School of Clinical Medicine, University of Queensland, Queensland, Australia.
School of Clinical Medicine, University of Queensland, Queensland, Australia; Department of Paediatric Respiratory & Sleep Medicine, Queensland Children's Hospital, Australia.
Int J Pediatr Otorhinolaryngol. 2022 Jan;152:110966. doi: 10.1016/j.ijporl.2021.110966. Epub 2021 Nov 10.
The aim of this systematic review is to summarise the existing literature regarding management of residual obstructive sleep apnoea post adenotonsillectomy in children with Down Syndrome.
PubMed, EMBASE, Cochrane and Scopus were searched to retrieve all studies published up to May 2020 regarding the management of obstructive sleep apnoea in children with Down Syndrome post adenotonsillectomy.
Eight studies were identified including five retrospective studies, two prospective and one case series. Five articles addressed surgical treatments only, two articles addressed hypoglossal nerve stimulation and one article addressed both surgical and medical treatments. Findings were similar across most studies where the obstructive apnoea hypopnoea index (oAHI) was reduced post intervention however given the heterogeneity in methodology and patient demographics, results were not directly comparable. Limited evidence was found regarding BMI and outcome post-surgery, suggesting that those who were normal weight or overweight had a significant reduction in the oAHI, compared to those who were obese.
The most optimal treatment for the management of residual obstructive sleep apnoea remains uncertain. There are various treatment options described in the literature, however, they have not been thoroughly studied, with only eight relevant articles found. Studies comparing outcomes following different treatment interventions and using consistent parameters are required to gain further understanding of the most optimal treatment for residual obstructive sleep apnoea in this population. Understanding if specific phenotypic features, such as weight, influence response to therapy will also be important. This information will help to develop treatment algorithms, which will assist in improving patient care by directing treatment and ensuring a more consistent approach to overall management. The high prevalence of residual obstructive sleep apnoea in children with Down Syndrome following first line treatment makes this a clinically important area to target in this particular cohort of children to avoid long term complications of untreated OSA.
本系统评价旨在总结现有文献,了解唐氏综合征患儿腺样体扁桃体切除术后残留阻塞性睡眠呼吸暂停的治疗方法。
检索 PubMed、EMBASE、Cochrane 和 Scopus,以获取截至 2020 年 5 月有关唐氏综合征患儿腺样体扁桃体切除术后阻塞性睡眠呼吸暂停治疗的所有研究。
共确定了 8 项研究,包括 5 项回顾性研究、2 项前瞻性研究和 1 项病例系列研究。5 篇文章仅探讨了手术治疗,2 篇文章探讨了舌下神经刺激,1 篇文章探讨了手术和药物治疗。大多数研究的结果相似,干预后阻塞性呼吸暂停低通气指数(oAHI)降低,但由于方法学和患者特征的异质性,结果无法直接比较。关于术后 BMI 和结果的证据有限,表明与肥胖者相比,正常体重或超重者的 oAHI 显著降低。
对于残留阻塞性睡眠呼吸暂停的治疗,最理想的治疗方法仍不确定。文献中描述了各种治疗选择,但这些治疗方法尚未得到充分研究,仅发现了 8 篇相关文章。需要比较不同治疗干预措施后的结果,并使用一致的参数,以进一步了解该人群中残留阻塞性睡眠呼吸暂停的最佳治疗方法。了解特定表型特征(如体重)是否影响治疗反应也很重要。这些信息将有助于制定治疗方案,通过指导治疗并确保对整体管理采取更一致的方法,从而改善患者的护理。一线治疗后唐氏综合征患儿残留阻塞性睡眠呼吸暂停的高患病率使得这一领域成为这一特定儿童群体的一个重要临床目标,以避免未经治疗的 OSA 的长期并发症。