Adenotonsillectomy in Obese Children with Obstructive Sleep Apnea Syndrome: Magnetic Resonance Imaging Findings and Considerations
Adenotonsillectomy in Obese Children with Obstructive Sleep Apnea Syndrome: Magnetic Resonance Imaging Findings and Considerations
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DOI：
10.5665/sleep.2708
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发表时间：
2013-06-01
期刊：
影响因子：
5.6
通讯作者：
Arens, Raanan
中科院分区：
文献类型：
--
作者：
Nandalike, Kiran;Shifteh, Keivan;Arens, Raanan
目的：目前尚不清楚腺扁桃体切除术（AT）治疗肥胖儿童阻塞性睡眠呼吸暂停综合征（OSAS）效果较差的原因。因此，本研究的目的是评估导致气道阻塞的解剖因素如何在这些儿童中受到AT的影响。方法：27例肥胖OSAS患儿（年龄13.0 +/- 2.3岁，体重指数z -评分2.5 +/- 0.3）在AT前后的清醒状态下进行多导睡眠图和头部磁共振成像。使用商业软件（AMIRA (R)）对上气道和周围组织进行体积分析。结果：AT术后随访6.1 +/- 3.6个月。AT将平均阻塞性呼吸暂停低通气指数（AHI）从23.7 +/- 21.4改善至5.6 +/- 8.7 （P < 0.001）。44%（27人中的12人）的OSAS得到缓解，但严重OSAS （AHI 10）的患者只有22%（18人中的4人）得到缓解。AT增加了鼻咽和口咽的体积(2.9 +/- 1.3 vs 4.4 +/- 0.9 cm(3), P < 0.001, 3.2 +/- 1.2 vs 4.3 +/- 2.0 cm(3), P < 0.01)，缩小了扁桃体（11.3 +/- 4.3 vs 1.3 +/- 1.4 cm(3), P < 0.001），但对腺样体、舌扁桃体或咽后淋巴结没有影响。软腭和舌的体积也有轻微的显著增加（7.3 +/- 2.5 cm vs 8.0 +/- 1.9 cm, P = 0.02; 88.2 +/- 18.3 cm vs 89.3 +/- 24.4 cm, P = 0.005）。结论：这是第一个量化肥胖OSAS患儿腺扁桃体切除术后上呼吸道体积变化的报告，显示明显的腺样组织残留，舌和软腭体积增加。这些发现可以解释肥胖OSAS儿童AT成功率低的原因，也是临床医生治疗这些儿童的重要考虑因素。
Objective: The reasons why adenotonsillectomy (AT) is less effective treating obese children with obstructive sleep apnea syndrome (OSAS) are not understood. Thus, the aim of the study was to evaluate how anatomical factors contributing to airway obstruction are affected by AT in these children.Methods: Twenty-seven obese children with OSAS (age 13.0 +/- 2.3 y, body mass index Z-score 2.5 +/- 0.3) underwent polysomnography and magnetic resonance imaging of the head during wakefulness before and after AT. Volumetric analysis of the upper airway and surrounding tissues was performed using commercial software (AMIRA (R)).Results: Patients were followed for 6.1 +/- 3.6 mo after AT. AT improved mean obstructive apnea-hypopnea index (AHI) from 23.7 +/- 21.4 to 5.6 +/- 8.7 (P < 0.001). Resolution of OSAS was noted in 44% (12 of 27), but only in 22% (4 of 18) of those with severe OSAS (AHI > 10). AT increased the volume of the nasopharynx and oropharynx (2.9 +/- 1.3 versus 4.4 +/- 0.9 cm(3), P < 0.001, and 3.2 +/- 1.2 versus 4.3 +/- 2.0 cm(3), P < 0.01, respectively), reduced tonsils (11.3 +/- 4.3 versus 1.3 +/- 1.4 cm(3), P < 0.001), but had no effect on the adenoid, lingual tonsil, or retropharyngeal nodes. A small significant increase in the volume of the soft palate and tongue was also noted (7.3 +/- 2.5 versus 8.0 +/- 1.9 cm(3), P = 0.02, and 88.2 +/- 18.3 versus 89.3 +/- 24.4 cm(3), P = 0.005, respectively).Conclusions: This is the first report to quantify volumetric changes in the upper airway in obese children with OSAS after adenotonsillectomy showing significant residual adenoid tissue and an increase in the volume of the tongue and soft palate. These findings could explain the low success rate of AT reported in obese children with OSAS and are important considerations for clinicians treating these children.