Discussion on the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome
10.3760/cma.j.issn.1673-0860.2014.07.010
- VernacularTitle:儿童阻塞性睡眠呼吸暂停低通气综合征的治疗方法探讨
- Author:
Ling SHEN
1
;
Zongtong LIN
;
Yangyang XU
;
Zhongjie YANG
Author Information
1. 350005,福建省福州儿童医院耳鼻咽喉科福建医科大学教学医院
- Keywords:
Sleep apnea,obstructive;
Child;
Adenoidectomy;
Tonsillectomy;
Rhinitis;
Brug therapy
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2014;49(7):574-581
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS).Methods A total of 386 children with OSAHS were enrolled from June 2008 to April 2011.Ninety children with adenoid and tonsil ≤ degree Ⅲ (group A) were randomly divided into A1 subgroup and A2 subgroup,while 22 of 296 (group B) children aged less than 3 years old with degree Ⅳ adenoid and(or) tonsil were divided into B1 subgroup,and the other 274 of 296 children with degree Ⅳ adenoid and (or) tonsil were divided into B1 subgroup,B2 subgroup and B3 subgroup.The adenoid,tonsil size examination and nasal endoscopic examination scores were performed before treatment,3 months and 6 months after treatment.Drug therapy included oral antibiotics,mometasone furoate as a nasal spray,leukotriene receptor antagonist (LTRAs),mucoactive medications.Conservative treatment meant drug therapy plus negative pressure of sputum aspiration.Surgical treatment meant coblation adenotonsillectomy.A1 subgroup received drug therapy for 3 months; A2 and B1 subgroup received conservative treatment for 3 months; B2 subgroup received coblation adenotonsillectomy after 3 days conservative treatment and postoperative drug therapy for 2 weeks; B3 subgroup received coblation adenotonsillectomy after 2 weeks conservative treatment and postoperative drug therapy for 3 months.Results The adenoid and tonsil size of A2 subgroup decreased at 3 months after treatment (Wald x2 were 10.584 and 8.366,respectively,P ＜ 0.05),no significant re-increase was found at 6 months,and no decrease was found in the A1 subgroup (P ＞ 0.05).The nasal endoscopic examination scores decreased in both A1 and A2 subgroup at 3 months after the treatment (F =403.420,P ＜ 0.05),but it was found re-increase in A1 subgroup at the 6 months (P ＜ 0.05),no significant re-increase was found in the A2 subgroup.The polysomnography (PSG) monitor of A2 subgroup was 100.0％ normal at 3 months after treatment,while the A1 subgroup was only 43.2％ (x2 =36.189,P ＜ 0.05).B2 and B3 subgroups cured after coblation adenotonsillectomy,but no decrease of the adenoid and tonsil size was found in B1 subgroup (P ＞ 0.05).The nasal endoscopic examination scores of B1,B2 and B3 subgroups showed significant decrease after the treatment,but re-increase was found in both B1 and B2 subgroups at the 6 months (F =1 614.244,P ＜ 0.05),no significant re-increase was found in the B3 subgroup.The PSG monitor of B3 subgroup was 100.0％ normal at 3 months after treatment,B2 subgroup 73.4％,and B1 subgroup only 57.4％ (x2 =90.846,P ＜ 0.05).Conclusions The treatment method of children with OSAHS should be selected according to the age,condition of disease,and size of the adenoid and tonsil.Adenoid and tonsil ≤ degree Ⅲ should select conservative treatment; while for degree Ⅳ adenoid and (or) tonsil,surgical treatment should be primary choice.Conservative treatment can reduce the risk of perioperative and adequate postoperative drug therapy can help prevent recurrence after surgery.
