Wiet G J, Bower C, Seibert R, Griebel M
Arkansas Children's Hospital, Little Rock 72202-3591, USA.
Int J Pediatr Otorhinolaryngol. 1997 Aug 20;41(2):133-43. doi: 10.1016/s0165-5876(97)00065-7.
Evaluate the effectiveness of surgical treatment of obstructive sleep apnea in a diverse population of children.
A retrospective case series of pre and post operative polysomnograms (PSG) of pediatric patients with obstructive sleep apnea (OSA).
Tertiary care children's hospital.
48 patients in whom sleep studies were performed pre-operatively for either an unclear history and/or physical findings or complicated OSA. Thirteen patients had no complicating medical factors, 35 patients had various associated medical problems, including 20 with morbid obesity, five with Down syndrome, four with asthma, two with cerebral palsy, and four other. The average age was 7.5 years with a range of 1.5-20 years.
Thirty-one patients had a tonsillectomy and adenoidectomy (T and A) only, 13 had T and A with uvulopalatopharyngoplasty (UPPP), and three had tonsillectomy and UPPP.
Pre and postoperative PSG results including apnea/hypopnea index (AHI), percent of sleep with oxygen saturation below 90%, and percent sleep time with end-tidal pCO2 > 50.
The mean pre-operative (AHI) was 27 +/- 4 (mean +/- S.E.M.) and post operatively was 6 +/- 1 (P < 0.001). Twenty six of 48 (54%) had a postoperative AHI of less than five. Pre-operative percent of sleep with oxygen saturation below 90% was 17.9 +/- 4.5%, post-operatively it was 1.4 +/- 0.1% (P < 0.001). Pre-operative percent sleep time with end-tidal pCO2 > 50 was 22.3 +/- 3.4%, post operatively it was 12.6 +/- 2.9% (P < 0.01). UPPP was performed more commonly in patients with Down syndrome. There was a trend toward more improvement in patients who had T and performed than those undergoing UPPP (post op AHI of 4.7 vs. 7.4 respectively).
Tonsillectomy, adenoidectomy and UPPP are effective in the treatment of OSA in a diverse group of pediatric patients. Patients with asthma, cerebral palsy, Down syndrome, morbid obesity, and hereditary syndromes all improved significantly with surgical management.
评估在不同儿童群体中阻塞性睡眠呼吸暂停手术治疗的效果。
对阻塞性睡眠呼吸暂停（OSA）儿科患者术前和术后多导睡眠图（PSG）进行回顾性病例系列研究。
三级护理儿童医院。
48例患者，他们因病史不明和/或体格检查结果不明确或复杂的OSA而在术前进行了睡眠研究。13例患者无合并症，35例患者有各种相关的医疗问题，包括20例病态肥胖、5例唐氏综合征、4例哮喘、2例脑瘫和其他4例。平均年龄为7.5岁，范围为1.5至20岁。
31例患者仅进行了扁桃体切除术和腺样体切除术（T&A），13例患者进行了T&A加悬雍垂腭咽成形术（UPPP），3例患者进行了扁桃体切除术和UPPP。
术前和术后PSG结果，包括呼吸暂停/低通气指数（AHI）、血氧饱和度低于90%的睡眠时间百分比以及呼气末二氧化碳分压>50的睡眠时间百分比。
术前平均AHI为27±4（平均值±标准误），术后为6±1（P<0.001）。48例患者中有26例（54%）术后AHI小于5。术前血氧饱和度低于90%的睡眠时间百分比为17.9±4.5%，术后为1.4±0.1%（P<0.001）。术前呼气末二氧化碳分压>50的睡眠时间百分比为22.3±3.4%，术后为12.6±2.9%（P<0.01）。UPPP在唐氏综合征患者中更常进行。进行T&A的患者比接受UPPP的患者改善趋势更明显（术后AHI分别为4.7和7.4）。
扁桃体切除术、腺样体切除术和UPPP对不同组别的儿科OSA患者治疗有效。哮喘、脑瘫、唐氏综合征、病态肥胖和遗传性综合征患者通过手术治疗均有显著改善。
