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Effects of Rapid Palatal Expansion on the Upper Airway Space in Children with Obstructive Sleep Apnea (OSA): A Case-Control Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020244. [PMID: 36832373 PMCID: PMC9954808 DOI: 10.3390/children10020244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Obstructive Sleep Apnea (OSA) in children needs a multidisciplinary approach. Even if the first-line treatment of pediatric OSA is adenotonsillectomy, nowadays rapid palatal expansion (RPE) is considered a valid additional treatment. The aim of this study is to evaluate cephalometric changes in upper airways dimensions after rapid palatal expansion (RPE) in children suffering from Obstructive Sleep Apnea (OSA). A total of 37 children (range age 4-10 years) with diagnosis of OSA referred to Dentistry Unit of Bambino Gesù Children's Research Hospital IRCCS (Rome, Italy) were included in this pre-post study and underwent lateral radiographs at the start (T0) and at the end (T1) of a RPE treatment. Inclusion criteria were: diagnosis of OSA confirmed by cardiorespiratory polygraphy (AHI > 1) or pulse oximetry (McGill = >2), skeletal maxillary contraction evaluated by presence of posterior crossbite. A control group of 39 untreated patients (range age 4-11 years), in good general health, was set up. A paired T-test was used to investigate the statistical differences between T0 and T1 values in both groups. The results showed a statistically significant increase of nasopharyngeal width in the treated group after RPE treatment. Moreover, the angle that identifies mandibular divergence compared to palatal plane (PP-MP°) was significantly reduced. In the control group, no statistically significant differences were observed. The present study showed that RPE treatment determines a significant sagittal space increase in the upper airways space and a counterclockwise mandibular growth in children with OSA compared to a control group. These results suggest that a widening of the nasal cavities induced by RPE may support a return to physiological nasal breathing and promote a counterclockwise mandibular growth in children. This evidence confirms the crucial role of the orthodontist in the management of OSA in pediatric patients.
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Perspectives on paediatric sleep-disordered breathing in the UK: a qualitative study. The Journal of Laryngology & Otology 2022; 136:520-526. [DOI: 10.1017/s0022215121004242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThere is limited understanding of treatment pathways for paediatric sleep-disordered breathing. This study explored current UK pathways and what is important to well-being for parents and children.MethodThe study comprised in-depth qualitative interviews (n = 22) with parents of children (2–9 years) with symptoms of sleep-disordered breathing referred to a regional ENT clinic (n = 11), general practitioners who might refer these children to ENT (n = 5) and hospital doctors involved in treating these children (n = 6). Interviews were audio recorded, transcribed verbatim, anonymised and analysed thematically.ResultsGeneral practitioners rarely identify seeing children with sleep-disordered breathing; conversely hospital doctors identify unsuspected issues. Parents are worried their child will stop breathing, but routes to referral and diagnosis are not straightforward. Modern technology can aid investigation and diagnosis. Patient weight is an issue for general practitioners and hospital doctors. Adenotonsillectomy is the treatment of choice, and information on paediatric sleep-disordered breathing is needed.ConclusionGuidelines for the management of paediatric sleep-disordered breathing are needed.
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Quality-of-life but not behavior improves 48-months post-adenotonsillectomy in children with SDB. Sleep Med 2021; 81:418-429. [PMID: 33831667 DOI: 10.1016/j.sleep.2021.02.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Long term follow-up studies (>12 mths) of changes in behavior and quality-of-life (QoL) in children with sleep disordered breathing (SDB) post-adenotonsillectomy are limited and there is a lack of consensus in the reported findings. The aim of this study was to evaluate children's sleep, QoL and behavior at baseline and 6 mths and 48 mths post-adenotonsillectomy for clinically diagnosed SDB. METHODS This prospective longitudinal study of children aged 3-12 y recruited from a Children's Hospital otolaryngology clinic compared polysomnographic parameters, behavior (Child Behavior Checklist; CBCL) and QoL (OSA-18) at baseline, 6mths and 48mths post-adenotonsillectomy and compared these parameters to healthy non-snoring controls recruited from the general community at the same time points. RESULTS Sixty-four children completed sleep, behavior and QoL assessments (SDB = 20M/9F, Controls = 18M/17F) at all three time points. Sleep and ventilatory parameters significantly improved in children with SDB with minimal residual obstruction evident at 48 mths post-adenotonsillectomy. Compared to baseline, OSA-18 scores significantly improved post-adenotonsillectomy in children with SDB and were equivalent to the scores of controls at 6 mths and 48 mths post-AT. No significant improvement was observed in behavior in children with SDB post-adenotonsillectomy over the same time period. CONCLUSION Baseline deficits in sleep and QoL in children with SDB were normalized at 6 mths post-adenotonsillectomy and gains were maintained at 48 mths post-adenotonsillectomy. Children with SDB did not show significant gains in behavior either at 6 mths or 48 mths post-adenotonsillectomy.
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Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. 24-Hour Ambulatory Blood Pressure Variability in Children with Obstructive Sleep Apnea. Laryngoscope 2021; 131:2126-2132. [PMID: 33599298 DOI: 10.1002/lary.29455] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/06/2021] [Accepted: 01/29/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate blood pressure (BP) variability in 24-hour ambulatory BP monitoring in children with obstructive sleep apnea (OSA). STUDY DESIGN Case series study. METHODS Children aged 4 to 16 years with clinical symptoms were recruited in a tertiary medical center. Overnight polysomnography and 24-hour recordings of ambulatory BP were performed for each child. The severity of OSA was classified as primary snoring (apnea-hypopnea index [AHI] < 1), mild OSA (1 ≤ AHI < 5), moderate OSA (10 > AHI ≥ 5), and severe OSA (AHI ≥ 10). The standard deviation of mean BP was used as an indicator of BP variability. RESULTS A total of 550 children were included (mean age: 7.6 years; 70% were boys; 20% were obese). Compared with the children with primary snoring, children with severe OSA exhibited significantly higher nighttime systolic BP (108.0 vs. 100.5 mmHg, P < .001), nighttime diastolic BP (58.9 vs 55.6 mmHg, P = .002), nighttime mean arterial pressure (75.3 vs. 70.5 mmHg, P < .001), nighttime systolic BP load (40.5% vs. 25.0%, P < .001), nighttime diastolic BP load (25.3% vs. 12.9%, P < .001), and nighttime systolic BP variability (11.4 vs. 9.6, P = .001). Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP variability (regression coefficient = 0.31, 95% CI = 0.06-0.56, P = .015) after adjustment for age, gender, adiposity, and hypertensive status. CONCLUSIONS OSA in children is associated with increased BP and BP variability. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2126-2132, 2021.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Bariani RCB, Guimaraes TM, Moura W, Cappellette Junior M, Tufik S, Moreira GA, Fujita RR. Quality of life related to residual snoring after adenotonsillectomy: a pilot study. Sleep Sci 2021; 14:330-336. [PMID: 35087629 PMCID: PMC8776272 DOI: 10.5935/1984-0063.20200093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Few studies have addressed long-term quality of life related to residual snoring after adenotonsillectomy. The aim of this study was to compare scores from the OSA-18 questionnaire between children with residual snoring and non-snoring children two or more years after adenotonsillectomy. MATERIAL AND METHODS The sample comprised 25 children divided into two groups, a group of 14 snoring children, and a control group of 11 non-snoring children. The OSA-18 questionnaire was applied to the volunteers. In the control group, it was completed by the caregivers of the children, while in individuals with residual snoring it was completed by the caregivers of children in the presence of a doctor or dentist. A statistical comparison was made using a generalized linear model. RESULTS The snorer group had a higher total OSA-18 score, and a higher score in all five domains compared to the control group. CONCLUSION Children with residual snoring two or more years after adenotonsillectomy may have a worse quality of life compared to the control group.
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Affiliation(s)
- Rita Catia Brás Bariani
- Universidade Federal de São Paulo, Department of
Otorhinolaryngology and Head and Neck Surgery - São Paulo - SP - Brazil
| | - Thais Moura Guimaraes
- Universidade Federal de São Paulo, Departamento de
Psicobiologia - São Paulo - SP - Brazil
| | - Wilana Moura
- Faculdade de Odontologia de Bauru, Departamento de Ortodontia -
São Paulo - SP - Brazil
| | - Mario Cappellette Junior
- Universidade Federal de São Paulo, Department of
Otorhinolaryngology and Head and Neck Surgery - São Paulo - SP - Brazil
| | - Sergio Tufik
- Universidade Federal de São Paulo, Departamento de
Psicobiologia - São Paulo - SP - Brazil
| | - Gustavo A. Moreira
- Universidade Federal de São Paulo, Departamento de
Psicobiologia - São Paulo - SP - Brazil
| | - Reginaldo Raimundo Fujita
- Universidade Federal de São Paulo, Department of
Otorhinolaryngology and Head and Neck Surgery - São Paulo - SP - Brazil
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Quality of life in children and adolescents with overweight or obesity: Impact of obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2020; 138:110320. [PMID: 32889438 DOI: 10.1016/j.ijporl.2020.110320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the association between obstructive sleep apnea (OSA) and health related quality of life (HRQOL) in children and adolescents referred to an obesity treatment clinic. In addition, we examined the association between body mass index standard deviation score (BMI SDS) and HRQOL comparing children and adolescents with overweight or obesity without OSA with a control group of children and adolescents with normal weight without OSA. METHODS This cross-sectional study included 130 children and adolescents with overweight or obesity (BMI SDS > 1.28) aged 7-18 years recruited from an obesity treatment clinic. The control group consisted of 28 children and adolescents with normal weight (BMI SDS ≤ 1.28) aged 7-18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor, Nox T3. OSA was defined as apnea-hypopnea index (AHI) ≥ 2. HRQOL was measured by the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scale. RESULTS A total of 56 children and adolescents with overweight or obesity were diagnosed with OSA (43%). The children and adolescents with OSA were older (p = 0.01) and had higher BMI SDS (p = 0.04) than children and adolescents without OSA. In generalized linear regression analyses adjusted for age, sex, BMI SDS and pubertal development stage there was no association between OSA or AHI and HRQOL in children and adolescents with overweight or obesity. In the analysis, including children and adolescents without OSA and the normal-weight control group, the generalized linear regression adjusted for age, sex and AHI revealed an association between BMI SDS and HRQOL (p < 0.001). CONCLUSION We found no association between AHI or OSA and HRQOL in children and adolescents with overweight or obesity. However, we found an association between BMI SDS and HRQOL in children and adolescents without OSA.
