Eastern Virginia Medical School, Norfolk.
Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, Virginia.
JAMA Otolaryngol Head Neck Surg. 2022 Nov 1;148(11):1038-1043. doi: 10.1001/jamaoto.2022.3031.
Children with apnea-predominant obstructive sleep apnea (OSA) are hypothesized to have a more severe form of the disease. However, research is lacking as to whether there is a significant difference in outcomes between children with apnea-predominant vs hypopnea-predominant OSA.
To assess the association between baseline apnea-predominant or hypopnea-predominant OSA on polysomnography and quality of life (QOL) outcomes in children with obstructive sleep apnea managed by watchful waiting with supportive care (WWSC) or adenotonsillectomy (AT).
DESIGN, SETTING, AND PARTICIPANTS: This case-control study is a secondary analysis of a randomized clinical trial, the Childhood Adenotonsillectomy Trial, which was conducted at multiple tertiary children's hospitals from October 2007 to June 2012. Children aged 5.0 to 9.9 years with OSA were randomized to WWSC or AT and underwent polysomnography and completed validated QOL and symptom assessments at baseline and 7 months. The current data analysis was performed from October 2020 to February 2022.
Apnea-predominant OSA was defined as an apnea hypopnea index (AHI) greater than 2 with more than 50% of the obstructive events being apneas. Patients were considered to have hypopnea-predominant OSA if they had an AHI greater than 2 and more than 50% of the obstructive events were hypopneas.
A total of 386 children (185 boys [48%]; mean [SD] age, 6.56 [1.4] years) were analyzed. The mean (SD) obstructive AHI for patients was 6.98 (5.62), with 198 patients (51%) having mild disease. Thirty-seven children (10%) had apnea-predominant OSA at baseline. Black children were at increased risk for apnea-predominant OSA vs White children (odds ratio [OR], 13.40; 95% CI, 5.70-33.90). Children with apnea predominance were more likely to have severe OSA (AHI >10) compared with children with hypopnea predominance (OR, 2.30; 95% CI, 1.03-5.03); baseline Pediatric Sleep Questionnaire and OSA-18 QOL scores were similar between the 2 groups. Among children undergoing AT, those with baseline apnea predominance were more likely to have a Pediatric Sleep Questionnaire score greater than 0.33 at follow-up (OR, 3.30; 95% CI, 1.01-10.80). Rates of OSA resolution and improvements in QOL scores following AT or WWSC were similar between the apnea-predominant and hypopnea-predominant groups.
In children with OSA, apnea-predominant disease is uncommon. Apnea predominance was not associated with symptom resolution and cure rates in children undergoing AT or WWSC for OSA. Further research is needed to assess how apnea predominance affects AT outcomes in children with more severe disease.
患有以呼吸暂停为主的阻塞性睡眠呼吸暂停（OSA）的儿童被假设为患有更严重形式的疾病。然而，关于以呼吸暂停为主或低通气为主的 OSA 患者在接受观察等待伴支持性护理（WWSC）或腺样体扁桃体切除术（AT）治疗的情况下，其睡眠呼吸暂停多导睡眠图和生活质量（QOL）结果是否存在显著差异，研究仍存在不足。
评估基线时以呼吸暂停为主或低通气为主的 OSA 在多导睡眠图上的表现与接受 WWSC 或 AT 治疗的阻塞性睡眠呼吸暂停儿童的 QOL 结局之间的相关性。
设计、设置和参与者：这是一项二次分析，来自一项随机临床试验，即儿童腺样体扁桃体切除术试验，该试验于 2007 年 10 月至 2012 年 6 月在多个三级儿童医院进行。纳入年龄为 5.0 至 9.9 岁的 OSA 儿童，随机分为 WWSC 或 AT 组，并在基线和 7 个月时进行多导睡眠图和经过验证的 QOL 和症状评估。当前的数据分析于 2020 年 10 月至 2022 年 2 月进行。
以呼吸暂停为主的 OSA 定义为呼吸暂停低通气指数（AHI）大于 2，且 50%以上的阻塞性事件为呼吸暂停。如果患者的 AHI 大于 2 且 50%以上的阻塞性事件为低通气，则认为患者存在以低通气为主的 OSA。
共纳入 386 名儿童（185 名男孩[48%]；平均[SD]年龄，6.56[1.4]岁）进行分析。患者的平均（SD）阻塞性 AHI 为 6.98（5.62），其中 198 名患者（51%）患有轻度疾病。37 名儿童（10%）基线时患有以呼吸暂停为主的 OSA。黑人儿童患以呼吸暂停为主的 OSA 的风险高于白人儿童（比值比[OR]，13.40；95%CI，5.70-33.90）。与以低通气为主的 OSA 相比，以呼吸暂停为主的 OSA 患儿更可能患有严重 OSA（AHI>10）（OR，2.30；95%CI，1.03-5.03）；两组基线时儿科睡眠问卷和 OSA-18 QOL 评分相似。在接受 AT 的儿童中，与基线时以低通气为主的 OSA 相比，以呼吸暂停为主的 OSA 患儿在随访时更可能儿科睡眠问卷评分大于 0.33（OR，3.30；95%CI，1.01-10.80）。在接受 AT 或 WWSC 治疗的儿童中，OSA 缓解率和 QOL 评分改善情况在以呼吸暂停为主和以低通气为主的组之间相似。
在患有 OSA 的儿童中，以呼吸暂停为主的疾病并不常见。在接受 AT 或 WWSC 治疗的儿童中，以呼吸暂停为主与症状缓解和治愈率无关。需要进一步研究以评估在更严重疾病的儿童中，以呼吸暂停为主如何影响 AT 结果。
