Changes during medical treatments before adenotonsillectomy in children with obstructive sleep apnea.
Changes during medical treatments before adenotonsillectomy in children with obstructive sleep apnea.
复制标题
阻塞性睡眠呼吸暂停儿童腺样体扁桃体切除术前药物治疗期间的变化。
DOI：
10.1016/j.anl.2021.11.001
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发表时间：
2022
影响因子：
1.7
通讯作者：
Hyodo M
中科院分区：
文献类型：
--
作者：
Kajiyama T;Komori M;Hiyama M;Kobayashi T;Hyodo M
目的小儿阻塞性睡眠呼吸暂停（OSA）的严重程度随季节变化可从轻度到重度（AHI≥30事件/小时）。在轻度和中度儿童阻塞性睡眠呼吸暂停的病例中，已经研究了药物治疗的效果，但在重度病例中尚未进行彻底的研究。方法前瞻性队列研究纳入了2014年12月至2020年5月期间就诊的205名儿童。初诊后进行家庭睡眠测试，通过药物治疗优化鼻炎、鼻窦炎、腺样体肥大、扁桃体炎控制后进行多导睡眠图检查。结果改善至梗阻性AHI (O-AHI) < 1/h或行手术治疗的患者比例分别为43.4%和62.3%；中度病例分别为43.3%和52.2%；重症30.2%、68.4%；在非常严重的情况下是0.0%和100%。O-AHI < 1/h和O-AHI≥1/h患者的nadir sao2治疗前后均有显著改善（p< 0.0001,p= 0.0009）。治疗后O-AHI归一化的患者，治疗前最低sao2为74%。结论在手术前进行药物治疗，如果有时间，可以避免不必要的手术。相比之下，对于非常严重的OSA患儿或最低sao2低于74%的患儿，通过药物治疗可能难以使O-AHI正常化。
ObjectivesThe severity of pediatric obstructive sleep apnea (OSA) can vary from mild to very severe (AHI ≥ 30 events/h) with the seasons. The efficacy of medical treatment has been investigated in cases of mild and moderate pediatric OSA, but not in severe cases thoroughly.MethodsOur prospective cohort study involved 205 children who visited our outpatient clinic between December 2014 and May 2020. We performed home sleep tests after the initial visit, and then polysomnography after optimizing the control of rhinitis, sinusitis, adenoid hypertrophy, and tonsillitis by using medical treatments.ResultsThe respective proportions of patients who improved to obstructive AHI (O-AHI) < 1/h or who proceeded to surgery were 43.4% and 62.3% in mild cases; 43.3% and 52.2% in moderate cases; 30.2% and 68.4% in severe cases; and 0.0% and 100% in very severe cases. Additionally, nadir SaO2improved significantly between before and after medical treatment in both O-AHI < 1/h and O-AHI ≥ 1/h patients (respectivelyp< 0.0001,p= 0.0009). The lowest nadir SaO2before medical treatment was 74% in patients in whom O-AHI was normalized after medical treatments.ConclusionMedical treatment instituted before a surgical decision is made can provide substantial benefits and avoid unnecessary surgery if there is time for such treatments. In contrast, it may be difficult to normalize the O-AHI in pediatric patients with very severe OSA or a nadir SaO2of less than 74% by medical treatment.