Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.
J Formos Med Assoc. 2024 May;123(5):540-550. doi: 10.1016/j.jfma.2023.09.004. Epub 2023 Sep 16.
This review summarizes the current evidence in systematic reviews, meta-analysis and randomized controlled trials regarding adenotonsillectomy outcomes in pediatric obstructive sleep apnea (OSA). Adenotonsillectomy is effective in treating OSA in children without co-morbidities, despite postoperative residual OSA remained in roughly half of these children. For children with comorbidities such as Down syndrome, Prader-Willi syndrome, sickle cell disease, or cerebral palsy, adenotonsillectomy is less effective and associated with more postoperative complications than that in children without comorbidities. For other OSA-related outcomes, evidence from meta-analyses and randomized controlled trials confirm adenotonsillectomy results in improvement of subjective OSA-related outcomes (e.g. symptoms, behaviors, and quality of life), but the results in objective OSA-related outcomes (e.g. cardiometabolic parameters or neurocognitive functions) are inconsistent. Future studies should focus on randomized controlled trials comparing objective OSA-related outcomes and the long-term effects of adenotonsillectomy in children with OSA.
这篇综述总结了系统评价、荟萃分析和随机对照试验中关于腺样体扁桃体切除术治疗儿童阻塞性睡眠呼吸暂停（OSA）结局的现有证据。腺样体扁桃体切除术在治疗无合并症的儿童 OSA 方面是有效的，尽管术后仍有约一半的儿童存在残余 OSA。对于合并症如唐氏综合征、普拉德-威利综合征、镰状细胞病或脑瘫的儿童，腺样体扁桃体切除术的效果较差，且术后并发症较无合并症的儿童更多。对于其他与 OSA 相关的结局，荟萃分析和随机对照试验的证据证实了腺样体扁桃体切除术可改善主观 OSA 相关结局（例如症状、行为和生活质量），但在客观 OSA 相关结局（例如心血管代谢参数或神经认知功能）方面的结果不一致。未来的研究应侧重于比较客观 OSA 相关结局和腺样体扁桃体切除术对 OSA 儿童的长期效果的随机对照试验。
