山东大学耳鼻喉眼学报 ›› 2018, Vol. 32 ›› Issue (2): 9-13.doi: 10.6040/j.issn.1673-3770.0.2018.069

• 儿童睡眠呼吸障碍诊断与治疗新进展专题笔谈 • 上一篇    下一篇

重视阻塞性睡眠呼吸暂停低通气综合征儿童腺样体

许志飞1,倪鑫2   

  1. 2015BAl12B09);
    北京市科技计划课题(Z161100000116050)第一作者:许志飞。 E-mail:zhifeixu@aliyun.com通讯作者:倪鑫。 E-mail:nixin_123@163.comDOI:10.6040/j.issn.1673-3770.0.2018.069重视阻塞性睡眠呼吸暂停低通气综合征儿童腺样体扁桃体切除术后的管理许志飞1, 倪鑫2(1.首都医科大学附属北京儿童医院呼吸科 国家呼吸系统临床医学研究中心 国家儿童医学中心, 北京 100045;
    2.首都医科大学附属北京儿童医院耳鼻喉科 国家儿童医学中心, 北京 100045
  • 收稿日期:2018-01-28 出版日期:2018-03-20 发布日期:2018-03-20
  • 通讯作者: 倪鑫. E-mail:nixin_123@163.com
  • 基金资助:
    国家科技支撑计划(2015BAl12B09);北京市科技计划课题(Z161100000116050)

Post-surgery management in children with obstructive sleep apnea syndrome

XU Zhifei1, NI Xin2   

  1. Department of Respiratory Medicine, Beijing Childrens Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Childrens Health, Beijing 100045, China;
  • Received:2018-01-28 Online:2018-03-20 Published:2018-03-20

摘要: 儿童阻塞性睡眠呼吸暂停低通气综合征(OSAS)是常见的儿童睡眠呼吸疾病。OSAS对儿童体格、神经认知发育、心血管系统以及内分泌代谢水平都可能产生危害。腺样体、扁桃体肥大是儿童OSAS的主要病因,腺样体、扁桃体切除术(T&A)因而是治疗儿童OSAS的一线治疗方法。多数接受T&A治疗的儿童睡眠呼吸障碍有显著改善,但按照研究定义的不同,儿童T&A术后OSAS残留的发生率在21.6%~49.0%之间。一些儿童存在术后OSAS残留的危险因素,对这些患儿后续的监测和管理有助于纠正残留疾病导致的病理生理危害及并发症。就腺样体、扁桃体切除术后残留的危险因素以及后续检查、治疗做一综述,旨在加强对儿童OSAS术后随访和管理的重视,提高儿童睡眠疾病的整体诊断和治疗水平。

关键词: 儿童, 腺样体、扁桃体切除术, 睡眠呼吸暂停, 阻塞性, 残留症状

Abstract: Obstructive sleep apnea syndrome(OSAS)is a common pediatric sleep-respiratory disorder. OSAS can cause impairments in childrens physical and neurocognitive development, cardiovascular systems, endocrine systems, and metabolic status. Adenoidal or tonsillar hypertrophy are the most common causes of pediatric OSAS. Adenotonsillectomy(T&A)is therefore the first-line treatment for children with OSAS. Although most children show significant improvement after T&A, the incidence of residual disease is between 21.6% and 49%, depending on the definition of residual disease and the presence or absence of risk factors for OSAS. Follow-up and management of residual OSAS is beneficial to avoid disease-related complications. This paper summarizes the potential risk factors for residual OSAS and useful follow-up strategies after adenotonsillectomy in children, and aims to improve the diagnosis and management of pediatric sleep-disordered breathing.

