Sjölander Isabella, Borgström Anna, Nerfeldt Pia, Friberg Danielle
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Sleep Med X. 2022 Sep 8;4:100055. doi: 10.1016/j.sleepx.2022.100055. eCollection 2022 Dec.
Adenotonsillectomy (ATE) is a common treatment for pediatric obstructive sleep apnea (OSA). Intracapsular adenotonsillotomy (ATT) is associated with less postoperative morbidity. Our previous randomized controlled trial (RCT) compared ATE and ATT in otherwise healthy children with moderate to severe OSA. No differences in polysomnographic (PSG) and OSA-18 were found between the groups at one-year follow-up. This study presents the long-term results of the RCT.
Non-obese children (n = 79, 2-6 years) who had undergone either ATE (n = 40) or ATT (n = 39) were offered PSG and OSA-18 questionnaire five-years after surgery. Primary outcome was the group difference in postoperative Obstructive Apnea/Hypopnea Index (OAHI). ATE was recommended to the ATT group if they had a relapse of OSA.
The follow-up was completed by 45 of 79 (57%) children; 28 (35%) drop-outs, and six of 39(15%) in the ATT group were excluded after ATE. After ATE(n = 17), OAHI decreased from mean 12.3(SD 8.0) to 0.6(0.7), and after ATT(n = 28) from 12.6(7.4) to 0.5(0.6), a mean difference in postoperative OAHI of 0.1(95% CI -0.3 - 0.5). Sensitivity analyses did not change the results. The median OSA-18 decreased in the ATE group from 57(interquartile range 47-79) to 27(22-36), and in the ATT group from 67(53-79) to 32(25-44), without group differences for postoperative values.
The results of this five-year follow-up of otherwise healthy OSA-children showed a high drop-out rate, but indicates that ATT could be an effective treatment for pediatric OSA. However, ATT warrants follow-up due to the risk of recurrence, and further studies are needed.
腺样体扁桃体切除术（ATE）是治疗小儿阻塞性睡眠呼吸暂停（OSA）的常用方法。囊内腺样体扁桃体切开术（ATT）术后发病率较低。我们之前的随机对照试验（RCT）比较了ATE和ATT对其他方面健康的中重度OSA儿童的疗效。在一年的随访中，两组之间的多导睡眠图（PSG）和OSA-18没有差异。本研究展示了该RCT的长期结果。
对接受过ATE（n = 40）或ATT（n = 39）的非肥胖儿童（n = 79，2至6岁）在术后五年进行PSG检查和OSA-18问卷调查。主要结局是术后阻塞性呼吸暂停/低通气指数（OAHI）的组间差异。如果ATT组出现OSA复发，则建议他们接受ATE治疗。
79名儿童中有45名（57%）完成了随访；28名（35%）失访，ATT组39名中有6名（15%）在接受ATE治疗后被排除。接受ATE治疗后（n = 17），OAHI从平均12.3（标准差8.0）降至0.6（0.7），接受ATT治疗后（n = 28）从12.6（7.4）降至0.5（0.6），术后OAHI的平均差异为0.1（95%可信区间 -0.3至0.5）。敏感性分析未改变结果。ATE组OSA-18的中位数从57（四分位间距47 - 79）降至27（22 - 36），ATT组从67（53 - 79）降至32（25 - 44），术后值无组间差异。
对其他方面健康的OSA儿童进行的这项五年随访结果显示失访率较高，但表明ATT可能是治疗小儿OSA的有效方法。然而，由于存在复发风险，ATT需要进行随访，并且需要进一步研究。
