Hazkani Inbal, Stein Eli, Ghadersohi Saied, Ida Jonathan, Thompson Dana M, Valika Taher
Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Am J Otolaryngol. 2023 Mar-Apr;44(2):103798. doi: 10.1016/j.amjoto.2023.103798. Epub 2023 Feb 3.
Refractory obstructive sleep apnea (OSA) is a common condition in children with medical comorbidities, leading to a significant impact on quality of life. Drug-induced sleep endoscopy (DISE) has become the standard of care in identifying the levels of obstruction in children with refractory OSA. Epiglottopexy has been shown to improve OSA symptoms in adults and healthy children with epiglottic prolapse in a few studies, with minimal long-term complications. The objective of our study was to evaluate the role of epiglottopexy in children with refractory OSA.
A retrospective chart review of children with refractory OSA who were found to have epiglottic prolapse on DISE, and underwent epiglottopexy between January 2018 and November 2021 at a pediatric tertiary care hospital.
42 patients (age 8.1 ± 5.1 years) met inclusion criteria. Thirty patients (71.4 %) suffered from neurodevelopmental disease or congenital syndrome, and 14 patients (33.3 %) were gastrostomy-tube dependent. All patients had at least one prior surgical procedure to address their OSA. Thirty-six patients (85.7 %) were diagnosed with refractory OSA by polysomnography prior to surgery, with an average apnea-hypopnea index (AHI) of 12.4 ± 9.7/h. Forty patients (95.2 %) required an additional procedure in conjunction with epiglottopexy including lingual tonsillectomy (n = 27, 64.3 %), supraglottoplasty (n = 14, 33.3 %), tonsillectomy with or without revision adenoidectomy (n = 9, 21.4 %) and tongue base suspension (n = 1, 2.4 %). Twenty-one patients had repeated polysomnography; 4 patients were found to have residual severe OSA post-operatively (average AHI 17.4 ± 11.4/h), while the remaining patients demonstrated clinical improvement and a significant reduction in OSA severity, with an average AHI of 1.5 ± 2.2/h. Regression analysis identified pre-operative oxygen nadir <75 % to be associated with residual OSA postoperatively. Following surgery, 7 patients were found to have new-onset or worsening dysphagia, 6 of whom were diagnosed with complex medical comorbidities.
Epiglottopexy, as part of multi-level airway surgery, is associated with a significant improvement in the severity of refractory OSA. Dysphagia may complicate the post-operative course, particularly in children with medical comorbidities.
难治性阻塞性睡眠呼吸暂停（OSA）在患有合并症的儿童中很常见，对生活质量有重大影响。药物诱导睡眠内镜检查（DISE）已成为确定难治性OSA儿童气道阻塞部位的标准治疗方法。在一些研究中，会厌固定术已被证明可改善成人和患有会厌脱垂的健康儿童的OSA症状，且长期并发症极少。我们研究的目的是评估会厌固定术在难治性OSA儿童中的作用。
对2018年1月至2021年11月在一家儿科三级护理医院接受DISE检查发现会厌脱垂并接受会厌固定术的难治性OSA儿童进行回顾性病历审查。
42例患者（年龄8.1±5.1岁）符合纳入标准。30例患者（71.4%）患有神经发育疾病或先天性综合征，14例患者（33.3%）依赖胃造瘘管。所有患者此前至少接受过一次治疗OSA的外科手术。36例患者（85.7%）在手术前通过多导睡眠图诊断为难治性OSA，平均呼吸暂停低通气指数（AHI）为12.4±9.7次/小时。40例患者（95.2%）在会厌固定术的同时需要进行额外手术，包括舌扁桃体切除术（n = 27，64.3%）、声门上成形术（n = 14，33.3%）、扁桃体切除术（伴或不伴腺样体切除术修正）（n = 9，21.4%）和舌根悬吊术（n = 1，2.4%）。21例患者进行了重复多导睡眠图检查；4例患者术后仍有严重OSA残留（平均AHI 17.4±11.4次/小时），其余患者临床症状改善，OSA严重程度显著降低，平均AHI为1.5±2.2次/小时。回归分析确定术前最低血氧饱和度<75%与术后残留OSA相关。术后，7例患者出现新发或加重的吞咽困难，其中6例被诊断患有复杂的合并症。
会厌固定术作为多级气道手术的一部分，与难治性OSA严重程度的显著改善相关。吞咽困难可能使术后病程复杂化，尤其是在患有合并症的儿童中。