Key words: Sleep apnea, obstructive, Children, Adenotonsillectomy, Residual symptoms

中图分类号: 

  • R766.7
[1] Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome[J]. Pediatrics, 2012, 130(3):576-584.
[2] Tauman R, Gulliver TE, Krishna J, et al. Persistence of obstructive sleep apnea syndrome in children after denotonsillectomy[J]. J Ped, 2006, 149(6):803-808.
[3] Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study[J]. Am J Respir Crit Care Med, 2010, 182(5):676-683.
[4] Lee CH, Hsu WC, Chang WH, et al. Polysomnographic findings after adenotonsillectomy for obstructive sleep apnoea in obese and non-obese children: a systematic review and meta-analysis[J]. Clin Otolaryngol, 2016, 41(5):498-510.
[5] Tagaya M, Nakata S, Yasuma F, et al. Children with severe or moderate obstructive sleep apnoea syndrome show a high incidence of persistence after adenotonsillectomy[J]. Acta Otolaryngol, 2012, 132(11):1208-1214.
[6] 张亚梅,赵靖,安嘉清,等. 儿童阻塞性睡眠呼吸暂停低通气综合征外科治疗效果欠佳病例的分析[J]. 中华耳鼻咽喉头颈外科杂志,2007,42(2):90-94. ZHANG Yamei, ZHAO Jing, AN Jiaqing, et al. Analysis of poor-responding sleep apnea children to adenoidtonsillectomy and further treatment[J]. Chin J Otorhinolarynol Head Neck Surg, 2007, 42(2):90-94.
[7] Mitchell RB, Kelly J. Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children[J]. Otolaryngol Head Neck Surg, 2007, 137(1):43-48.
[8] Costa DJ, Mitchell R. Adenotonsillectomy for obstructive sleepapnea in obese children: a meta-analysis[J]. Otolaryngol Head Neck Surg, 2009, 140(4):455-460.
[9] Berry RB, Chediak A, Brown LK, et al. Best clinical practices for the sleep center adjustment of noninvasive positive pressure ventilation(NPPV)in stable chronic alveolar hypoventilation syndromes[J]. J Clin Sleep Med, 2010, 6(5):491-509.
[10] Zandieh SO, Padwa BL, Katz ES. Adenotonsillectomy for obstructive sleep apnea in children with syndromic craniosynos-tosis[J]. Plast Reconstr Surg, 2013, 131(4):847-852.
[11] Maris M, Verhulst S, Wojciechowski M, et al. Outcome of adenotonsillectomy in children with down syndrome and obstructive sleep apnoea[J]. Arch Dis Child, 2017,102(4):331-336.
[12] Afsharpaiman S, Saburi A, Waters KA. Respiratory difficulties and breathing disorders in achondroplasia[J]. Paed Respir Rev, 2013, 14(4):250-255.
[13] Kontorinis G, Thevasagayam MS, Bateman ND. Airway obstruction in children with cerebral palsy: need for tracheostomy?[J]. Int J Ped Otorhinolaryngol, 2013, 77(10):1647-1650.
[14] Sedky K, Bennett DS, Pumariega A. Prader willi syndrome and obstructive sleep apnea: co-occurrence in the pediatric population[J]. J Clin Sleep Med 2014, 10:403-409.
[15] 许志飞,熊晖,吴云肖,等.以睡眠相关低通气为主要表现的SEPN1基因相关肌病一例[J]. 中华儿科杂志,2017,55(10):790-791.
[16] Giordano L, Toma S, Palonta F, et al. Obstructive sleep apnea in Prader-Willi syndrome: risks and advantages of adenotonsillectomy[J]. Pediatr Med Chir, 2015, 37(2):pmc.2015.107.
[17] Tagaya M, Nakata S, Yasuma F, et al. Children with severe or moderate obstructive sleep apnoea syndrome show a high incidence of persistence after adenotonsillectomy[J]. Acta Otolaryngol, 2012, 132(11):1208-1214.
[18] Ye J, Liu H, Zhang GH, et al. Outcome of adenotonsillectomy for obstructive sleep apnea syndrome in children[J]. Ann Otol Rhinol Laryngol, 2010, 119(8):506-513.
[19] Tan HL, Gozal D, Kheirandish-Gozal L. Obstructive sleep apnea in children: a critical update[J]. Nat Sci Sleep, 2013, 5:109-123.
