1
|
Magalhães MC, Normando D, Soares CJ, Araujo E, Novaes RMO, Teodoro VV, Flores-Mir C, Kim KB, Almeida GA. Impact of adenotonsillectomy and palatal expansion on the apnea-hypopnea index and minimum oxygen saturation in nonobese pediatric obstructive sleep apnea with balanced maxillomandibular relationship: A cross-over randomized controlled trial. Pediatr Pulmonol 2024. [PMID: 39239911 DOI: 10.1002/ppul.27239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE To determine the impact and best management sequence between adenotonsillectomy (AT) and rapid palatal expansion (RPE) on the apnea-hypopnea index (AHI) and minimum oxygen saturation (MinSaO2) in nonobese pediatric obstructive sleep apnea (OSA) patients presenting balanced maxillomandibular relationship. STUDY DESIGN/METHODS Thirty-two nonobese children with balanced maxillomandibular relationship and a mean age of 8.8 years, with a graded III/IV tonsillar hypertrophy and maxillary constriction, participated in a cross-over randomized controlled trial. As the first intervention, one group underwent AT while the other underwent RPE. After 6 months, interventions were switched in those groups, but only to participants with an AHI > 1 after the first intervention. OSA medical diagnosis with the support of Polysomnography (PSG) was conducted before (T0), 6 months after the first (T1) and the second (T2) intervention. The influence of sex, adenotonsillar hypertrophy degree, initial AHI and MinSaO2 severity, and intervention sequence were evaluated using linear regression analysis. Intra- and intergroup comparisons for AHI and MinSaO2 were performed using ANOVA and Tukey's test. RESULTS The initial AHI severity and intervention sequence (AT first) explained 94.9% of AHI improvement. The initial MinSaO2 severity accounted for 83.1% of MinSaO2 improvement changes. Most AHI reductions and MinSaO2 improvements were due to AT. CONCLUSIONS Initial AHI severity and AT as the first intervention accounted for most of the AHI improvement. The initial MinSaO2 severity alone accounted for the most changes in MinSaO2 increase. In most cases, RPE had a marginal effect on AHI and MinSaO2 when adjusted for confounders.
Collapse
Affiliation(s)
- Maria Cecilia Magalhães
- Department of Pediatric Dentistry and Orthodontics, Federal University of Uberlândia, Uberlândia, Brazil
| | - David Normando
- Department of Orthodontics, Federal University of Para, Belem, Brazil
| | - Carlos José Soares
- Department of Dental Materials, School of Dentistry, Federal University of Uberlândia Uberlândia, Brazil
| | - Eustaquio Araujo
- Department of Orthodontics, Center for Advanced Dental School (CADE), Saint Louis University, Saint Louis, Missouri, USA
| | | | | | - Carlos Flores-Mir
- Department of Dentistry and Dental Hygiene, University of Alberta, Edmonton, Alberta, Canada
| | - Ki Beom Kim
- Department of Orthodontics, Center for Advanced Dental School (CADE), Saint Louis University, Saint Louis, Missouri, USA
| | - Guilherme A Almeida
- Department of Pediatric Dentistry and Orthodontics, Federal University of Uberlândia, Uberlândia, Brazil
| |
Collapse
|
2
|
Kang KT, Hsu WC. Efficacy of adenotonsillectomy on pediatric obstructive sleep apnea and related outcomes: A narrative review of current evidence. J Formos Med Assoc 2024; 123:540-550. [PMID: 37718211 DOI: 10.1016/j.jfma.2023.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/18/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
This review summarizes the current evidence in systematic reviews, meta-analysis and randomized controlled trials regarding adenotonsillectomy outcomes in pediatric obstructive sleep apnea (OSA). Adenotonsillectomy is effective in treating OSA in children without co-morbidities, despite postoperative residual OSA remained in roughly half of these children. For children with comorbidities such as Down syndrome, Prader-Willi syndrome, sickle cell disease, or cerebral palsy, adenotonsillectomy is less effective and associated with more postoperative complications than that in children without comorbidities. For other OSA-related outcomes, evidence from meta-analyses and randomized controlled trials confirm adenotonsillectomy results in improvement of subjective OSA-related outcomes (e.g. symptoms, behaviors, and quality of life), but the results in objective OSA-related outcomes (e.g. cardiometabolic parameters or neurocognitive functions) are inconsistent. Future studies should focus on randomized controlled trials comparing objective OSA-related outcomes and the long-term effects of adenotonsillectomy in children with OSA.