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Predicting the outcome after adenoidectomy-alone for adenoid hypertrophy causing sleep disordered breathing. Am J Otolaryngol 2020; 41:102646. [PMID: 32688182 DOI: 10.1016/j.amjoto.2020.102646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE By using preoperative parameters age, body mass index, nasopharyngeal obstruction as assessed using flexible videonasopharyngoscopy, and quality of life scores in patients undergoing adenoidectomy-alone because of adenoid hypertrophy causing sleep disordered breathing, we aimed to examine the relationship between the change in quality of life scores, and preoperative parameters and to develop a tool to predict the change. MATERIALS AND METHODS Patients who were scheduled for adenoidectomy-alone in a 12-month period were included. Flexible videnonasopharyngoscopy of the nasopharynx was performed. Nasopharyngeal obstruction was measured by using Image J software. Preoperative quality of life was evaluated using OSA-18 quality of life survey. OSA-18 survey has 5 subcategories consisting of sleep disturbance (O1), physical suffering (O2), emotional distress (O3), daytime problems (O4), caregiver concerns (O5). A question about the overall quality of life(O6) was added. Postoperative OSA-18 domain scores were obtained at the 3-month-follow-up. Preoperative OSA-18 subscores were compared to postoperative subscores. Linear regression analysis to predict the proportional change in OSA-18 subscores was performed. RESULTS Our study group consisted of 94 cases. Mean postoperative O1, O2,O3, O4 and O5 scores were significantly lower compared to the preoperative scores. Mean postoperative O6 score was significantly higher. Linear regression analysis was carried out for predicting change in O1(r2 = 0.686; p = 0.006), O5(r2 = 0.711; p = 0.003) and O6(r2 = 0.757; p = 0.001). CONCLUSION Change in quality of life scores for sleep disturbance, physical suffering and general quality of life may be predicted by using preoperative parameters.
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Pavkovic IM, Kothare SV. Migraine and Sleep in Children: A Bidirectional Relationship. Pediatr Neurol 2020; 109:20-27. [PMID: 32165029 DOI: 10.1016/j.pediatrneurol.2019.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/05/2019] [Accepted: 12/24/2019] [Indexed: 01/03/2023]
Abstract
Migraine and sleep disorders in children exhibit a bidirectional relationship. This relationship is based on shared pathophysiology. Migraine involves activation of the trigeminal vascular system. Nociceptive neurons that innervate the dura release various vasoactive peptides. Calcitonin gene-related peptide is the most active of these peptides. Neural pathways that are involved in sleep generation are divided into those responsible for circadian rhythm, wake promotion, non-rapid eye movement, and rapid eye movement sleep activation. Sleep state switches are a critical component of these systems. The cerebral structures, networks, and neurochemical systems that are involved in migraine align closely with those responsible for the regulation of sleep. Neurochemical systems that are involved with both the pathogenesis of migraine and regulation of sleep include adenosine, melatonin, orexin, and calcitonin gene-related peptide. Sleep disorders represent the most common comorbidity with migraine in childhood. The prevalence of parasomnias, obstructive sleep apnea, and sleep-related movement disorders is significantly greater in children migraineurs. Infantile colic is a precursor of childhood migraine. Treatment of comorbid sleep disorders is important for the appropriate management of children with migraine. Sleep-based behavioral interventions can be of substantial benefit. These interventions are particularly important in children due to limited evidence for effective migraine pharmacotherapy.
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Affiliation(s)
- Ivan M Pavkovic
- Division of Pediatric Neurology, Department of Pediatrics, Cohen Children's Medical Center, Lake Success, New York; Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Sanjeev V Kothare
- Divison of Pediatric Neurology, Department of Pediatircs, Cohen Children's Medical Center, Lake Success, New York; Pediatric Sleep Program (Neurology), Department of Pediatircs, Cohen Children's Medical Center, Lake Success, New York; Pediatric Neurology Service Line for Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Pediatrics & Neurology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
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Ali NES, Alyono JC, Kumar AR, Cheng H, Koltai PJ. Sleep surgery in syndromic and neurologically impaired children. Am J Otolaryngol 2020; 41:102566. [PMID: 32504854 DOI: 10.1016/j.amjoto.2020.102566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/03/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To examine surgery performed for obstructive sleep apnea (OSA) in children with syndromic or neurologic comorbidities. MATERIAL AND METHODS Medical records of 375 children with OSA were retrospectively reviewed, including 142 patients with trisomy 21, 105 with cerebral palsy, 53 with muscular dystrophy, 32 with spinal muscular atrophy, 18 with mucopolysaccharidoses, 14 with achondroplasia, and 11 with Prader-Willi. OUTCOME MEASURES Apnea-hypopnea index (AHI), complications, length of postoperative stay, and endoscopic findings. RESULTS 228 patients received 297 surgical interventions, with the remainder undergoing observation or positive pressure ventilation. Adenoidectomy was the most common procedure performed (92.1% of patients), followed by tonsillectomy (91.6%). Average AHI decreased following tonsillectomy, from 12.4 to 5.7 (p = 0.002). The most common DISE finding was the tongue base causing epiglottic retroflexion. Lingual tonsillectomy also resulted in an insignificant decrease in the AHI. CONCLUSIONS Adenotonsillectomy, when there is hypertrophy, remains the mainstay of management of syndromic and neurologically-impaired children with OSA. However, additional interventions are often required, due to incomplete resolution of the OSA. DISE is valuable in identifying remaining sites of obstruction and guiding future management.
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10
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Correlations between disease-specific quality of life and polysomnographic findings in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2020; 134:110077. [PMID: 32402922 DOI: 10.1016/j.ijporl.2020.110077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) can have a negative impact on quality of life in children. The OSA-18 is a disease-specific quality of life questionnaire for children. The questionnaire has been found to be a poor predictor of OSA diagnosed with polysomnography (PSG), yet OSA-18 scores do markedly improve after adenotonsillectomy. The aim of this study was to examine the correlations between OSA-18 and PSG findings, beyond the apnea hypopnea index (AHI). METHODS This study was a prospective study of children 2-6 years of age who were referred to an Ear, Nose and Throat department for adenoidectomy and/or tonsillectomy. Prior to surgery, all of the children underwent PSG and a physical examination, and their parent completed the OSA-18 questionnaire. Spearman correlations were used to determine the associations between OSA-18 scores and PSG parameters. RESULTS The sample consisted of 97 children who underwent PSG and their parents who answered the OSA-18 questionnaire. We found positive correlations between the AHI and both the OSA-18 total score (rho = 0.21, p = 0.04) and the sleep disturbance subscale (rho = 0.51, p < 0.01). The only other PSG parameter that significantly correlated with the OSA-18 was the number of awakenings and arousals per hour of sleep (rho = 0.29, p < 0.01). CONCLUSION We only found weak correlations between the OSA-18 score and PSG findings, suggesting the two methods are measuring different aspects of pediatric OSA. CLINICAL TRIAL NCT02233166.
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Sojisirikul N, Sophonphan J, Bongsebandhu-phubhakdi C. Growth after Adenotonsillectomy in Thai Children with Adenotonsillar Hypertrophy. SLEEP MEDICINE RESEARCH 2020. [DOI: 10.17241/smr.2020.00598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Prospektive Erfassung der postinterventionellen Lebensqualität nach Adenotomie und Adenotonsillotomie bei Kindern. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00939-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Zusammenfassung
Hintergrund
Die Bewertung der Effektivität der Adenotomie (AT) und Adenotonsillotomie (ATT) bei symptomatischer adenotonsillärer Hyperplasie orientiert sich in Studien oft nur am Ausmaß der postoperativen Symptomreduktion. Daher sollte erstmals im Rahmen dieser Studie erfasst werden, ob die AT und ATT zu einer postoperativen Verbesserung der kindlichen Lebensqualität (LQ) mittels dem Fragebogen „Glasgow Children’s Benefit Inventory“ (GCBI) und einer visuellen Analogskala (VAS) zur LQ führt.
Material und Methoden
Es wurden n = 111 Kinder prospektiv rekrutiert (3 bis 6 Jahre, ♂ 65 % ♀ 35 %, Æ Alter 4,2 Jahre, AT (66 %), ATT (34 %), Follow-up 3,5 Monate). Die kindliche LQ wurde mittels GCBI (24 Items) und einer VAS zur LQ (0 bis 10 Punkte) erfasst.
Ergebnisse
Bei 107 Kindern (96,4 %) ergab sich eine postoperative Verbesserung der LQ anhand der GCBI-Score-Werte. Es ergab sich ein mittlerer Score-Wert von +32,7 ± 22,14, Konfidenzintervall (KI) [+28,5–+36,9] mit maximal +97,9 und minimal −25,0 Punkten. In der Gruppe ATT wurde mit +39,4 ± 25,18 ein signifikant höherer mittlerer Score-Wert als in der Gruppe AT +29,3 ± 19,67 erreicht (p = 0,024). Bei 91 (82,0 %) der Kinder gaben die Eltern postoperativ einen höheren Punktewert in der VAS an, bei 16 (14,4 %) bemerkten die Eltern keine Änderung, nur bei 4 (3,6 %) verschlechterte sich die LQ.
Diskussion
Schon die reine Rachenmandelhyperplasie beeinflusst die allgemeine LQ relevant. Die Verbesserung der LQ in GCBI und VAS durch die Operation belegt den klaren Benefit. Bei zusätzlicher Hyperplasie der Gaumenmandeln verbessert eine zusätzliche Tonsillotomie die LQ noch deutlicher. Adenotomie und Adenotonsillotomie sind daher bei differenzierter Indikationsstellung effektive Operationen, um neben der reinen Symptomreduktion auch eine signifikante Verbesserung der kindlichen LQ zu erzielen.
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Caixeta JAS, Sampaio JCS, Costa VV, Silveira IMBD, Oliveira CRFD, Caixeta LCAS, Avelino MAG. Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing. Int Arch Otorhinolaryngol 2020; 25:e123-e128. [PMID: 33542762 PMCID: PMC7851366 DOI: 10.1055/s-0040-1709195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/25/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction
Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear.
Objective
To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB).
Method
This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis,
p
-values lower than 0.05 were defined as statistically significant.
Results
A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores.
Conclusion
This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.
