferential upper airway collapse during DISE (odds ratio 1.67; 95% confidence interval 1.12─2.65; P = 0.011). Outcome of DISE-directed treatment was similar in normal-weight (success: 91.4%; cure: 78.5%), overweight (success: 88.0%; cure: 80.0%), and obese (success: 90.5%; cure: 76.5%) children. Children with circumferential collapse responded better to continuous positive airway pressure than to (adeno)tonsillectomy.
Increasing body weight is associated with circumferential upper airway collapse during DISE and, accordingly, may require treatment strategies other than (adeno)tonsillectomy.
目的/背景：阻塞性睡眠呼吸暂停（OSA）的外科手术干预对肥胖儿童的效果不如对体重正常儿童的效果好。然而，支撑这种关系的机制尚未完全明确。因此，本研究旨在探讨体重如何影响OSA儿童的上气道塌陷及治疗结果。
我们对前瞻性收集的有关多导睡眠图、药物诱导睡眠内镜检查（DISE）以及其他方面健康的OSA儿童治疗结果的数据进行了回顾性分析。使用逻辑回归模型评估体重指数（BMI）z评分与DISE期间上气道塌陷之间的关联。治疗成功定义为阻塞性呼吸暂停低通气指数（oAHI）<5次/小时，治愈定义为oAHI<2次/小时且阻塞性呼吸暂停指数<1次/小时。
共纳入139名儿童[中位数（第一四分位数─第三四分位数）；年龄4.5（3.1─8.4）岁；BMI z评分0.3（-0.8至1.4）；oAHI 10.8（6.8─18.0）次/小时]。其中25名超重，21名肥胖。在调整年龄和上气道手术史后，BMI z评分与DISE期间上气道周向塌陷显著相关（比值比1.67；95%置信区间1.12─2.65；P = 0.011）。体重正常（成功：91.4%；治愈：78.5%）、超重（成功：88.0%；治愈：80.0%）和肥胖（成功：90.5%；治愈：76.5%）儿童的DISE导向治疗结果相似。上气道周向塌陷的儿童对持续气道正压通气的反应比对（腺样体）扁桃体切除术的反应更好。
体重增加与DISE期间上气道周向塌陷相关，因此可能需要采用（腺样体）扁桃体切除术以外的治疗策略。
