Tran-Minh Dien, Phi-Thi-Quynh Anh, Nguyen-Dinh Phuc, Duong-Quy Sy
Department of ENT, National Pediatric Hospital, Hanoi, Vietnam.
Department of ENT, Hanoi University of Medicine, Hanoi, Vietnam.
Front Neurol. 2022 Sep 27;13:1008310. doi: 10.3389/fneur.2022.1008310. eCollection 2022.
Prevalence of obstructive sleep apnea (OSA) in children with adenotonsillar hypertrophy is high and related to the occlusion of the upper airway. The main treatments of OSA in these children is adenotonsillectomy. However, this intervention is an invasive method with a various success rate. Thus, the indications of tonsillectomy remain debatable and non-invasive treatment is still a potential choice in these patients.
It was a cross-sectional and interventional study. This study included children aged from 2 to 12 years-old who were diagnosed with OSA by respiratory polygraphy and had tonsillar hypertrophy with/without adenoid hypertrophy. All main data including age, gender, height, weight, body mass index (BMI), clinical symptoms, and medical history were recorded for analysis. Physical examination and endoscopy were done to evaluate the size of tonsillar and adenoid hypertrophy by using Brodsky and Likert classifications, respectively. The severity of OSA was done by using the classification of AHI severity for children.
There were 114 patients (2-12 years old) with a mean age of 5.5 ± 2.1 years included in the present study. The main reasons for consultations were snoring (96.7%), a pause of breathing (57.1%), an effort to breathe (36.8%), unrefreshing sleep (32%), doziness (28.2%), and hyperactivity (26.3%). There were 36% of subjects with tonsillar hypertrophy grade 1-2, 48.2% with grade 3, and 15.8% with grade 4 (Brodsky classification); among them, there were 46.5% of subjects with grades 1-2 of adenoid hypertrophy, 45.6% with grade 3, and 7.0% with grade 4 (Likert classification). The mean AHI was 12.6 ± 11.2 event/h. There was a significant correlation between the mean AHI and the level of tonsillar and adenoid hypertrophy severity (r = 0.7601 and r = 0.7903; < 0.05 and < 0.05, respectively). The improvement of clinical symptoms of study subjects was found in both groups treated with ALR (antileukotriene receptor) or ST (surgery therapy). The symptoms related to OSA at night including snoring, struggle to breathe, sleeping with the mouth open, and stopping breathing during sleep were significantly improved after treatment with ATR and with ST ( < 0.001 and = 0.001, respectively). The mean AHI was significantly reduced in comparison with before treatment in study subjects treated with ALR (0.9 ± 1.0 vs. 3.9 ± 2.7 events/h; = 0.001) or with ST (3.5 ± 1.4 vs. 23.4 ± 13.1 events/h; < 0.001).
The treatment of OSA due to adeno-tonsillar hypertrophy with ALR for moderate OSA or surgery for severe OSA might reduce the symptoms related to OSA at night and during the day.
腺样体扁桃体肥大患儿阻塞性睡眠呼吸暂停（OSA）的患病率较高，且与上气道阻塞有关。这些患儿OSA的主要治疗方法是腺样体扁桃体切除术。然而，这种干预是一种侵入性方法，成功率各不相同。因此，扁桃体切除术的适应证仍存在争议，非侵入性治疗仍是这些患者的一种潜在选择。
这是一项横断面和干预性研究。本研究纳入了2至12岁经呼吸多导仪诊断为OSA且有扁桃体肥大伴/不伴腺样体肥大的儿童。记录所有主要数据，包括年龄、性别、身高、体重、体重指数（BMI）、临床症状和病史，进行分析。分别采用布罗德斯基（Brodsky）和李克特（Likert）分类法进行体格检查和内镜检查，以评估扁桃体和腺样体肥大的程度。采用儿童AHI严重程度分类法评估OSA的严重程度。
本研究共纳入114例年龄在2至12岁之间的患者，平均年龄为5.5±2.1岁。就诊的主要原因是打鼾（96.7%）、呼吸暂停（57.1%）、用力呼吸（36.8%）、睡眠未恢复精力（32%）、嗜睡（28.2%）和多动（26.3%）。36%的受试者扁桃体肥大1-2级，48.2%为3级，15.8%为4级（布罗德斯基分类）；其中，46.5%的受试者腺样体肥大1-2级，45.6%为3级，7.0%为4级（李克特分类）。平均AHI为12.6±11.2次/小时。平均AHI与扁桃体和腺样体肥大严重程度之间存在显著相关性（r = 0.7601和r = 0.7903；P均<0.05）。接受抗白三烯受体（ALR）或手术治疗（ST）的两组研究对象的临床症状均有改善。经抗白三烯受体（ATR）和手术治疗（ST）后，夜间与OSA相关的症状，包括打鼾、呼吸费力、张口呼吸和睡眠期间呼吸暂停，均有显著改善（P分别<0.001和=0.001）。与治疗前相比，接受ALR治疗的研究对象平均AHI显著降低（0.9±1.0 vs. 3.9±2.7次/小时；P = 0.001），接受ST治疗的研究对象平均AHI也显著降低（3.5±1.4 vs. 23.4±13.1次/小时；P<0.001）。
对于中度OSA采用ALR治疗或重度OSA采用手术治疗腺样体扁桃体肥大所致的OSA，可能会减轻夜间和白天与OSA相关的症状。