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Linguistic adaptation and validation of Italian version of OSA-18, a quality of life questionnaire for evaluation of children with obstructive sleep apnea-hypopnea syndrome (OSAS). Int J Pediatr Otorhinolaryngol 2020; 129:109727. [PMID: 31734562 DOI: 10.1016/j.ijporl.2019.109727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/03/2019] [Accepted: 10/12/2019] [Indexed: 11/22/2022]
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Trajectory of ambulatory blood pressure after adenotonsillectomy in children with obstructive sleep apnea: comparison at three- and six-month follow-up. Sleep Med 2020; 65:127-133. [DOI: 10.1016/j.sleep.2019.07.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 12/28/2022]
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Lee CH, Hsu WC, Ko JY, Yeh TH, Lin MT, Kang KT. Adenotonsillectomy for the Treatment of Obstructive Sleep Apnea in Children with Prader-Willi Syndrome: A Meta-analysis. Otolaryngol Head Neck Surg 2019; 162:168-176. [DOI: 10.1177/0194599819893115] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective Adenotonsillectomy outcomes in obstructive sleep apnea (OSA) treatment among children with Prader-Willi syndrome (PWS) remain unclear. This study aimed to elucidate the effectiveness of adenotonsillectomy in OSA treatment among children with PWS. Data Source PubMed, MEDLINE, Embase, and Cochrane Review up to February 2019. Review Methods The registry number of the protocol published on PROSPERO was CRD42015027053. Two authors independently searched the relevant database. Polysomnography outcomes in these children were examined, including net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum and mean oxygen saturation, the overall success rate for a postoperative AHI <1, and the overall success rate for a postoperative AHI <5. Results Six studies with 41 patients were analyzed (mean age, 5.0 years; 55% boys; mean sample size, 6.8 patients). All children had PWS and received adenotonsillectomy for the treatment of OSA. The AHI was 13.1 events per hour (95% CI, 11.0-15.1) before surgery and 4.6 events per hour (95% CI, 4.1-5.1) after surgery. The mean change in the AHI was a significant reduction of 8.0 events per hour (95% CI, −10.8 to −5.1). The overall success rate was 21% (95% CI, 11%-38%) for a postoperative AHI <1 and 71% (95% CI, 54%-83%) for a postoperative AHI <5. Some patients developed velopharyngeal insufficiency postoperatively. Conclusion Adenotonsillectomy was associated with OSA improvement among children with PWS. However, residual OSA was frequently observed postoperatively in these patients.
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Affiliation(s)
- Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City
- Department of Otolaryngology, National Taiwan University Hospital, Taipei
- Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei
- Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei
- Sleep Center, National Taiwan University Hospital, Taipei
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital, Taipei
- Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, Taipei
- Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei
| | - Ming-Tzer Lin
- Sleep Center, National Taiwan University Hospital, Taipei
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City
| | - Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City
- Department of Otolaryngology, National Taiwan University Hospital, Taipei
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Prévost AS, Hylands M, Gervais M, Praud JP, Battista MC, Déziel-Malouin S, Lachance M, Lamontagne F. Drug-induced sleep endoscopy compared with systematic adenotonsillectomy in the management of obstructive sleep apnoea in children: a systematic review and meta-analysis protocol. BMJ Open 2019; 9:e028242. [PMID: 31511282 PMCID: PMC6738734 DOI: 10.1136/bmjopen-2018-028242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 08/16/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea affects up to 6% of children worldwide. Although current guidelines recommend systematic tonsillectomy and adenoidectomy, many children do not benefit from these interventions. Drug-induced sleep endoscopy (DISE) allows the dynamic evaluation of patients' airways to identify the specific anatomic sites of obstruction. This intervention can potentially guide subsequent invasive procedures to optimise outcomes and minimise the number of children exposed to unnecessary operations. METHODS AND ANALYSIS We will identify randomised controlled trials and controlled observational studies comparing DISE-directed interventions to systematic tonsillectomy and adenoidectomy in paediatric populations. We will search MEDLINE, EMBASE, CINAHL, CENTRAL as well as clinical trial registries and conference proceedings (initial electronic search date 9 October 2018). Screening, data extraction and risk of bias assessments will be performed in duplicate by independent reviewers. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to assess the overall quality of evidence and present our results. ETHICS AND DISSEMINATION Ethics approval is not required for this systematic review of published data. This review will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will present our findings at otorhinolaryngology conferences and publish a report in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018085370.
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Affiliation(s)
- Anne-Sophie Prévost
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mathieu Hylands
- Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mireille Gervais
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean-Paul Praud
- Division of Pediatric Pulmonology-Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Claude Battista
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Monia Lachance
- Department of Anesthesia, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Francois Lamontagne
- Department of Internal Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Kang KT, Chiu SN, Lin CY, Weng WC, Lee PL, Hsu WC. Effect of Adenotonsillectomy on Ambulatory Blood Pressure in Pediatric Obstructive Sleep Apnea: 6-Month Follow-up Study. Otolaryngol Head Neck Surg 2019; 160:911-921. [DOI: 10.1177/0194599818825462] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective To investigate 24-hour ambulatory blood pressure changes 6 months after surgery among children with obstructive sleep apnea. Study Design Prospective interventional study. Setting Tertiary medical hospital. Subjects and Methods Children aged 4 to 16 years with symptoms of obstructive sleep apnea (apnea-hypopnea index >1) were recruited. All children underwent adenotonsillectomy and postoperative polysomnography overnight. The 24-hour ambulatory blood pressure was measured before and 6 months after surgery. Results The study cohort enrolled 124 children: mean (SD) age, 7.3 (3.1) years; 73% boys. After surgery, the apnea-hypopnea index significantly decreased from 13.3 (18.1) to 3.3 (7.2) events per hour ( P < .001). Overall systolic blood pressure and diastolic blood pressure were not significantly different following surgery, while daytime systolic blood pressure was slightly increased (114.3 to 117.3 mm Hg, P < .01) postoperatively. The hypertensive group (n = 43) exhibited significantly decreased levels of overall diastolic, nighttime systolic, and nighttime diastolic blood pressure ( P < .05), and 54% of hypertensive children became nonhypertensive after surgery. The nonhypertensive group (n = 81) showed slightly increased levels of nocturnal overall systolic, daytime systolic, and nighttime systolic blood pressure. A generalized linear mixed model revealed that children with hypertension had a greater decrease in systolic and diastolic ambulatory blood pressure during the daytime and nighttime (all P < .05) than those without hypertension. Conclusions Ambulatory blood pressure changes after adenotonsillectomy among children with obstructive sleep apnea are minimal. The decrease in ambulatory blood pressure after surgery is more prominent for hypertensive children than nonhypertensive children.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital and Children’s Hospital, Taipei, Taiwan
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei, Taiwan
| | - Che-Yi Lin
- Department of Otolaryngology, National Taiwan University Hospital and Children’s Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei, Taiwan
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital and Children’s Hospital, Taipei, Taiwan
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Otolaryngology, College of Medicine, National Taiwan University, Taiwan
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Konieczny KM, Pitts-Tucker TN, Biggs TC, Pringle MB. A five-year follow-up observational study of the T-14 paediatric throat disorders outcome measure in tonsillectomy and adenotonsillectomy. Ann R Coll Surg Engl 2019; 101:40-43. [PMID: 30112941 PMCID: PMC6303835 DOI: 10.1308/rcsann.2018.0133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The T-14 questionnaire is a validated outcome measurement tool to assess the value of paediatric tonsillectomy from a parent's perspective. There is a paucity of data regarding the long-term postoperative effects of tonsillectomy on quality of life in the paediatric population. Our previous study assessed T-14 scores up to year 2 postoperatively, with this study extending follow-up to 5 years. MATERIALS AND METHODS We undertook a prospective uncontrolled observational study examining 54 paediatric patients undergoing tonsillectomy at Portsmouth Hospitals NHS Trust. Parents of children undergoing surgery were invited to complete a T-14 questionnaire preoperatively, as well as at 3 months, 6 months, 1 year, 2 years and now 5 years postoperatively. RESULTS In total, 44 of 54 patients completed questionnaires preoperatively and at all postoperative time points, with 46 being completed at 5 years. There was a highly significant (P < 0.001) difference between the preoperative scores and all other measured T-14 scores postoperatively. The mean score preoperatively was 33.3 compared with 1.0 at 5 years. CONCLUSIONS This is the first study to assess long-term quality of life following paediatric tonsillectomy using the T-14 questionnaire. The benefits of tonsillectomy on long-term quality of life further confirms its value within the paediatric population.
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Affiliation(s)
- KM Konieczny
- Portsmouth Hospitals NHS Foundation Trust, Portsmouth, UK
| | - TN Pitts-Tucker
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - TC Biggs
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - MB Pringle
- Portsmouth Hospitals NHS Foundation Trust, Portsmouth, UK
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Hsueh WY, Hsu WC, Ko JY, Yeh TH, Lee CH, Kang KT. Population-based survey of inpatient pediatric tonsillectomy and postoperative hemorrhage in Taiwan, 1997-2012. Int J Pediatr Otorhinolaryngol 2018; 108:55-62. [PMID: 29605366 DOI: 10.1016/j.ijporl.2018.02.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/11/2018] [Accepted: 02/12/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Tonsil surgery in children is a common surgical procedure, and is mostly performed as an inpatient procedure in Taiwan. This study elucidates the epidemiology and postoperative hemorrhage of inpatient tonsillectomies in Taiwanese children. METHODS This study used the Taiwan National Health Insurance Research Database for analysis. From 1997 to 2012, all in-hospital children (aged <18 years) who underwent tonsillectomies were identified through the International Codes of Diseases (9th Revision). Incidence rates and trends of inpatient pediatric tonsillectomies during the study period were identified. Major complications, including readmission, reoperation, and mortality were identified. The factors associated with major complications were analyzed. RESULTS From 1997 to 2012, 17326 children received inpatient tonsillectomies (mean age, 8.6 ± 3.8 y; 65% boys). The overall incidence rate was 20.6 per 100,000 children. The incidence rate was highest in children who were 6-8 years of age, and boys exhibited a higher rate than girls (P < 0.001). Longitudinal data indicated that the incidence rate increased from 1997 (15.7/100,000 children) to 2012 (19.2/100,000 children) (P trend < 0.001). The proportions of readmission for any reason, readmission for bleeding, and reoperation were 1.8%, 0.9%, and 0.3%, respectively. No mortality occurred within 30 days of the tonsillectomy. A multivariable logistic model indicated that toddlers were associated with an increased risk of readmission for any reason (OR, 2.70; 95% CI 1.60-4.56), and adolescents were at risk of bleeding-related readmission (OR, 2.81; 95% CI 1.91-4.14) and reoperation (OR, 2.86; 95% CI 1.47-5.55). Children with comorbidities (OR, 3.14; 95% CI 1.93-5.09) or a surgical indication of tumor (OR, 11.73; 95% CI 4.93-27.91) had a higher risk of readmission. The use of nonsteroidal anti-inflammatory drugs or steroids is associated with an increased risk of readmission or reoperation. Moreover, concurrent procedures (i.e., adenoidectomy, ear surgery, or nasal surgery) did not increase the risk of readmission or reoperation. CONCLUSIONS The incidence rate and indications of obstructive sleep disorders for inpatient pediatric tonsillectomy increased during 1997-2012 in Taiwan. Postoperative readmission and reoperation were rare. Age, surgical indication, comorbidities, and drug administration were associated with readmission or reoperation in this study cohort.
