肥胖青少年阻塞性睡眠呼吸暂停的腺样体扁桃体切除术治疗效果。
Adenotonsillectomy outcomes in obese adolescents with obstructive sleep apnea.
机构信息
Eastern Virginia Medical School, Norfolk, Virginia.
Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, Virginia.
出版信息
J Clin Sleep Med. 2022 Dec 1;18(12):2855-2860. doi: 10.5664/jcsm.10234.
STUDY OBJECTIVES
(1) To assess adenotonsillectomy (AT) outcomes in adolescents with obesity and with obstructive sleep apnea (OSA); (2) To identify clinical factors predicting OSA in adolescents following AT.
METHODS
Adolescents 12 to 18 years old with obesity who underwent AT for OSA were included. Subjects had pre-AT and post-AT polysomnogram. Nonobese adolescents with OSA that underwent AT were included as a comparison.
RESULTS
Seventy adolescents with obesity with a mean age of 14.2 years and a mean body mass index of 38.0 kg/m were included. Patients in the nonobese group (n = 32) were similar demographically to the obese group, with the exception of body mass index. The majority of adolescents with obesity (74%) had severe OSA (apnea-hypopnea index [AHI] ≥ 10 events/h) with a mean baseline AHI of 33.9 events/h (standard deviation 28.5). The obese and control groups experienced clinically meaningful improvements in AHI following AT, with median change scores of 18.3 (95% confidence interval -29.2, -11.2, < .001) and 14.6 (95% confidence interval -25.5, -8.5, < .001), respectively. In the adolescents with obesity, 48% had an AHI < 5 events/h on postoperative PSG. However, adolescents with obesity were 7 times more likely (odds ratio = 7.1, 95% confidence interval [2.24, 22.48], = .001) to have moderate or severe persistent OSA (AHI > 5 events/h) after AT compared with patients who were not obese. The need for post-AT positive airway pressure therapy was significantly higher in adolescents with obesity, with 37.1% of participants requiring this therapy (odds ratio = 8.3, 95% confidence interval 1.8, 37.6, < .001).
CONCLUSIONS
AT results in improvement in polysomnogram parameters in adolescents with obesity and OSA. However, patients with obesity are at high risk for persistent OSA. Future research should include prospective trials to compare outcomes between AT and positive airway pressure therapy for adolescents with obesity.
CITATION
Kearney TC, Vazifedan T, Baldassari CM. Adenotonsillectomy outcomes in obese adolescents with obstructive sleep apnea. . 2022;18(12):2855-2860.
研究目的
（1）评估肥胖合并阻塞性睡眠呼吸暂停（OSA）青少年行腺样体扁桃体切除术（AT）的疗效；（2）确定预测肥胖青少年 AT 后 OSA 持续存在的临床因素。
方法
纳入肥胖合并 OSA 并接受 AT 治疗的 12 至 18 岁青少年。所有患者均在 AT 前行多导睡眠图（PSG）检查，AT 后复查 PSG。同时纳入非肥胖合并 OSA 且接受 AT 治疗的青少年作为对照组。
结果
本研究共纳入 70 例肥胖青少年，平均年龄 14.2 岁，平均 BMI 为 38.0 kg/m。非肥胖组（n = 32）在年龄、性别、AHI 等方面与肥胖组无差异，仅 BMI 存在统计学差异。大部分肥胖青少年（74%）存在严重 OSA（AHI≥10 次/小时），平均基线 AHI 为 33.9 次/小时（标准差 28.5）。肥胖组和对照组患者 AT 后 AHI 均有显著改善，改善值分别为 18.3（95%置信区间：-29.2，-11.2，<0.001）和 14.6（95%置信区间：-25.5，-8.5，<0.001）。肥胖组术后 48%的患者 PSG 结果提示 AHI<5 次/小时，但肥胖组患者在 AT 后发生中重度 OSA（AHI>5 次/小时）的风险是无肥胖组的 7 倍（比值比=7.1，95%置信区间[2.24，22.48]，<0.001）。肥胖组患者更需要术后气道正压通气治疗，需要该治疗的患者占比为 37.1%（比值比=8.3，95%置信区间 1.8，37.6，<0.001）。
结论
肥胖合并 OSA 青少年行 AT 后 PSG 结果有显著改善，但肥胖患者 OSA 持续存在的风险较高。未来的研究应包括前瞻性试验，以比较肥胖青少年接受 AT 和气道正压通气治疗的效果。
引文
Kearney TC, Vazifedan T, Baldassari CM. Adenotonsillectomy outcomes in obese adolescents with obstructive sleep apnea.. 2022;18(12):2855-2860.
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