Collapse
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
| | - 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.
| |
Collapse
|
3
|
Liu K, Zang C, Wang J, Liu J, Chen Z, He M, Liu B, Su X, Zhang Y, Yi M. Effects of common lifestyle factors on obstructive sleep apnea: precautions in daily life based on causal inferences. Front Public Health 2024; 12:1264082. [PMID: 38504681 PMCID: PMC10948455 DOI: 10.3389/fpubh.2024.1264082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/07/2024] [Indexed: 03/21/2024] Open
Abstract
Background This study aimed to evaluate the causal impact of common modifiable lifestyles on obstructive sleep apnea (OSA), which is beneficial for recommendations to prevent and manage OSA. Method Published genome-wide association study (GWAS) summary statistics were used to perform two-sample Mendelian randomization (MR). Variants associated with each exposure of smoking, drinking, and leisure sedentary behaviors at the genetic level were used as instrumental variables (IVs). Then, inverse-variance weighting (IVW) was considered the primary result for causality. Moreover, several complimented approaches were also included to verify the observed associations. MR-PRESSO and MR-Egger intercept were applied to test the horizontal pleiotropy. To assess heterogeneity, Cochran's Q test by IVW and MR-Egger were applied. Results Regular smoking history increased OSA risk in all applied approaches [OR (95% CI)IVW = 1.28 (1.12, 1.45), p = 1.853 × 10-4], while the causality of lifetime smoking index [OR (95% CI)IVW = 1.39 (1.00, 1.91), p = 0.048], alcohol intake frequency [outliers removed OR (95% CI)IVW = 1.26 (1.08, 1.45), p = 0.002], and coffee intake behavior [OR (95% CI)IVW = 1.66 (1.03, 2.68), p = 0.039] on OSA risk were not always consistent in other approaches. In addition, no robust causal associations were observed for the effect of sedentary leisure behaviors on OSA risk. In sensitivity analysis, we observed no sign of horizontal pleiotropy or heterogeneity. Conclusion Ever regularly smoking has a robust causal role in increasing OSA risk, which should be discouraged as precautions from developing OSA.
Collapse
Affiliation(s)
- Kun Liu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- School of Life Sciences, Central South University, Changsha, China
- Department of Medical Imaging Laboratory and Rehabilitation, Xiangnan University, Chenzhou, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chenyang Zang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Medical School, Central South University, Changsha, China
| | - Jixu Wang
- Department of Medical Imaging Laboratory and Rehabilitation, Xiangnan University, Chenzhou, China
| | - Jie Liu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Medical School, Central South University, Changsha, China
| | - Ziliang Chen
- School of Life Sciences, Central South University, Changsha, China
| | - Meng He
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Liu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoli Su
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Minhan Yi
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- School of Life Sciences, Central South University, Changsha, China
| |
Collapse
|
4
|
Velu PS, Kariveda RR, Palmer WJ, Levi JR. A review of uvulopalatopharyngoplasty for pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2024; 176:111819. [PMID: 38101098 DOI: 10.1016/j.ijporl.2023.111819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/18/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES To evaluate existing literature to understand the utility and safety of uvulopalatopharyngoplasty (UPPP) for treatment of pediatric obstructive sleep apnea (OSA). METHODS A literature review was conducted by two authors to search for studies from the inception of two databases until March 1, 2023. Studies in which participants were under 18 years of age and underwent UPPP for OSA or upper airway obstruction were selected. Data on variables such as pre- and postoperative severity, efficacy, complications, and follow-up were collected from all studies. RESULTS After applying inclusion criteria to the initial 91 abstracts that were screened, 26 studies remained that included 224 patients who underwent UPPP. Most children who underwent UPPP had neurologic impairment, developmental delay, craniofacial abnormalities, or were obese, and underwent several procedures for OSA treatment. Of the studies that reported outcomes, 85.6 % of patients had subjective improvement, and 25.6 % of patients had a reported complication. CONCLUSIONS Most children who underwent UPPP had serious medical comorbidities with moderate or severe OSA and a multi-procedural treatment plan. Although most patients had subjective improvement and there were low complication rates, the heterogeneity of existing literature makes it difficult to draw conclusions. Future multi-center, prospective studies should be conducted to analyze the true safety and efficacy of UPPP in pediatric patients.
Collapse
Affiliation(s)
- Preetha S Velu
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Rohith R Kariveda
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - William J Palmer
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Jessica R Levi
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, USA.
| |
Collapse
|