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Affiliation(s)
- Wan-Yi Hsueh
- Department of Otolaryngology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University, College of Medicine, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University, College of Medicine, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University, College of Medicine, Taiwan
| | - Chia-Hsuan Lee
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan.
| | - Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
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Lee CH, Kang KT, Chiu SN, Chang IS, Weng WC, Lee PL, Hsu WC. Association of Adenotonsillectomy With Blood Pressure Among Hypertensive and Nonhypertensive Children With Obstructive Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2018; 144:300-307. [PMID: 29450504 PMCID: PMC5876823 DOI: 10.1001/jamaoto.2017.3127] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/29/2017] [Indexed: 11/14/2022]
Abstract
Importance Hypertension in childhood may continue into adulthood and lead to adverse cardiovascular outcomes. Evidence suggests that adenotonsillectomy for childhood obstructive sleep apnea (OSA) may be associated with blood pressure (BP) improvement. However, how adenotonsillectomy is associated with BP in hypertensive and nonhypertensive children with OSA remains unclear. Objective To investigate disparities in BP changes after adenotonsillectomy in hypertensive and nonhypertensive children with OSA. Design, Setting, and Participants From January 1, 2010, to April 30, 2016, children (aged <18 years) with symptoms of OSA treated at National Taiwan University Hospital were enrolled in this retrospective case series study. Interventions Children underwent polysomnography for diagnosis of OSA (apnea-hypopnea index >1). All children with OSA underwent adenotonsillectomy. Main Outcomes and Measures Preoperative and postoperative overnight polysomnographic data were obtained. Office BP was measured in a sleep center before (nocturnal BP) and after (morning) polysomnography. Results A total of 240 nonobese children (mean [SD] age, 7.3 [3.0] years; 160 [66.7%] male and 80 [33.3%] female) with OSA were recruited. Postoperatively, the apnea-hypopnea index decreased significantly from 12.1 to 1.7 events per hour (95% CI of difference, -12.3 to -8.4 events per hour). The whole cohort had a significant decrease in nocturnal diastolic BP (66.9 to 64.5 mm Hg; 95% CI of difference, -4.1 to -0.7 mm Hg) and morning diastolic BP (66.9 to 64.4 mm Hg; 95% CI of difference, -4.2 to -0.8 mm Hg). The number (percentage) of patients with diastolic BP in the greater than 95th percentile decreased significantly nocturnally (48 [20.0%] to 33 [13.8%]; 95% CI of difference, -12.1% to -0.4%) and in the morning (52 [21.7%] to 34 [14.2%]; 95% CI of difference, -13.6% to -1.4%). Postoperatively, hypertensive children had a significant decrease in all BP measures, including mean (SD) nocturnal and morning systolic BP (nocturnal: 107.5 [8.6] mm Hg; morning: 106.0 [9.4] mm Hg), systolic BP index (nocturnal: -4.3 [8.6]; morning: -5.7 [8.5]), diastolic BP (nocturnal: 65.1 [11.5] mm Hg; morning: 64.4 [10.1] mm Hg), and diastolic BP index (nocturnal: -10.7 [17.3]; morning: -11.6 [15.7]), whereas the nonhypertensive group had a slight increase in nocturnal systolic BP (103.8 to 105.9 mm Hg; 95% CI of difference, 0.4-3.9 mm Hg). A generalized estimating equation model for subgroup comparisons revealed that children with hypertension, compared with those without, had greater improvement in all BP measures. Conclusions and Relevance Hypertensive children with OSA had a significant improvement in BP after adenotonsillectomy. Hypertensive children with OSA should be screened and treated by adenotonsillectomy because proper treatment not only eases OSA symptoms but also potentially prevents future cardiovascular and end-organ disease.
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Affiliation(s)
- Cho-Hsueh Lee
- Department of Otolaryngology, National Taiwan University, College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University, College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Sheng Chang
- Department of Otolaryngology, National Taiwan University, College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University, College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
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Torretta S, Rosazza C, Pace ME, Iofrida E, Marchisio P. Impact of adenotonsillectomy on pediatric quality of life: review of the literature. Ital J Pediatr 2017; 43:107. [PMID: 29178907 PMCID: PMC5702149 DOI: 10.1186/s13052-017-0424-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 11/13/2017] [Indexed: 12/11/2022] Open
Abstract
Adenotonsillectomy (ADT) is one of the most widely used procedures in the treatment of paediatric recurrent acute tonsillitis (RAT) and obstructive sleep apnoea syndrome (OSAS), both of which have significant repercussions on the patients' quality of life (QoL). The purpose of our review of literature was to highlight the great variety of tools that are currently used to evaluate QoL in children, to examine data available on their efficacy and the feasibility of their use in daily clinical practice, and to determine possible limitations related to an indirect and subjective assessment of QoL in children.Although the use of different parameters makes it difficult to compare the published studies, an analysis of the evidence currently available in the literature suggests that ADT has a generally positive impact on the QoL (especially in case of OSAS). It also highlights the importance of combining tonsillectomy and adenoidectomy in the treatment of OSAS, and documents the comparability of tonsillectomy and tonsillotomy in improving obstructive symptoms. In conclusion, our findings suggest that literature supports that ADT is associated with positive changes in QOL; however further studies using comparable standardised criteria are necessary to confirm the size and duration of this benefit.
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Affiliation(s)
- Sara Torretta
- Department of Clinical Sciences and Community Health, University of Milan; Otolaryngological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy.
| | - Chiara Rosazza
- Department of Pathophysiology and Transplantation, University of Milan; Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Elisabetta Pace
- Department of Pathophysiology and Transplantation, University of Milan; Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Iofrida
- Department of Clinical Sciences and Community Health, University of Milan; Otolaryngological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy
| | - Paola Marchisio
- Department of Pathophysiology and Transplantation, University of Milan; Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Gudnadottir G, Ellegård E, Hellgren J. Intranasal Budesonide and Quality of Life in Pediatric Sleep-Disordered Breathing: A Randomized Controlled Trial. Otolaryngol Head Neck Surg 2017; 158:752-759. [DOI: 10.1177/0194599817742597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective To study the efficacy of budesonide nasal spray on the health-related quality of life and symptoms among children with sleep-disordered breathing. Study Design Randomized, parallel, double-blind, placebo-controlled trial. Setting Tertiary referral center. Subjects and Methods Sixty children (ages, 4-10 years) who were referred because of snoring and/or apneas for >3 months were included between January 2015 and June 2016 and randomized in a double-blind design to treatment with 64 μg/mL of budesonide nasal spray (n = 30) or placebo nasal spray (n = 30) twice daily for 6 weeks. The primary outcome measurement was the change in the mean OSA-18 total score from baseline. Other variables examined were individual OSA-18 domains, a visual analog scale for quality of life, symptoms (snoring, apneas, and nasal obstruction), and adenoid and tonsil size. The trial was investigator initiated and not sponsored by the pharmaceutical industry. Results Fifty-five children completed the trial. An intention-to-treat analysis revealed a significantly greater improvement in the mean OSA-18 total score after treatment with budesonide than placebo (19.5 vs 7.5, P = .0014). Intranasal budesonide also improved 2 OSA-18 domains (sleep disturbance, caregivers’ concerns), the visual analog scale score for quality of life, as well as snoring, apneas, and nasal obstruction. No serious adverse events were reported that could be linked to the treatment. Conclusion Among children with sleep-disordered breathing, 6 weeks’ treatment with intranasal budesonide significantly improved quality of life and symptoms as compared with placebo nasal spray.
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Affiliation(s)
- Gunnhildur Gudnadottir
- Department of Otorhinolaryngology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Eva Ellegård
- Department of Otorhinolaryngology, Halland’s Hospital, Kungsbacka, Sweden
| | - Johan Hellgren
- Department of Otorhinolaryngology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Kang KT, Koltai PJ, Lee CH, Lin MT, Hsu WC. Lingual Tonsillectomy for Treatment of Pediatric Obstructive Sleep Apnea: A Meta-analysis. JAMA Otolaryngol Head Neck Surg 2017; 143:561-568. [PMID: 28208178 DOI: 10.1001/jamaoto.2016.4274] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Evidence indicates correlations between lingual tonsil hypertrophy and pediatric obstructive sleep apnea (OSA). However, to our knowledge, a meta-analysis of surgical outcomes for lingual tonsillectomy in children with OSA has not been conducted. Objective To evaluate the therapeutic outcomes of lingual tonsillectomy for treatment of pediatric OSA. Data Sources The study protocol was registered on PROSPERO (CRD42015027053). PubMed, MEDLINE, EMBASE, and the Cochrane Reviews databases were searched independently by 2 authors for relevant articles published by September 2016. Study Selection The literature search identified English-language studies that used polysomnography to evaluate children with lingual tonsil hypertrophy and OSA after lingual tonsillectomy alone. The search keywords were lingual tonsil, lingual tonsillectomy, sleep endoscopy, sleep apnea, and child. Data Extraction and Synthesis Polysomnographic data from each study were extracted. A random-effects model pooled postoperative sleep variable changes and success rates for lingual tonsillectomy in treating pediatric OSA. Main Outcomes and Measures Four outcomes for lingual tonsillectomy were analyzed. These included net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum oxygen saturation, the overall success rate for a postoperative AHI less than 1, and the overall success rate for a postoperative AHI less than 5. Results This meta-analysis consisted of 4 studies (mean sample size, 18.25 patients), with a total of 73 unique patients (mean [SD] age, 8.3 [1.1] years). Fifty-nine percent (27 of 46) of the patients were male, and 1 of the 4 studies did not specify number of males. Lingual tonsillectomy was indicated for persistent OSA after adenotonsillectomy in all cases. Lingual tonsil hypertrophy was evaluated using computed tomography or magnetic resonance imaging in 1 study, sleep endoscopy in 2 studies, and cine magnetic resonance imaging in 1 study. The mean change in the AHI after lingual tonsillectomy was a reduction of 8.9 (95% CI, -12.6 to -5.2) events per hour. The mean change in the minimum oxygen saturation after lingual tonsillectomy was an increase of 6.0% (95% CI, 2.7%-9.2%). The overall success rate was 17% (95% CI, 7%-35%) for a postoperative AHI less than 1 and 51% (95% CI, 25%-76%) for a postoperative AHI less than 5. Postoperative complications that developed included airway obstruction, bleeding, and pneumonia. Conclusions and Relevance Lingual tonsillectomy is an effective surgical management for children with OSA caused by lingual tonsil hypertrophy, and it achieves significant improvement in the AHI and the minimum oxygen saturation. However, children frequently have residual OSA after lingual tonsillectomy, and postoperative complications must be carefully managed.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei2Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Peter J Koltai
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Chia-Hsuan Lee
- Department of Otolaryngology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei2Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ming-Tzer Lin
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan5Sleep Center, National Taiwan University Hospital, Taipei
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei5Sleep Center, National Taiwan University Hospital, Taipei
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Todd CA, Bareiss AK, McCoul ED, Rodriguez KH. Adenotonsillectomy for Obstructive Sleep Apnea and Quality of Life: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2017; 157:767-773. [PMID: 28675097 DOI: 10.1177/0194599817717480] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To determine the impact of adenotonsillectomy on the quality of life of pediatric patients with obstructive sleep apnea (OSA) and to identify gaps in the current research. Data Sources The MEDLINE, EMBASE, and Cochrane databases were systematically searched via the Ovid portal on June 18, 2016, for English-language articles. Review Methods Full-text articles were selected that studied boys and girls <18 years of age who underwent adenotonsillectomy for OSA or sleep-disordered breathing and that recorded validated, quantitative quality-of-life outcomes. Studies that lacked such measures, performed adenotonsillectomy for indications other than OSA or sleep-disordered breathing, or grouped adenotonsillectomy with other procedures were excluded. Results Of the 328 articles initially identified, 37 were included for qualitative analysis. The level of evidence was generally low. All studies involving short-term follow-up (≤6 months) showed improvement in quality-of-life scores after adenotonsillectomy as compared with preoperative values. Studies involving long-term follow-up (>6 months) showed mixed results. Modifications to and concurrent procedures with conventional adenotonsillectomy were also identified that showed quality-of-life improvements. Three studies were identified for meta-analysis that compared pre- and postoperative Obstructive Sleep Apnea-18 scores. Short- and long-term follow-up versus preoperative scores showed significant improvement ( P < .001). Short- and long-term scores showed no significant difference. Conclusion This systematic review and meta-analysis demonstrate adenotonsillectomy's effectiveness in improving the quality of life of pediatric patients with OSA. This is well demonstrated in the short term and has strong indications in the long term.
