儿童鼾症伴轻度睡眠呼吸暂停的腺扁桃体切除术及保健应用

IF 24.7 1区医学 Q1 PEDIATRICS

JAMA Pediatrics Pub Date : 2025-03-17 DOI:10.1001/jamapediatrics.2025.0023

Jessie P. Bakker, Fang Zhang, Raouf Amin, Cristina M. Baldassari, Ronald D. Chervin, Susan L. Garetz, Fauziya Hassan, Sally Ibrahim, Stacey L. Ishman, Erin M. Kirkham, Ariel Linden, Ron B. Mitchell, Kamal Naqvi, Carol L. Rosen, Kristie Ross, Ignacio E. Tapia, Lisa R. Young, Phoebe K. Yu, Susan Redline, Rui Wang

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引用次数: 0

摘要

文献表明，未经治疗的中重度阻塞性睡眠呼吸暂停患儿的医疗保健利用率（HCU）高于诊断前的匹配对照，并且治疗与未接受治疗的患儿HCU下降有关。关于这一主题的研究仅限于回顾性分析和观察性队列研究；人们对许多打鼾和轻度睡眠呼吸障碍（SDB）儿童的HCU知之甚少。目的确定腺扁桃体切除术与观察等待支持治疗相比是否与医疗就诊和处方减少有关。设计、环境和参与者这项随机临床试验，儿科腺扁桃体切除术治疗打鼾试验（PATS），是一项为期12个月的平行对照试验，于2016年至2022年在美国三级医疗中心进行。参与者从耳鼻喉科、睡眠科、肺科或普通儿科诊所招募；3至13岁；诊断为轻度SDB；扁桃体肥大2级或以上；身体质量指数z小于3。从当地电子病历系统以外的临床医生转介的儿童被排除在外。数据分析时间为2022年6月至2024年4月。。接受InterventionEarly腺样扁桃体切除术HCU的评估是PATS预先设定的次要目标。分析随机化后12个月的总就诊情况和总处方。结果在随机抽取的459名儿童中，剔除当地电子病历系统外转诊的儿童后，分析样本包括381名儿童。中位（IQR）年龄为6（4-8）岁；192名参与者（50%）为女性，189名（50%）为男性。腺扁桃体切除术与总医疗就诊次数减少32%相关(平均差异为- 1.25 /参与者/年；95% CI, - 1.96至- 0.53)，处方减少48%(平均差异，每位参与者每年- 2.53；95% CI, - 4.12 ~ - 0.94)。接触的差异主要是由于较少的办公室访问和门诊程序，而不是减少住院或紧急护理访问。结论及相关性本研究发现，腺扁桃体切除术与轻度SDB患儿全因HCU降低相关，支持对轻度SDB患儿进行早期干预。未来的研究重点是儿科SDB腺扁桃体切除术的成本效益。临床试验注册号：NCT02562040

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Adenotonsillectomy and Health Care Utilization in Children With Snoring and Mild Sleep Apnea

ImportanceThe literature indicates that health care utilization (HCU) of children with untreated moderate-to-severe obstructive sleep apnea is greater than that of matched controls before diagnosis, and treatment is associated with a decline in HCU not observed in those who remain untreated. Research on this topic has been limited to retrospective analyses and observational cohort studies; little is known about HCU among the many children with snoring and mild sleep-disordered breathing (SDB).ObjectiveTo determine whether adenotonsillectomy in comparison with watchful waiting with supportive care is associated with fewer health care encounters and prescriptions.Design, Setting, and ParticipantsThis randomized clinical trial, Pediatric Adenotonsillectomy Trial for Snoring (PATS), was a 12-month, parallel-arm trial conducted from 2016 to 2022 in tertiary care centers in the United States. Participants were recruited from otolaryngology, sleep, pulmonary, or general pediatric clinics; aged 3 to 13 years; diagnosed with mild SDB; had a tonsillar hypertrophy grade of 2 or more; and had a body mass index z score less than 3. Children referred from a clinician outside of the local electronic medical record system were excluded. Data analysis was conducted from June 2022 to April 2024.InterventionEarly adenotonsillectomy.Main Outcomes and MeasuresEvaluation of HCU was a prespecified secondary aim of PATS. Total encounters and total prescriptions over the 12 months after randomization were analyzed.ResultsAmong 459 children who were randomized, the analytic sample included 381 children, after excluding those referred from outside the local electronic medical record system. The median (IQR) age was 6 (4-8) years; 192 participants (50%) were female and 189 (50%) male. Adenotonsillectomy was associated with a 32% reduction in total health care encounters (mean difference, −1.25 per participant per year; 95% CI, −1.96 to −0.53) and a 48% reduction in prescriptions (mean difference, −2.53 per participant per year; 95% CI, −4.12 to −0.94). The difference in encounters was primarily driven by fewer office visits and outpatient procedures rather than by reduced hospitalizations or urgent care visits.Conclusions and RelevanceThis study found that adenotonsillectomy was associated with reduced all-cause HCU in children with mild SDB, supporting early intervention for children with mild SDB. Future research focused on the cost effectiveness of adenotonsillectomy for pediatric SDB is warranted.Trial RegistrationClinicalTrials.gov Identifier: NCT02562040

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来源期刊

JAMA Pediatrics PEDIATRICS-

CiteScore

31.60

自引率

1.90%

发文量

357

期刊介绍： JAMA Pediatrics, the oldest continuously published pediatric journal in the US since 1911, is an international peer-reviewed publication and a part of the JAMA Network. Published weekly online and in 12 issues annually, it garners over 8.4 million article views and downloads yearly. All research articles become freely accessible online after 12 months without any author fees, and through the WHO's HINARI program, the online version is accessible to institutions in developing countries. With a focus on advancing the health of infants, children, and adolescents, JAMA Pediatrics serves as a platform for discussing crucial issues and policies in child and adolescent health care. Leveraging the latest technology, it ensures timely access to information for its readers worldwide.