Leonard James A, Blumenthal Daniel L, Almasri Mohamad M, Zalzal Habib, Riley Charles A, Lawlor Claire M
Department of Pediatric Otolaryngology, Children's National Hospital, Washington, District of Columbia, USA.
Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
Otolaryngol Head Neck Surg. 2025 Mar;172(3):759-773. doi: 10.1002/ohn.1021. Epub 2024 Oct 19.
To evaluate the improvement in respiratory parameters of infants with obstructive sleep apnea (OSA) treated with medical or surgical intervention.
A comprehensive review was completed using the PubMed, Web of Science, Embase, and Cochrane libraries including articles published from 1975 to 2024.
Interventions studied included adenotonsillectomy, mandibular distraction osteogenesis (MDO), tongue/lip adhesion, partial glossectomy, floor-of-mouth release, supraglottoplasty, oral appliances, tracheostomy, and positioning. Continuous positive airway pressure (CPAP) served as a control. Outcomes studied included pre- and postintervention obstructive apnea-hypopnea index. Studies included randomized controlled trials and case-control trials. A total of 2161 records were identified, and 59 studies were included in the analysis. Data was extracted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and pooled using a random-effects model. The primary study outcome established prior to data collection was a change in the apnea-hypopnea index.
A meta-analysis of MDO performed in infants for OSA demonstrated an overall pooled mean difference (pre-apnea-hypopnea index minus post-apnea hypopnea index) of 30.1 (95% confidence interval: 22.9, 37.4; 10 studies, 373 patients). No other data was pooled for analysis due to study heterogeneity. All CPAP studies showed apnea resolution. Tailored therapies including supraglottoplasty and tongue-lip adhesion reduced but did not resolve apneic events.
Current investigations of the evaluation and treatment of infant OSA are limited by heterogeneity in reporting and study. Mandibular distraction and CPAP are promising.
评估接受药物或手术干预治疗的阻塞性睡眠呼吸暂停（OSA）婴儿呼吸参数的改善情况。
使用PubMed、科学网、Embase和Cochrane图书馆完成了一项全面综述，纳入了1975年至2024年发表的文章。
所研究的干预措施包括腺样体扁桃体切除术、下颌骨牵张成骨术（MDO）、舌/唇粘连术、部分舌切除术、口底松解术、声门上成形术、口腔矫治器、气管切开术和体位调整。持续气道正压通气（CPAP）作为对照。所研究的结局包括干预前后的阻塞性呼吸暂停低通气指数。研究包括随机对照试验和病例对照试验。共识别出2161条记录，59项研究纳入分析。按照系统评价和Meta分析的首选报告项目指南提取数据，并使用随机效应模型进行汇总。在数据收集之前确定的主要研究结局是呼吸暂停低通气指数的变化。
对婴儿OSA进行MDO的Meta分析显示，总体合并平均差异（术前呼吸暂停低通气指数减去术后呼吸暂停低通气指数）为30.1（95%置信区间：22.9，37.4；10项研究，373例患者）。由于研究异质性，未汇总其他数据进行分析。所有CPAP研究均显示呼吸暂停得到解决。包括声门上成形术和舌唇粘连术在内的针对性治疗减少但未解决呼吸暂停事件。
目前对婴儿OSA评估和治疗的研究受到报告和研究异质性的限制。下颌骨牵张和CPAP很有前景。