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Affiliation(s)
- Cameron A Todd
- 1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Anna K Bareiss
- 1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Edward D McCoul
- 1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,2 Department of Otorhinolaryngology-Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.,3 Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Kimsey H Rodriguez
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
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Revision adenoidectomy in children: a population-based cohort study in Taiwan. Eur Arch Otorhinolaryngol 2017; 274:3627-3635. [DOI: 10.1007/s00405-017-4655-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
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27
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Chang IS, Kang KT, Tseng CC, Weng WC, Hsiao TY, Lee PL, Hsu WC. Revisits after adenotonsillectomy in children with sleep-disordered breathing: A retrospective single-institution study. Clin Otolaryngol 2017; 43:39-46. [DOI: 10.1111/coa.12899] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 12/17/2022]
Affiliation(s)
- I.-S. Chang
- Department of Otolaryngology; National Taiwan University; College of Medicine and National Taiwan University Hospital; Taipei Taiwan
| | - K.-T. Kang
- Department of Otolaryngology; National Taiwan University; College of Medicine and National Taiwan University Hospital; Taipei Taiwan
- Department of Otolaryngology; Taipei Hospital, Ministry of Health and Welfare; New Taipei City Taiwan
| | - C.-C. Tseng
- Department of Otolaryngology; National Taiwan University; College of Medicine and National Taiwan University Hospital; Taipei Taiwan
| | - W.-C. Weng
- Sleep Center; National Taiwan University Hospital; Taipei Taiwan
- Department of Pediatrics; National Taiwan University Hospital; Taipei Taiwan
| | - T.-Y. Hsiao
- Department of Otolaryngology; National Taiwan University; College of Medicine and National Taiwan University Hospital; Taipei Taiwan
| | - P.-L. Lee
- Sleep Center; National Taiwan University Hospital; Taipei Taiwan
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - W.-C. Hsu
- Department of Otolaryngology; National Taiwan University; College of Medicine and National Taiwan University Hospital; Taipei Taiwan
- Sleep Center; National Taiwan University Hospital; Taipei Taiwan
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Zhang XQ, Wang H, Zhou J, Zeng P, Zhao Y, Zhang Y, Liu C, Jiang LQ, Lan YJ. Efficacy of minimally invasive tonsil surgery for treatment of obstructive sleep apnea-hypopnea syndrome in children. Braz J Med Biol Res 2017; 50:e5846. [PMID: 28443988 PMCID: PMC5441284 DOI: 10.1590/1414-431x20175846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/20/2017] [Indexed: 11/22/2022] Open
Abstract
This study aimed to investigate the efficacy of minimally invasive tonsil surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. Tonsil ablation or turbinate reduction was performed on 49 pediatric patients with OSAHS by minimally invasive tonsil surgery. In order to evaluate the efficacy of surgery, a comparison was conducted between pre-operation and post-operation data in terms of the symptoms, signs and polysomnography test. Total effectiveness rate of the surgery was 83.7%. Subgroup analysis was also performed based on the severity of their conditions: mild, moderate, and severe groups had an effectiveness rate of 90.0, 88.9, and 66.7%, respectively (Hc=6.665, P<0.05). Postoperatively, the apnea-hypopnea index, the minimum oxygen saturation (SaO2), and corresponding symptoms improved compared to pre-operation conditions (P<0.05). Minimally invasive tonsil surgery was a safe and effective method for treating OSAHS in children.
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Affiliation(s)
- X.-Q. Zhang
- Sleep Medicine Center, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Occupational Health, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - H. Wang
- Sleep Medicine Center, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Occupational Health, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - J. Zhou
- Sleep Medicine Center, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - P. Zeng
- Sleep Medicine Center, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Y. Zhao
- Sleep Medicine Center, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Y. Zhang
- Department of Occupational Health, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - C. Liu
- Sleep Medicine Center, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Occupational Health, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - L.-Q. Jiang
- Sleep Medicine Center, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Y.-J. Lan
- Department of Occupational Health, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
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Alsufyani NA, Noga ML, Witmans M, Cheng I, El-Hakim H, Major PW. Using cone beam CT to assess the upper airway after surgery in children with sleep disordered breathing symptoms and maxillary-mandibular disproportions: a clinical pilot. J Otolaryngol Head Neck Surg 2017; 46:31. [PMID: 28399908 PMCID: PMC5387252 DOI: 10.1186/s40463-017-0204-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 03/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The surgical excision of anatomic obstructions such as adenoids, palatine or lingual tonsils are commonly performed in children with sleep disordered breathing (SDB). Imaging studies measuring airway changes post-surgery in the SDB pediatric population are scarce, rarely addresses the nasal cavity, and are based on global measures (e.g. volume) that do not represent the complexity of the upper airway anatomy. The purpose of this pilot is to test the feasibility in using cone beam CT (CBCT) to analyze the nasal and pharyngeal airway space post-surgery using meaningful methods of analyses, and correlating imaging findings with clinical outcomes in children with SDB symptoms and maxillary-mandibular disproportion. METHODS Twelve non-syndromic children with SDB symptoms and jaw disproportions were evaluated by interdisciplinary airway team before and after upper airway surgery. CBCT and OSA-18 quality of life questionnaire pre and post-operatively were completed. Conventional and new airway variables were measured based on 3D models of the upper airways and correlated with OSA-18. Conventional measures include volume, surface area, and cross-sectional area. New airway measures include constriction and patency; point-based analyses. RESULTS Eight females and four males were 8.8 ± 2 years with mean BMI of 18.7 ± 3. OSA-18 improved, median (lower quartile-upper quartile) from 64.2 (54.7-79.5) to 37.6 (28.7-43) postoperatively, p < 0.001. The median of all airway measures improved however with very wide range. Subjects with the smallest amounts of constriction relief and/or gain in airway patency presented with least improvement in OSA-18. New airway measures show strong correlation with changes in OSA-18 (ρ = 0.44 to 0.71) whereas conventional measures showed very weak correlation (ρ = -0.04 to 0.37). CONCLUSIONS Using point-based analyses, new airway measures better explained changes in clinical symptoms compared to conventional measures. Airway patency gained by at least 150% and constriction relief by at least 15% showed marked improvement in OSA-18 by 40-55%, after surgery in the tested cohort.
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Affiliation(s)
- Noura A Alsufyani
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. .,Edmonton Clinic Health Academy- School of Dentistry, 5th floor, 11405-87 AVE NW, Edmonton, T6G 1C9, AB, Canada. .,Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
| | - Michelle L Noga
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Manisha Witmans
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Irene Cheng
- Department of Computing Science, Faculty of Science, University of Alberta, Edmonton, Canada
| | - Hamdy El-Hakim
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Paul W Major
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. Comparisons of Office and 24-Hour Ambulatory Blood Pressure Monitoring in Children with Obstructive Sleep Apnea. J Pediatr 2017; 182:177-183.e2. [PMID: 27939257 DOI: 10.1016/j.jpeds.2016.11.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 10/05/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare office blood pressure (BP) and 24-hour ambulatory BP (ABP) monitoring to facilitate the diagnosis and management of hypertension in children with obstructive sleep apnea (OSA). STUDY DESIGN Children aged 4-16 years with OSA-related symptoms were recruited from a tertiary referral medical center. All children underwent overnight polysomnography, office BP, and 24-hour ABP studies. Multiple linear regression analyses were applied to elucidate the association between the apnea-hypopnea index and BP. Correlation and consistency between office BP and 24-hour ABP were measured by Pearson correlation, intraclass correlation, and Bland-Altman analyses. RESULTS In the 163 children enrolled (mean age, 8.2 ± 3.3 years; 67% male). The prevalence of systolic hypertension at night was significantly higher in children with moderate-to-severe OSA than in those with primary snoring (44.9% vs 16.1%, P = .006). Pearson correlation and intraclass correlation analyses revealed associations between office BP and 24-hour BP, and Bland-Altman analysis indicated an agreement between office and 24-hour BP measurements. However, multiple linear regression analyses demonstrated that 24-hour BP (nighttime systolic BP and mean arterial pressure), unlike office BP, was independently associated with the apnea-hypopnea index, after adjustment for adiposity variables. CONCLUSIONS Twenty-four-hour ABP is more strongly correlated with OSA in children, compared with office BP.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.
