Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
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DOI：
10.1542/peds.2012-1672
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发表时间：
2012-09-01
期刊：
影响因子：
8
通讯作者：
Spruyt, Karen
中科院分区：
文献类型：
--
作者：
Marcus, Carole L.;Brooks, Lee J.;Spruyt, Karen
目的：本技术报告描述了制定儿童阻塞性睡眠呼吸暂停综合征（OSAS）管理建议的过程。方法：对1999年至2011年的文献进行评估。结果与结论：共审查了3166篇文献，其中350篇提供了相关数据。大多数文章为二级至四级。OSAS的患病率范围为0%至5.7%，肥胖是一个独立的危险因素。阻塞性睡眠呼吸暂停综合征与心血管、生长、神经行为异常和可能的炎症有关。大多数诊断性筛查试验的敏感性和特异性较低。OSAS的治疗导致行为和注意力的改善，并可能改善认知能力。主要治疗方法是扁桃体切除术（AT）。数据不足以推荐特定的手术技术，然而，儿童接受部分扁桃体切除术应监测可能复发的阻塞性睡眠呼吸暂停综合征。虽然术后OSAS得到改善，但低风险人群中残留OSAS的患者比例为13%至29%，当包括肥胖儿童并使用更严格的多导睡眠图标准时，残留OSAS的患者比例为73%。然而，即使是肥胖儿童，AT后OSAS也可能改善，因此支持手术作为合理的初始治疗。大量肥胖患者术后需要插管或持续气道正压通气（CPAP），这加强了住院观察的必要性。CPAP治疗OSAS有效，但依从性是主要障碍。因此，当AT是一种选择时，CPAP不推荐作为OSAS的一线治疗。鼻内类固醇可以改善轻度OSAS，但需要随访。数据不足以推荐快速上颌扩弓。儿科2012; 130：e714-e755
OBJECTIVE: This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS).METHODS: The literature from 1999 through 2011 was evaluated.RESULTS AND CONCLUSIONS: A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion. Pediatrics 2012; 130: e714-e755