Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Department of Plastic and Reconstructive Surgery, Amsterdam University Medical Centre, Emma Children's Hospital, Amsterdam, The Netherlands.
J Clin Sleep Med. 2021 Aug 1;17(8):1717-1729. doi: 10.5664/jcsm.9394.
Identifying optimal treatment for infants with Robin sequence (RS) is challenging due to substantial variability in the presentation of upper airway obstruction (UAO) in this population. Objective assessments of UAO and treatments are not standardized. A systematic review of objective measures of UAO was conducted as a step toward evidence-based clinical decision-making for RS.
A literature search was performed in the PubMed and Embase databases (1990-2020) following PRISMA guidelines. Articles reporting on RS and UAO treatment were included if the following objective measures were studied: oximetry, polysomnography, and blood gas. Quality was appraised by the methodological index for nonrandomized studies (range: 0-24).
A total of 91 articles met the inclusion criteria. The mean methodological index for nonrandomized studies score was 7.1 (range: 3-14). Polysomnography was most frequently used (76%) followed by oximetry (20%) and blood gas (11%). Sleep position of the infant was reported in 35% of studies, with supine position most frequently, and monitoring time in 42%, including overnight recordings, in more than half. Of 71 studies that evaluated UAO interventions, the majority used polysomnography (90%), of which 61% did not specify the polysomnography technique. Reported polysomnography metrics included oxygen saturation (61%), apnea-hypopnea index (52%), carbon dioxide levels (31%), obstructive apnea-hypopnea index (27%), and oxygen desaturation index (16%). Only 42 studies reported indications for UAO intervention, with oximetry and polysomnography thresholds used equally (both 40%). In total, 34 distinct indications for treatment were identified.
This systematic review demonstrates a lack of standardization, interpretation, and reporting of assessment and treatment indications for UAO in RS. An international, multidisciplinary consensus protocol is needed to guide clinicians on optimal UAO assessment in RS.
Logjes RJH, MacLean JE, de Cort NW, et al. Objective measurements for upper airway obstruction in infants with Robin sequence: what are we measuring? A systematic review. . 2021;17(8):1717-1729.
由于该人群中上气道梗阻 (UAO) 的表现存在很大差异，因此为罗宾序列 (RS) 婴儿确定最佳治疗方法具有挑战性。UAO 的客观评估和治疗方法尚未标准化。对 UAO 的客观测量进行了系统评价，作为为 RS 进行循证临床决策的一步。
根据 PRISMA 指南，在 PubMed 和 Embase 数据库中进行了文献检索 (1990-2020 年)。如果研究报告了以下客观测量指标，则纳入报告 RS 和 UAO 治疗的文章：血氧饱和度、多导睡眠图和血气。通过非随机研究方法学指数 (范围：0-24) 评估质量。
共有 91 篇文章符合纳入标准。非随机研究方法学指数的平均得分为 7.1(范围：3-14)。多导睡眠图的应用最为广泛 (76%)，其次是血氧饱和度 (20%)和血气 (11%)。35%的研究报告了婴儿的睡眠姿势，其中仰卧位最常见，42%的研究报告了监测时间，超过一半的研究进行了过夜记录。在 71 项评估 UAO 干预的研究中，大多数使用多导睡眠图 (90%)，其中 61%未指定多导睡眠图技术。报告的多导睡眠图指标包括血氧饱和度 (61%)、呼吸暂停低通气指数 (52%)、二氧化碳水平 (31%)、阻塞性呼吸暂停低通气指数 (27%)和氧减指数 (16%)。只有 42 项研究报告了 UAO 干预的适应证，血氧饱和度和多导睡眠图的阈值使用相同 (各占 40%)。总共确定了 34 种不同的治疗适应证。
本系统评价表明，RS 中 UAO 的评估和治疗适应证缺乏标准化、解释和报告。需要制定国际、多学科共识方案，指导临床医生对 RS 中最佳 UAO 评估。
Logjes RJH、MacLean JE、de Cort NW 等人。患有罗宾序列的婴儿的上气道阻塞的客观测量：我们在测量什么？系统评价。 2021;17(8):1717-1729。