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31
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Kang KT, Chang IS, Tseng CC, Weng WC, Hsiao TY, Lee PL, Hsu WC. Impacts of disease severity on postoperative complications in children with sleep-disordered breathing. Laryngoscope 2017; 127:2646-2652. [DOI: 10.1002/lary.26539] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/04/2016] [Accepted: 01/23/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology; National Taiwan University, College of Medicine and National Taiwan University Hospital; Taipei Taiwan
- Department of Otolaryngology; Taipei Hospital, Ministry of Health and Welfare; New Taipei City Taiwan
| | - I-Sheng Chang
- Department of Otolaryngology; National Taiwan University, College of Medicine and National Taiwan University Hospital; Taipei Taiwan
| | - Chia-Chen Tseng
- Department of Otolaryngology; National Taiwan University, College of Medicine and National Taiwan University Hospital; Taipei Taiwan
| | - Wen-Chin Weng
- Sleep Center; National Taiwan University Hospital; Taipei Taiwan
- Department of Pediatrics; National Taiwan University Hospital; Taipei Taiwan
| | - Tzu-Yu Hsiao
- Department of Otolaryngology; National Taiwan University, College of Medicine and National Taiwan University Hospital; Taipei Taiwan
| | - Pei-Lin Lee
- Sleep Center; National Taiwan University Hospital; Taipei Taiwan
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology; National Taiwan University, College of Medicine and National Taiwan University Hospital; Taipei Taiwan
- Sleep Center; National Taiwan University Hospital; Taipei Taiwan
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32
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Mims M, Thottam PJ, Kitsko D, Shaffer A, Choi S. Characterization of Sleep Architecture in Down Syndrome Patients Pre and Post Airway Surgery. Cureus 2017; 9:e983. [PMID: 28229031 PMCID: PMC5315574 DOI: 10.7759/cureus.983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To define obstructive sleep architecture patterns in Down syndrome (DS) children as well as changes to sleep architecture patterns postoperatively. STUDY DESIGN The study was a retrospective review. METHODS Forty-five pediatric DS patients who underwent airway surgery between 2003 and 2014 at a tertiary children's hospital for obstructive sleep apnea (OSA) were investigated. Postoperative changes in respiratory parameters and sleep architecture (SA) were assessed and compared to general pediatric normative data using paired t-tests and Wilcoxon signed-rank test. RESULTS Twenty-two out of 45 of the participants were male. Thirty participants underwent tonsillectomy and adenoidectomy, four adenoidectomy, 10 tonsillectomy, and one base of tongue reduction. The patients were divided into two groups based on age (<6 years & >6 years) and compared to previously published age matched normative SA data. DS children in both age groups spent significantly less time than controls in rapid eye movement (REM) and N1 (p<0.02). Children younger than six spent significantly less time in N2 than previously published healthy controls (p<0.0001). Children six years of age or older spent more time than controls in N3 (p=0.003). Airway surgery did not significantly alter SA except for an increase in time spent in N1 (p=0.007). Surgery did significantly reduce median apnea hypopnea index (AHI) (p=0.004), obstructive apnea-hypopnea index (OAHI) (p=0.006), hypopneas (p=0.005), total apneas (p<0.001), and central apneas (p=0.02), and increased the lowest oxygen saturation (p=0.028). CONCLUSIONS DS children are a unique population with different SA patterns than the general pediatric population. Airway intervention assists in normalizing both central and obstructive events as well as sleep architecture stages.
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Affiliation(s)
| | - Prasad John Thottam
- Michigan Pediatric Ear, Nose and Throat Associates, Children's Hospital of Michigan, Detroit Medical Center
| | | | | | - Sukgi Choi
- Otolaryngology, Children's Hospital of Pittsburgh
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Gorman D, Ogston S, Hussain SSM. Improvement in symptoms of obstructive sleep apnoea in children following tonsillectomy versus tonsillotomy: a systematic review and meta-analysis. Clin Otolaryngol 2016; 42:275-282. [PMID: 27506317 DOI: 10.1111/coa.12717] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tonsillotomy (or intracapsular tonsillectomy) is a modern technique which is seen by some as potentially superior to traditional (extracapsular) tonsillectomy for the removal of tonsillar tissue to treat obstructive sleep apnoea in children. It has been suggested that peri-operative pain and haemorrhage and postoperative haemorrhage are reduced with the tonsillotomy technique. However, no systematic reviews have been carried out to assess its efficacy in treating obstructive sleep apnoea compared to tonsillectomy. OBJECTIVE OF REVIEW To assess whether subjective improvement in symptoms of obstructive sleep apnoea following tonsillotomy is comparable to that following tonsillectomy, measured using a standardised questionnaire, the Obstructive sleep apnoea-18 (OSA-18) tool. TYPE OF REVIEW Systematic review of the literature and meta-analysis. SEARCH STRATEGY PubMed (MEDLINE), followed by Ovid (MEDLINE), Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, and the British Medical Journal were searched for articles published in English between 1995 and 2015 inclusive. EVALUATION METHOD Literature search, systematic review and meta-analysis. Studies examining improvement in mean OSA-18 score following tonsillotomy, improvement in mean OSA-18 score following tonsillectomy, and examining both were selected, examined and used for meta-analysis. Studies with and without concurrent adenoidectomy were included. RESULTS Four studies examining tonsillotomy and 16 studies examining tonsillectomy were included in the analysis. Using a random effects model, the pooled improvement in OSA-18 score for tonsillotomy was 2.46 (95% CI 1.92-2.99), and for tonsillectomy, it was 2.10 (95% CI 1.91-2.30). There was no significant difference between the methods. CONCLUSION That there is no significant difference in subjective outcome between tonsillotomy and tonsillectomy may support wider use of tonsillotomy over tonsillectomy for the treatment of obstructive sleep apnoea in children.
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Affiliation(s)
- D Gorman
- School of Medicine, University of Dundee & Ninewells Hospital, Dundee, UK
| | - S Ogston
- School of Medicine, University of Dundee & Ninewells Hospital, Dundee, UK.,Departments of Medical Statistics, University of Dundee & Ninewells Hospital, Dundee, UK
| | - S S M Hussain
- School of Medicine, University of Dundee & Ninewells Hospital, Dundee, UK.,Otolaryngology, University of Dundee & Ninewells Hospital, Dundee, UK
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Lee CF, Hsu WC, Lee CH, Lin MT, Kang KT. Treatment outcomes of supraglottoplasty for pediatric obstructive sleep apnea: A meta-analysis. Int J Pediatr Otorhinolaryngol 2016; 87:18-27. [PMID: 27368437 DOI: 10.1016/j.ijporl.2016.05.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/20/2016] [Accepted: 05/15/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To comprehensively review changes in sleep parameters and the success rate of supraglottoplasty for treating obstructive sleep apnea (OSA) in children. In particular, to elucidate treatment modalities and factors affecting treatment outcomes in children with both laryngomalacia and OSA. METHODS The study protocol was registered on PROSPERO (CRD42015027053). Two authors independently searched databases including PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords were "supraglottoplasty," "laryngomalacia," "OSA," "polysomnography," "child," and "humans." Supraglottoplasty served as the primary treatment for OSA or secondary treatment for persistent disease after previous surgeries. Subgroup analyses were conducted for children receiving supraglottoplasty as the primary or secondary treatment for OSA, and for children with and without comorbidities. RESULTS Eleven studies with 121 patients were analyzed (mean age: 3.7 years; 64% boys; mean sample size: 11 patients). After surgery, the mean differences between the pre- and postoperative measurements were a significant reduction of 8.9 events/h in the apnea-hypopnea index (AHI) and an increase of 3.7% in minimum oxygen saturation (MinSaO2; P < 0.05). The overall success rate was 28% according to a postoperative AHI <1 and 72% according to an AHI <5. Children receiving supraglottoplasty as the primary treatment had significantly younger ages (0.6 vs 6.4 years P < 0.001) than those receiving supraglottoplasty as the secondary treatment, but the outcomes were similar (33% vs 19% for a postoperative AHI < 1, P = 0.27; 77% vs 61% for a postoperative AHI < 5, P = 0.233). Moreover, children with comorbidities, compared with those without, had a similar success rate according to a postoperative AHI <1 (25% vs 21%, P = 0.805) and postoperative AHI <5 (62% vs 84%, P = 0.166). CONCLUSIONS Supraglottoplasty is an effective surgery for AHI reduction and MinSaO2 increase in children with OSA and laryngomalacia. However, complete resolution of OSA is not achieved in most cases, and factors affecting treatment outcomes in these children require future studies.
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Affiliation(s)
- Chia-Fan Lee
- Speech Language Pathologist, Child Developmental Assessment and Intervention Center, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, ROC; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC
| | - Ming-Tzer Lin
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC; Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei, Taiwan, ROC.
| | - Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC.
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Brunelli V, Lione R, Franchi L, Cozza P, Becker HMG, Franco LP, Souki BQ. Maxillary dentoskeletal changes 1-year after adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2016; 86:135-41. [PMID: 27260596 DOI: 10.1016/j.ijporl.2016.04.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To measure the maxillary dentoskeletal and soft tissue changes of severely obstructed mouth breathing (MB) young children who had their mode of breathing normalized after adenotonsillectomy (T&A), in comparison with a matched group of severely obstructed untreated MB children (CG). METHODS Seventy patients who had an Ear, Nose, and Throat examination (ENT), including flexible nasal endoscopy, to confirm the severe obstruction of the upper airways and the indication of T&A composed the sample. Cephalograms and dental casts were available from the patient's orthodontic records. Treatment group (TG) and CG included 35 children each. Groups were matched by gender (24 males and 11 females in each group), age (TG, 6.7 ± 1.8 years; CG, 6.9 ± 2.3 years), tooth development (TG, 13 primary dentition, 22 mixed dentition; CG, 14 primary dentition, 21 mixed dentition), and skeletal maturation status. Records were taken at baseline (T0) and 1-year after T&A (T1) for TG; while CG records were taken with a 1-year interval. Dentoskeletal measurements were performed in the lateral cephalograms, and dental casts were used to assess the palatal volume and occlusal changes. RESULTS TG showed a significant increase (503.3 mm(3), P < 0.001) in the palatal volume (10% of change), while CG palatal volume was stable. No dimensional occlusal changes were detected between T0 and T1 in both groups. Significant downward (point A, 2.1 mm; ANS, 2.1 mm) and forward displacements (point A, 0.7 mm; ANS, 1 mm) of the anterior region of the maxilla were observed in the TG, but CG presented only significant downward displacement (point A, 1.8 mm; ANS, 1.4 mm). The maxillary posterior region (PNS, PTM, and Molar) displaced downward in both groups (P < 0.05), however no sagittal change was found. The palatal plane inclination was stable in both groups. CONCLUSIONS TG presented significant increase in the palatal volume and in the forward displacement of the maxilla. No other significant maxillary dentoskeletal changes were found.
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Affiliation(s)
- Valerio Brunelli
- Department of Clinical Sciences and Traslational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Roberta Lione
- Department of Clinical Sciences and Traslational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, Orthodontics, University of Florence, Florence, Italy; Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, United States
| | - Paola Cozza
- Department of Clinical Sciences and Traslational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Helena M G Becker
- Outpatient Clinic for Mouth-Breathers, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Letícia P Franco
- Outpatient Clinic for Mouth-Breathers, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Bernardo Q Souki
- Outpatient Clinic for Mouth-Breathers, Federal University of Minas Gerais, Belo Horizonte, Brazil; School of Dentistry, Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil.
