Utility of concurrent pharyngoplasty with adenotonsillectomy to treat pediatric obstructive sleep apnea.

IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY
Sweeya V Raj, Kelly L Vittetoe, Emily L Mace, Daniel Larson, Amy S Whigham
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Abstract

Objective: This study assesses whether surgical procedures to address pharyngeal anatomy performed concurrently with adenotonsillectomy (AT) lead to improved postoperative polysomnogram (PSG) outcomes in children with obstructive sleep apnea (OSA) compared to AT alone.

Study design/setting: This is a retrospective cohort study conducted at a tertiary care children's hospital in the southeastern United States.

Methods: Patients were identified using Current Procedural Terminology (CPT) codes for pharyngoplasty and AT. Retrospective chart review was conducted to obtain clinical data. Patients were matched by age, body mass index (BMI), and preoperative apnea hypopnea index (AHI) to children who underwent AT alone.

Results: Forty-six children who underwent AT with concomitant pharyngoplasty were identified along with 187 patients who underwent AT alone. Age, BMI, and preoperative AHI were significantly higher in the pharyngoplasty + AT group. The pharyngoplasty + AT group demonstrated significantly greater improvement in AHI, REM AHI, and obstructive AHI (oAHI) postoperatively; however, multivariable regression showed that BMI predicted postoperative change in AHI. Twenty children in each group were therefore matched by age, BMI, and preoperative AHI. Subsequent analysis of matched cases revealed no significant difference in surgical outcomes between groups.

Conclusion: After controlling for age, BMI, and preoperative AHI, there was no difference between AT with concurrent pharyngoplasty and AT alone with respect to change in AHI or oxygen saturation nadir postoperatively. Ultimately, children who undergo pharyngoplasty in combination with AT are a clinically distinct group, and further randomized controlled trials within this population are necessary to define the role of pharyngoplasty concurrent with AT.

咽成形术并发腺扁桃体切除术治疗儿童阻塞性睡眠呼吸暂停的疗效。
目的:本研究评估与单独进行腺扁桃体切除术(AT)相比,治疗咽解剖的外科手术是否能改善阻塞性睡眠呼吸暂停(OSA)儿童术后多导睡眠图(PSG)结果。研究设计/环境:这是一项在美国东南部一家三级保健儿童医院进行的回顾性队列研究。方法:使用现行程序术语(CPT)编码对咽成形术和咽移植患者进行识别。回顾性图表复习以获得临床资料。患者的年龄、体重指数(BMI)和术前呼吸暂停低通气指数(AHI)与单独接受AT治疗的儿童相匹配。结果:46例患儿行AT合并咽成形术,187例患儿单独行AT。咽成形术+ AT组的年龄、BMI和术前AHI明显增高。咽成形术+ AT组术后AHI、REM AHI、梗阻性AHI (oAHI)改善显著;然而,多变量回归显示BMI可以预测术后AHI的变化。因此,每组20名儿童按年龄、BMI和术前AHI进行匹配。随后对匹配病例的分析显示,两组之间的手术结果无显著差异。结论:在控制了年龄、BMI和术前AHI后,AT联合咽成形术与单独AT在术后AHI或血氧饱和度最低点的变化方面没有差异。最终,接受咽成形术联合AT的儿童是一个临床独特的群体,需要在该人群中进行进一步的随机对照试验,以确定咽成形术联合AT的作用。
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来源期刊
CiteScore
3.20
自引率
6.70%
发文量
276
审稿时长
62 days
期刊介绍: The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.
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