[20] Shen YE, Xu ZF, Huang ZZ, et al. Increased cysteinyl leukotriene con-centration and receptor ewpression in tonsillar tissues of Chinese children with sleep-disordered breathing[J]. Int Immunopharmacol, 2012, 13(4):371-376.
[21] 刘婷,王岩,李延忠. 阻塞性睡眠呼吸暂停低通气综合征儿童中血清维生素D检测的意义[J].山东大学耳鼻喉眼学报,2017,31(20):21-26. LIU Ting, WANG Yan, LI Yanzhong. Relationship between vitamin D and obstructive sleep apnea hypopnea syndrome in children[J]. J Otolaryngol Ophthalmol Shandong Univ, 2017, 31(20):21-26.
[22] Manickam PV, Shott SR, Boss EF, et al. Systematic review of site of obstruction identi cation and non-CPAP treatment options for children with persistent pediatric obstructive sleep apnea[J]. Laryngoscope, 2016, 126(2):491-500.
[23] Flores MC, Korajem M, Heo G, et al. Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: a systematic review and meta-analysis[J]. J Am Dent Assoc, 2013, 144(3):269-277.
[24] Huynh NT, Desplats E, Almeida FR. Orthodontics treatments for managing obstructive sleep apnea syndrome in children: a systematic review andmeta-analysis[J]. Sleep Med Rev, 2016, 25:84-94.
[25] Villa MP, Rizzoli A, Rabasco J, et al. Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children[J]. Sleep Med, 2015, 16(6):709-716.
[26] 高雪梅. 口腔睡眠医学的孕育和发展[J]. 世界睡眠医学杂志,2014, 1(1):16-19. GAO Xuemei. Call for emergence and development of oral sleep medicine[J]. World J Sleep Med, 2014, 1(1):16-19.
[27] Manickam PV, Shott SR, Boss EF, et al. Systematic review of site of obstruction identi cation and non-CPAP treatment options for children with persistent pediatric obstructive sleep apnea[J]. Laryngoscope, 2016, 126(2):491-500.
[28] 中华医学会儿科学分会呼吸学组睡眠协作组.无创正压通气治疗儿童阻塞性睡眠呼吸暂停综合征专家共识(草案)[J]. 中华实用儿科临床杂志,2016,31(19):11-15
[29] Fauroux B, Lavis JF, Nicot F, et al. Facial side effects during noninvasive positive pressure ventilation in children[J]. Intensive Care Med, 2005, 31(7):965-969.
[30] Li KK, Riley RW, Guilleminault C. An unreported risk in the use of home nasal continuous positive airway pressure and home nasal ventilation in children: mid-face hypoplasia[J]. Chest, 2000, 117(3):916-918.
[31] Verhulst SL, Franckx H, Van Gaal L, et al. The effect of weight loss on sleep-disordered breathing in obese teenagers[J]. Obesity, 2009, 17(6):1178-1183.
[32] Dayyat E, Serpero LD, Kheirandish-Gozal L, et al. Leukotriene pathways and in vitro adenotonsillar cell proliferation in children with obstructive sleep apnea[J]. Chest, 2009, 135(5):1142-1149.
[33] Tsaoussoglou M, Hatzinikolaou S, Baltatzis GE, et al. Expression of leukotriene biosynthetic enzymes in tonsillar tissue of children with obstructive sleep apnea: a prospective nonrandomized study[J]. JAMA Otolaryngol Head Neck Surg, 2014, 140(10): 944-950.
[34] Goldbart AD, Veling MC, Goldman JL, et al. Glucocorticoid receptor subunit expression in adenotonsillar tissue of children with obstructive sleep apnea[J]. Pediatr Res, 2005, 57(2):232-236.
[35] Goldbart AD, Greenberg-Dotan S, Tal A. Montelukast for children with obstructive sleep apnea: adouble-blind, placebo-controlled study[J]. Pediatrics, 2012, 130(3):e575-e580.
[36] Kheirandish L, Goldbart AD, Gozal D. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children[J]. Pediatrics, 2006, 117(1):61-66.
[37] Villa MP, Brasili L, Ferretti A, et al. Oropharyngeal exercises to reduce symptomsof OSA after AT[J]. Sleep Breath, 2015, 19(1):281-289.
[38] Guilleminault C, Huang YS, Monteyrol PJ, et al. Critical role of myofascial reeducation in pediatric sleep-disordered breathing[J]. Sleep Med, 2013, 14(6):518-525.
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