Department of Otolaryngology - Head & Neck Surgery, University of Colorado, Aurora, Colorado.
Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
J Clin Sleep Med. 2024 Feb 1;20(2):237-243. doi: 10.5664/jcsm.10850.
Clinical practice guidelines recommend screening all children with Down syndrome for obstructive sleep apnea with polysomnography by age 4 years. Because persistent obstructive sleep apnea (obstructive apnea-hypopnea index > 1 event/h) following adenotonsillectomy (T&A) is common in children with Down syndrome, it is important to know whether clinicians can rely on parental assessment postoperatively. The primary objective is to identify accuracy of parental perception of nighttime breathing following T&A compared with preoperative assessment.
Patients with Down syndrome who underwent T&A along with polysomnography prior to and after the surgical procedure were included. Parents completed a 3-question pre- and postsurgery survey regarding nighttime symptoms. The responses were categorized into 3 groups: infrequent (< 3 nights/wk), sometimes (> 3 nights/wk but < 6 nights/wk), or frequent (≥ 6 nights/wk) on at least 1 question. The primary end point was identifying the accuracy of parental perception of nighttime breathing in children with Down syndrome following T&A.
A total of 256 children met inclusion criteria, of which 117 (46%) were included. A total of 71 (68%) children had an obstructive apnea-hypopnea index > 5 events/h preoperatively compared with 55 (47%) postoperatively. There was no association between parents' perception of symptoms and obstructive sleep apnea categorization postoperatively ( > .05) or of parents' perception of symptoms improving and obstructive sleep apnea categorization improving postoperatively ( > .05).
Despite previous experience, parents are unable to predict nighttime breathing patterns following a T&A. We recommend obtaining a polysomnogram rather than relying on parental assessment to determine whether a T&A has been successful.
Chabuz CA, Lackey TG, Pickett KL, Friedman NR. Accuracy of parental perception of nighttime breathing in children with Down syndrome after adenotonsillectomy. . 2024;20(2):237-243.
临床实践指南建议通过多导睡眠图在 4 岁时对所有唐氏综合征患儿进行阻塞性睡眠呼吸暂停筛查。由于唐氏综合征患儿在接受腺样体扁桃体切除术（T&A）后持续存在阻塞性睡眠呼吸暂停（阻塞性呼吸暂停低通气指数 > 1 次/小时）较为常见，因此了解术后临床医生是否可以依赖家长评估非常重要。主要目的是确定 T&A 术后父母对夜间呼吸的感知与术前评估的准确性。
纳入接受 T&A 并在手术前后进行多导睡眠图检查的唐氏综合征患者。父母在术前和术后完成了一个关于夜间症状的 3 个问题的调查。将回答分为 3 组：无（< 3 次/周）、有时（> 3 次/周但 < 6 次/周）或频繁（≥ 6 次/周），至少有 1 个问题。主要终点是确定 T&A 后唐氏综合征儿童父母对夜间呼吸的感知准确性。
共有 256 名儿童符合纳入标准，其中 117 名（46%）被纳入。术前共有 71 名（68%）儿童的阻塞性呼吸暂停低通气指数 > 5 次/小时，术后为 55 名（47%）。父母对症状的感知与术后阻塞性睡眠呼吸暂停分类之间无相关性（>.05），或父母对症状改善的感知与术后阻塞性睡眠呼吸暂停分类改善之间无相关性（>.05）。
尽管有先前的经验，父母仍无法预测 T&A 后的夜间呼吸模式。我们建议获取多导睡眠图，而不是依赖家长评估来确定 T&A 是否成功。
Chabuz CA、Lackey TG、Pickett KL、Friedman NR。唐氏综合征患儿行腺样体扁桃体切除术后父母对夜间呼吸的感知准确性。睡眠呼吸医学杂志，2024；20（2）：237-243。
