Tonsillectomy in adults with obstructive sleep apnea
Tonsillectomy in adults with obstructive sleep apnea
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DOI：
10.1002/lary.26038
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发表时间：
2016-12-01
期刊：
影响因子：
2.6
通讯作者：
Berggren, Diana
中科院分区：
文献类型：
--
作者：
Holmlund, Thorbjorn;Franklin, Karl A.;Berggren, Diana
目的/假设研究扁桃体切除术对成人大扁桃体患者阻塞性睡眠呼吸暂停(OSA)是否有效。研究设计：多中心前瞻性干预性研究。方法28例OSA患者，呼吸暂停低通气指数为10，大扁桃体(Friedman扁桃体大小为3和4)，年龄18-59岁。他们来自瑞典北部乌梅阿、斯凯勒夫塔和森德宾的41名连续患有大扁桃体的男性和女性，他们因涉嫌睡眠呼吸暂停而被转至耳、鼻和喉部。主要结果是呼吸暂停-低呼吸指数，在术后6个月用多导睡眠呼吸暂停记录仪测量。结果术后6个月随访，呼吸暂停低通气指数由平均每小时40个单位(95%可信区间28~51)降至7个单位/小时(95%可信区间3~11)，P<；0.001。所有患者的呼吸暂停低通气指数均下降，治愈18例(%)。Epworth嗜睡评分由平均11分(95%可信区间8~13分)降至6.0分(95%可信区间4~7分)，P<；0.001。在8名接受调查的患者中，有7人在手术前发现吞咽功能障碍。其中5例患者术后吞咽功能改善，无1例患者吞咽功能恶化。结论扁桃体切除术可能是治疗成人OSA合并大扁桃体的有效方法。对于患有阻塞性睡眠呼吸暂停综合征和扁桃体较大的成年人，可以建议进行扁桃体切除术。喉镜，126：2859-2862,2016
Objectives/HypothesisTo study whether tonsillectomy is effective on obstructive sleep apnea (OSA) in adults with large tonsils.Study DesignA multicenter prospective interventional study.MethodsThe study comprised 28 patients with OSA, an apnea-hypopnea index of > 10, large tonsils (Friedman tonsil size 3 and 4), and age 18 to 59 years. They were derived from 41 consecutive males and females with large tonsils referred for a suspicion of sleep apnea to the ear, nose, and throat departments in Umea, Skelleftea, and Sunderbyn in northern Sweden. The primary outcome was the apnea-hypopnea index, measured with polygraphic sleep apnea recordings 6 months after surgery. Secondary outcomes included daytime sleepiness, as measured with the Epworth Sleepiness Scale, and swallowing function, using video-fluoroscopy.ResultsThe apnea-hypopnea index was reduced from a mean of 40 units per hour (95% confidence interval [CI] 28-51) to seven units per hour (95% CI 3-11), P < 0.001, at the 6-month follow-up after surgery. The apnea-hypopnea index was reduced in all patients and 18 (64%) were cured. The Epworth Sleepiness Scale was reduced from a mean of 11 (95% CI 8-13) to 6.0 (95% CI 4-7), P < 0.001. A swallowing dysfunction was found in seven of eight investigated patients before surgery. Of those, swallowing function improved in five patients after surgery, whereas no one deteriorated.ConclusionTonsillectomy may be effective treatment for adult patients with OSA and large tonsils. Tonsillectomy may be suggested for adults with OSA and large tonsils.Level of Evidence4. Laryngoscope, 126:2859-2862, 2016