Vakharia N, Murkin C, Hall A, Bajaj Y
Department of ENT Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK.
J Laryngol Otol. 2022 Nov;136(11):1071-1076. doi: 10.1017/S0022215121002693. Epub 2021 Oct 1.
Adenotonsillectomy is a recognised treatment for paediatric obstructive sleep apnoea. Recent literature highlights the need to assess outcomes in the extremely obese subpopulation. This study reviewed the efficacy of adenotonsillectomy performed in patients with extreme obesity.
A retrospective analysis of attendees at a tertiary paediatric obesity clinic was performed, identifying patients with a body mass index -score equal to or more than three who had undergone adenotonsillectomy for obstructive sleep apnoea. Electronic patient records, including respiratory polygraphy, were analysed.
Nine patients met the study criteria. All required nocturnal non-invasive ventilation pre-operatively. Mean age at referral was 6.9 years, and average age of non-invasive ventilation commencement was 7.8 years. Post-operatively, 8 patients (89 per cent) required non-invasive ventilation with evidence of post-operative obstructive sleep apnoea.
In extreme obesity, adenotonsillectomy does not prevent the need for non-invasive ventilation. Management of this patient group requires treatment of obesity alongside potential surgical intervention. Poor efficacy in treating obstructive sleep apnoea may influence the decision to proceed with adenotonsillectomy.
腺样体扁桃体切除术是治疗小儿阻塞性睡眠呼吸暂停的一种公认疗法。近期文献强调了评估极度肥胖亚组患者治疗效果的必要性。本研究回顾了在极度肥胖患者中进行腺样体扁桃体切除术的疗效。
对一家三级儿科肥胖诊所的就诊者进行回顾性分析，确定体重指数评分等于或大于3且因阻塞性睡眠呼吸暂停接受过腺样体扁桃体切除术的患者。对包括呼吸多导睡眠图在内的电子病历进行分析。
9名患者符合研究标准。所有患者术前均需要夜间无创通气。转诊时的平均年龄为6.9岁，开始无创通气的平均年龄为7.8岁。术后，8名患者（89%）因术后阻塞性睡眠呼吸暂停需要无创通气。
在极度肥胖患者中，腺样体扁桃体切除术并不能避免无创通气的需求。对该患者群体的管理需要在进行潜在手术干预的同时治疗肥胖症。治疗阻塞性睡眠呼吸暂停的疗效不佳可能会影响是否进行腺样体扁桃体切除术的决策。
