Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
Respirology. 2021 Jul;26(7):690-699. doi: 10.1111/resp.14050. Epub 2021 Apr 1.
We evaluated inattention and behavioural outcomes following surgery versus watchful waiting (WW) in school-aged children with mild obstructive sleep apnoea (OSA).
A prospective randomized controlled study was performed in pre-pubertal children aged 6-11 years with polysomnography (PSG)-confirmed mild OSA. They were assigned randomly to early surgical intervention (ES) or WW. The surgical intervention consisting of tonsillectomy with or without adenoidectomy and turbinate reduction was carried out within 4-6 weeks after randomization. Both groups underwent PSG, attention and behavioural assessment and review by an otorhinolaryngologist at baseline and 9-month follow-up. The primary outcome was omission T score from Conners' continuous performance test (CPT). Secondary outcomes were parent-reported behaviours, quality of life, symptoms and PSG parameters.
A total of 114 participants were randomized. Data of 35 subjects from the ES and 36 from the WW group were available for final analysis. No significant treatment effect could be found in all CPT parameters and behavioural outcomes. Nevertheless, significantly greater reductions were seen in PSG parameters (obstructive apnoea-hypopnoea index [-1.4 ± 2.0 cf. +0.3 ± 4.1/h, p = 0.038] and arousal index [-1.3 ± 4.4 cf. +1.4 ± 4.5/h, p = 0.013]) and OSA-18 total symptom score (-17.3 ± 19.7 cf. -3.6 ± 14.1, p = 0.001) in the ES group. Subjects who underwent surgery also had significantly greater weight gain (+3.3 ± 2.1 cf. +2.2 ± 1.5 kg, p = 0.014) and increase in systolic blood pressure (+5.1 ± 12.4 cf. -1.2 ± 8.7 mm Hg, p = 0.016).
Despite improvements in PSG parameters and parent-reported symptoms, surgical treatment did not lead to parallel improvements in objective attention measures in school-aged children with mild OSA.
我们评估了学龄期轻度阻塞性睡眠呼吸暂停（OSA）患儿手术与观察等待（WW）治疗后注意力和行为结局。
本前瞻性随机对照研究纳入了经多导睡眠图（PSG）证实为轻度 OSA 的 6-11 岁青春期前儿童。他们被随机分配到早期手术干预（ES）或 WW 组。手术干预包括扁桃体切除术联合或不联合腺样体切除术和鼻甲切除术，在随机分组后 4-6 周内进行。两组均在基线和 9 个月随访时行 PSG、注意力和行为评估以及耳鼻喉科医生检查。主要结局为康纳斯连续操作测试（CPT）中的遗漏 T 评分。次要结局为父母报告的行为、生活质量、症状和 PSG 参数。
共纳入 114 名参与者，其中 ES 组 35 例和 WW 组 36 例的数据可用于最终分析。所有 CPT 参数和行为结局均未发现治疗效果的显著差异。然而，PSG 参数（阻塞性呼吸暂停低通气指数[-1.4 ± 2.0 比+0.3 ± 4.1/h，p = 0.038]和觉醒指数[-1.3 ± 4.4 比+1.4 ± 4.5/h，p = 0.013]）和 OSA-18 总症状评分（-17.3 ± 19.7 比-3.6 ± 14.1，p = 0.001）显著降低，ES 组的降幅更大。手术组的体重增加（+3.3 ± 2.1 比+2.2 ± 1.5kg，p = 0.014）和收缩压升高（+5.1 ± 12.4 比-1.2 ± 8.7mmHg，p = 0.016）更为显著。
尽管 PSG 参数和父母报告的症状有所改善，但手术治疗并未导致学龄期轻度 OSA 患儿的客观注意力测量结果得到平行改善。