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36
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Kang KT, Weng WC, Lee CH, Hsiao TY, Lee PL, Hsu WC. Clinical risk assessment model for pediatric obstructive sleep apnea. Laryngoscope 2016; 126:2403-9. [PMID: 26973061 DOI: 10.1002/lary.25912] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 12/21/2015] [Accepted: 01/14/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To develop a clinical risk prediction model that identifies children with obstructive sleep apnea (OSA) in a clinical setting by examining the symptoms, physical status, and OSA-18 questionnaire results. DESIGN Single institutional, cross-sectional study. METHODS Children aged 2 to 18 years with symptoms of OSA were enrolled. Pediatric OSA was diagnosed through full-night polysomnography. Clinical data, namely demographics, symptoms, OSA-18 survey results, tonsil and adenoid sizes, and the weight of each child, were examined for constructing a simple point-based clinical model for OSA prediction. Variables for the risk model were selected using multivariable logistic regression analyses. RESULTS Of the 310 participants (mean age, 7.6 ± 3.7 years; boys, 67%), 170 (55%) experienced OSA. Modeling variables were determined using several univariate logistic regression analyses, followed by multivariable logistic regression analyses. A point-based clinical model incorporating the age, tonsil size (5 points maximum), adenoid size (5 and 20 points for age > 6 years and < 6 years, respectively), obesity (5 points for age > 6 years), and breathing pauses (5 points) was developed (area under the curve = 0.832). Moreover, the optimal cutoff points for predicting the apnea-hypopnea index of > 1 and > 5 were 10 (sensitivity, 72.9%; specificity, 65.0%) and 12 (sensitivity, 77.5%; specificity, 56.9%), respectively. Internal validation using the bootstrap method revealed no apparent overfitting problem. CONCLUSION A novel clinical prediction model was developed for determining the risk of pediatric OSA; the model can be useful in identifying high-risk patients among those with sleep disturbances. LEVEL OF EVIDENCE 4. Laryngoscope, 126:2403-2409, 2016.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University Hospital, Taipei.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei.,Department of Pediatrics, National Taiwan University Hospital, Taipei
| | - Chia-Hsuan Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University Hospital, Taipei.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Tzu-Yu Hsiao
- Department of Otolaryngology, National Taiwan University Hospital, Taipei
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei.,Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei. .,Sleep Center, National Taiwan University Hospital, Taipei.
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Lee CH, Hsu WC, Chang WH, Lin MT, Kang KT. Polysomnographic findings after adenotonsillectomy for obstructive sleep apnoea in obese and non-obese children: a systematic review and meta-analysis. Clin Otolaryngol 2016; 41:498-510. [PMID: 26436726 DOI: 10.1111/coa.12549] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Use of polysomnography (PSG) is the gold standard of diagnosis and measurement of treatment effectiveness for paediatric obstructive sleep apnoea (OSA). Although adenotonsillectomy (T&A) is effective in diminishing the apnoea-hypopnoea index (AHI), a meta-analysis of postoperative changes for all other PSG parameters and outcome comparisons between obese and non-obese children following T&A have never been conducted. OBJECTIVE OF REVIEW To comprehensively review polysomnographic findings after surgery for obese and non-obese children with OSA. SEARCH STRATEGY Study protocol was registered on PROSPERO (CRD42013004737). Two authors independently searched databases including PubMed, MEDLINE, EMBASE and Cochrane Review from January 1997 to July 2014. The keywords used included the following: sleep apnea, OSA, sleep apnea syndromes, tonsillectomy, adenoidectomy, infant, child, adolescent, and Humans. EVALUATION METHOD A comprehensive systematic review and meta-analysis for literature for OSA children treated by T&A with polysomnography data. Random-effects model was applied to determine postoperative sleep parameter changes and the surgical success rate between obese and non-obese groups. The quality of studies was assessed using the Newcastle-Ottawa Scale. RESULTS In total, 51 studies with 3413 subjects were enrolled. After surgery, sleep architecture was altered by a significant decrease in sleep stage 1, and an increase in slow-wave sleep and the rapid eye movement stage, and enhanced sleep efficiency. The mean difference between pre- and postoperative was a significant reduction of 12.4 event/h in AHI, along with a reduction of obstructive index, hypopnoea index, central index and arousal index. Mean and minimum oxygen saturation increased significantly after surgery. The overall success rate was 51% for postoperative AHI <1 (obese versus non-obese versus combined, 34% versus 49% versus 56%), and 81% for AHI <5 (obese versus non-obese versus combined, 61% versus 87% versus 84%). Meta-regression analyses demonstrate that postoperative AHI was positively correlated with AHI and body mass index z score before surgery. CONCLUSIONS Meta-analysis of current literature shows T&A offers prominent improvement in a variety of sleep parameters. Improvements in non-obese children exceeded those for obese children. Postoperative residual OSA remained in roughly half of the children, especially those with severe disease and obesity, making additional treatment strategies and/or long-term follow-up highly desirable.
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Affiliation(s)
- C-H Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - W-C Hsu
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - W-H Chang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - M-T Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan.
| | - K-T Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
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Thong G, Davies K, Murphy E, Keogh I. Significant improvements in quality of life following paediatric tonsillectomy: a prospective cohort study. Ir J Med Sci 2016; 186:419-425. [PMID: 26782690 DOI: 10.1007/s11845-016-1398-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/05/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The clinical efficacy of adenotonsillectomy is under debate with falling tonsillectomy rates in the UK and Ireland. In 2010, an NHS commissioned randomised controlled trial recommended medical management, leading to some Primary Care Trusts refusing to commission any tonsillectomies at all. With the HSE cutting Hospital Spending by €200 million euro in 2014, data supporting the benefit of adenotonsillectomy in the Irish population are sorely lacking. AIMS We aimed to evaluate the symptomatic benefit reported by parents of children undergoing adenotonsillectomy/tonsillectomy in the Irish population. METHODS We utilised the T14 Paediatric Throat disorders Outcome Test, a disease-specific, validated questionnaire which assesses patient reported outcome measures (PROMs). We administered pre and post-operative questionnaires to parents of children ages 3-16 years undergoing tonsillectomy. Symptomatic children on our tonsillectomy waiting list were also simultaneously recruited. RESULT Eighty-six children were recruited. A total of 55 parents of children undergoing tonsillectomy filled questionnaires. These were well matched in age and gender with 31 children on the waiting list. An independent samples t test was conducted to compare the improvement scores for tonsillectomy and control groups. There was a significant difference in scores for the tonsillectomy group, with pre-operative scores of (M = 39.8, SD = 9.7) and at post-operative follow-up of (M = 1.6, SD = 7.3) t (61) = -18, p ≤ 0.0001 (two tailed). This correlated with a significant difference in the mean between the two periods (mean difference = 38.3, 95 % CI: 42.3-34.1). CONCLUSION This study provides clear evidence that tonsillectomy provides significant improvement in PROMs vs. watchful waiting. We consider tonsillectomy to be a procedure of considerable clinical benefit and a worthwhile allocation of HSE expenditure.
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Affiliation(s)
- G Thong
- Department of Otolaryngology, Head and Neck Surgery, University College Hospital Galway, Newcastle Road, Galway, Ireland.
| | - K Davies
- Department of Otolaryngology, Head and Neck Surgery, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - E Murphy
- Department of Surgery, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - I Keogh
- Department of Otolaryngology, Head and Neck Surgery, University College Hospital Galway, Newcastle Road, Galway, Ireland
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Venekamp RP, Hearne BJ, Chandrasekharan D, Blackshaw H, Lim J, Schilder AGM. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev 2015; 2015:CD011165. [PMID: 26465274 PMCID: PMC9242010 DOI: 10.1002/14651858.cd011165.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Obstructive sleep-disordered breathing (oSDB) is a condition that encompasses breathing problems when asleep, due to an obstruction of the upper airways, ranging in severity from simple snoring to obstructive sleep apnoea syndrome (OSAS). It affects both children and adults. In children, hypertrophy of the tonsils and adenoid tissue is thought to be the commonest cause of oSDB. As such, tonsillectomy - with or without adenoidectomy - is considered an appropriate first-line treatment for most cases of paediatric oSDB. OBJECTIVES To assess the benefits and harms of tonsillectomy with or without adenoidectomy compared with non-surgical management of children with oSDB. SEARCH METHODS We searched the Cochrane Register of Studies Online, PubMed, EMBASE, CINAHL, Web of Science, Clinicaltrials.gov, ICTRP and additional sources for published and unpublished trials. The date of the search was 5 March 2015. SELECTION CRITERIA Randomised controlled trials comparing the effectiveness and safety of (adeno)tonsillectomy with non-surgical management in children with oSDB aged 2 to 16 years. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS Three trials (562 children) met our inclusion criteria. Two were at moderate to high risk of bias and one at low risk of bias. We did not pool the results because of substantial clinical heterogeneity. They evaluated three different groups of children: those diagnosed with mild to moderate OSAS by polysomnography (PSG) (453 children aged five to nine years; low risk of bias; CHAT trial), those with a clinical diagnosis of oSDB but with negative PSG recordings (29 children aged two to 14 years; moderate to high risk of bias; Goldstein) and children with Down syndrome or mucopolysaccharidosis (MPS) diagnosed with mild to moderate OSAS by PSG (80 children aged six to 12 years; moderate to high risk of bias; Sudarsan). Moreover, the trials included two different comparisons: adenotonsillectomy versus no surgery (CHAT trial and Goldstein) or versus continuous positive airway pressure (CPAP) (Sudarsan). Disease-specific quality of life and/or symptom score (using a validated instrument): first primary outcomeIn the largest trial with lowest risk of bias (CHAT trial), at seven months, mean scores for those instruments measuring disease-specific quality of life and/or symptoms were lower (that is, better quality of life or fewer symptoms) in children receiving adenotonsillectomy than in those managed by watchful waiting:- OSA-18 questionnaire (scale 18 to 126): 31.8 versus 49.5 (mean difference (MD) -17.7, 95% confidence interval (CI) -21.2 to -14.2);- PSQ-SRBD questionnaire (scale 0 to 1): 0.2 versus 0.5 (MD -0.3, 95% CI -0.31 to -0.26);- Modified Epworth Sleepiness Scale (scale 0 to 24): 5.1 versus 7.1 (MD -2.0, 95% CI -2.9 to -1.1).No data on this primary outcome were reported in the Goldstein trial.In the Sudarsan trial, the mean OSA-18 score at 12 months did not significantly differ between the adenotonsillectomy and CPAP groups. The mean modified Epworth Sleepiness Scale scores did not differ at six months, but were lower in the surgery group at 12 months: 5.5 versus 7.9 (MD -2.4, 95% CI -3.1 to -1.7). Adverse events: second primary outcomeIn the CHAT trial, 15 children experienced a serious adverse event: 6/194 (3%) in the adenotonsillectomy group and 9/203 (4%) in the control group (RD -1%, 95% CI -5% to 2%).No major complications were reported in the Goldstein trial.In the Sudarsan trial, 2/37 (5%) developed a secondary haemorrhage after adenotonsillectomy, while 1/36 (3%) developed a rash on the nasal dorsum secondary to the CPAP mask (RD -3%, 95% CI -6% to 12%). Secondary outcomesIn the CHAT trial, at seven months, mean scores for generic caregiver-rated quality of life were higher in children receiving adenotonsillectomy than in those managed by watchful waiting. No data on this outcome were reported by Sudarsan and Goldstein.In the CHAT trial, at seven months, more children in the surgery group had normalisation of respiratory events during sleep as measured by PSG than those allocated to watchful waiting: 153/194 (79%) versus 93/203 (46%) (RD 33%, 95% CI 24% to 42%). In the Goldstein trial, at six months, PSG recordings were similar between groups and in the Sudarsan trial resolution of OSAS (Apnoea/Hypopnoea Index score below 1) did not significantly differ between the adenotonsillectomy and CPAP groups.In the CHAT trial, at seven months, neurocognitive performance and attention and executive function had not improved with surgery: scores were similar in both groups. In the CHAT trial, at seven months, mean scores for caregiver-reported ratings of behaviour were lower (that is, better behaviour) in children receiving adenotonsillectomy than in those managed by watchful waiting, however, teacher-reported ratings of behaviour did not significantly differ.No data on these outcomes were reported by Goldstein and Sudarsan. AUTHORS' CONCLUSIONS In otherwise healthy children, without a syndrome, of older age (five to nine years), and diagnosed with mild to moderate OSAS by PSG, there is moderate quality evidence that adenotonsillectomy provides benefit in terms of quality of life, symptoms and behaviour as rated by caregivers and high quality evidence that this procedure is beneficial in terms of PSG parameters. At the same time, high quality evidence indicates no benefit in terms of objective measures of attention and neurocognitive performance compared with watchful waiting. Furthermore, PSG recordings of almost half of the children managed non-surgically had normalised by seven months, indicating that physicians and parents should carefully weigh the benefits and risks of adenotonsillectomy against watchful waiting in these children. This is a condition that may recover spontaneously over time.For non-syndromic children classified as having oSDB on purely clinical grounds but with negative PSG recordings, the evidence on the effects of adenotonsillectomy is of very low quality and is inconclusive.Low-quality evidence suggests that adenotonsillectomy and CPAP may be equally effective in children with Down syndrome or MPS diagnosed with mild to moderate OSAS by PSG.We are unable to present data on the benefits of adenotonsillectomy in children with oSDB aged under five, despite this being a population in whom this procedure is often performed for this purpose.
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Affiliation(s)
- Roderick P Venekamp
- University Medical Center UtrechtJulius Center for Health Sciences and Primary Care & Department of OtorhinolaryngologyHeidelberglaan 100UtrechtNetherlands3508 GA
| | - Benjamin J Hearne
- Faculty of Brain Sciences, University College LondonevidENT, Ear InstituteLondonUK
| | | | - Helen Blackshaw
- Faculty of Brain Sciences, University College LondonevidENT, Ear InstituteLondonUK
| | - Jerome Lim
- Medway Maritime HospitalEar, Nose and Throat DepartmentWindmill RoadGillinghamKentUKME7 5NY
| | - Anne GM Schilder
- Faculty of Brain Sciences, University College LondonevidENT, Ear InstituteLondonUK
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Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. Analysis of 24-Hour Ambulatory Blood Pressure Monitoring in Children With Obstructive Sleep Apnea: A Hospital-Based Study. Medicine (Baltimore) 2015; 94:e1568. [PMID: 26448004 PMCID: PMC4616740 DOI: 10.1097/md.0000000000001568] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/14/2015] [Accepted: 08/19/2015] [Indexed: 12/04/2022] Open
Abstract
In the present study, we aimed to verify associations between ambulatory blood pressure (ABP) and pediatric obstructive sleep apnea (OSA) in a hospital-based population. This was a cross-sectional observational study on children aged 4 to 16 years with OSA-related symptoms from a tertiary referral medical center. All children received overnight polysomnography and 24-hour recording of ABP. Severity of the disease was classified as primary snoring (apnea-hypopnea index, AHI <1), mild OSA (AHI 1-5), and moderate-to-severe OSA (AHI >5). For 195 children enrolled in this study (mean age, 7.8 ± 3.4 years; 69% boy), ABP increased as severity of OSA increased. During daytime, children with moderate-to-severe OSA had significantly higher systolic blood pressure (BP) (117.0 ± 12.7 vs 110.5 ± 9.3 mmHg), mean arterial pressure (MAP) (85.6 ± 8 .1 vs 81.6 ± 6.8 mmHg), and diastolic BP load (12.0 ± 9.6 vs 8.4 ± 10.9 mmHg) compared with children with primary snoring. During nighttime, children with moderate-to-severe OSA had significantly higher systolic BP (108.6 ± 15.0 vs 100.0 ± 9.4 mmHg), MAP (75.9 ± 9.6 vs 71.1 ± 7.0 mmHg), systolic BP load (44.0 ± 32.6 vs 26.8 ± 24.5 mmHg), systolic BP index (0.5 ± 13.1 vs -6.8 ± 8.5 mmHg), and higher prevalence of systolic hypertension (47.6% vs 14.7 %) compared with children with primary snoring. Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP and MAP after adjusting for adiposity variables. This large hospital-based study showed that children with moderate-to-severe OSA had a higher ABP compared with children who were primary snorers. As elevated BP in childhood predicts future cardiovascular risks, children with severe OSA should be treated properly to prevent further adverse cardiovascular outcomes.
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Affiliation(s)
- Kun-Tai Kang
- From the Department of Otolaryngology, National Taiwan University Hospital (K-TK, W-CH); Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City (K-TK); Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University (K-TK); Department of Pediatrics (S-NC, W-CW); Sleep Center (W-CW, P-LL, W-CH); and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (P-LL)
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He K, Shen C, Chen X, Han L, Xi Z, Zhou T, Zhang J, Xia Q. Health-related quality of life and sleep among Chinese children after living donor liver transplantation. Pediatr Transplant 2015; 19:547-54. [PMID: 26096790 DOI: 10.1111/petr.12532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 12/16/2022]
Abstract
LDLT is a well-established treatment for most terminal liver diseases in children. Survival rates have improved, yet few studies have considered HRQoL or sleep problems in LDLT recipients. In this cross-sectional study, we enrolled 51 children who had undergone LDLT in Renji Hospital. PedsQL(™) 4.0 Generic Core Scales, PedsQL(™) 3.0 Transplant Module, and Pediatric Sleep Questionnaire were used to assess outcomes. Of all participants, 11.8% (6/51) reported low total HRQoL scores. Participants' scores on most HRQoL subscales were comparable to the scores of healthy children. However, compared with solid organ transplant recipients, LDLT recipients scored significantly lower in About My Medicines II (t = 3.092, p = 0.002) and Worry (t = 2.760, p = 0.006). Sleep problems (41.2%) were common among participants. Hierarchical regression analyses showed that SRBD accounted for significant variance in HRQoL on total generic HRQoL (R(2) = 0.446, p < 0.001), psychosocial health (R(2) = 0.372, p = 0.001), physical health (R(2) = 0.345, p = 0.003), total transplant-specific HRQoL (R(2) = 0.514, p < 0.001), About My Medicines I (R(2) = 0.365, p = 0.013), My Transplant and Others (R(2) = 0.334, p = 0.005), Pain and Hurt (R(2) = 0.544, p < 0.001), Worry (R(2) = 0.401, p = 0.001), Treatment Anxiety (R(2) = 0.526, p < 0.001), How I Look (R(2) = 0.221, p = 0.040), and Communication (R(2) = 0.343, p = 0.012). In conclusion, sleep problems are non-negligible in children after LDLT and predicted significant variance on HRQoL.
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Affiliation(s)
- Kang He
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Conghuan Shen
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaosong Chen
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Longzhi Han
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhifeng Xi
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Zhou
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianjun Zhang
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Kuo YL, Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. Blood Pressure after Surgery among Obese and Nonobese Children with Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2015; 152:931-40. [DOI: 10.1177/0194599815573927] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives Treating obstructive sleep apnea in children is found to be associated with blood pressure decreases. However, exactly how adenotonsillectomy (T&A) affects blood pressure in obese and nonobese children remains unclear. This study assesses how obesity affects blood pressure in children with sleep apnea after T&A. Study Design Case series with chart review. Setting A tertiary referral center. Subjects and Methods From 2010 to 2012, a total of 78 children were included. Based on propensity score methods (age, sex, and preoperative apnea-hypopnea index matched), children were assigned to either the obese group (n = 39) or the nonobese group (n = 39). All children received adenotonsillectomy. We recorded clinical symptoms, preoperative overnight polysomnography (PSG), and subsequent PSG within 3 months after T&A. We measured blood pressure 3 times before PSG (nocturnal blood pressure) and after PSG (morning blood pressure) in a sleep laboratory. Results Following surgery, the nonobese group had a significantly decreased nocturnal diastolic blood pressure (DBP) index (–12.0 to −18.8, P = .018), morning systolic blood pressure (SBP; 111.1 to 105.8 mm Hg, P = .014), SBP index (–5.4 to −10.9, P = .008), and DBP (–12.0 to −18.7, P = .023). Nevertheless, all blood pressure parameters in the obese group were not significantly changed postoperatively. The nonobese group improved more than obese group in nocturnal and morning DBP and DBP index by 2-way analysis of variance. Conclusion Among the children receiving T&A as treatment for OSA, nonobese children improved more than obese children did in terms of blood pressure, allowing us to infer that obese children with OSA may benefit less from T&A in cardiovascular morbidities.
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Affiliation(s)
- Yen-Lin Kuo
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Otolaryngology, National Taiwan University Hospital, Hsin-chu Branch, Taipei, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
Autism spectrum disorders (ASD) are common neurodevelopmental conditions, affecting 1 in 68 children. Sleep disturbance, particularly insomnia, is very common in children diagnosed with ASD, with evidence supporting overlapping neurobiological and genetic underpinnings. Disturbed sleep exacerbates core and related ASD symptoms and has a substantial negative impact on the entire family. Treatment of sleep disturbance holds promise for ameliorating many of the challenging behavioral symptoms that children with ASD and their families face. Behavioral and pharmacological studies indicate promising approaches to treating sleep disturbances in this population. Awareness of treatment options is particularly important as parents and clinicians may believe that sleep disturbance is part of autism and refractory to therapy. In addition, autism symptoms refractory to treatment with conventional psychiatric medications may improve when sleep is addressed. Additional evidence-based studies are needed, including those that address the underlying biology of this condition.
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Affiliation(s)
- Olivia J Veatch
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Angela C Maxwell-Horn
- Department of Developmental Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Beth A Malow
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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