哮喘控制较差儿童的阻塞性睡眠呼吸暂停：增殖腺扁桃体切除术的疗效
2011/06/17
摘要
背景：流行病学研究显示，儿童哮喘和阻塞性睡眠呼吸暂停(OSA)具有某些相似的危险因素，哮喘儿童打鼾的发生率较高，表明哮喘能增加OSA的风险。既然哮喘和OSA均为炎症性疾病，我们认为多导睡眠仪诊断的OSA在哮喘控制较差的患者(PCA)中更为常见，而且OSA治疗能降低急性哮喘恶化(AAE)的频率。
方法：对PCA患儿进行夜间睡眠研究，若同时存在OSA，则患儿接受增殖腺扁桃体切除手术（扁桃腺切除术和增殖腺切除术，T&A）。比较哮喘症状和恶化频率。
结果：年龄为3～10岁的92名PCA患者入选睡眠质量前瞻性研究，平均AAE频率为3.4 ± 0.4/年。58名患者出现OSA (i.e., AHI>5/hr TST)，与非哮喘患者相比，哮喘患者OSA的发生率显著增加（63.0%; OR: 40.9, 12.9-144.1, P<0.000001）。35名患儿接受T&A 并进行了为期1年的随访。与无OSA的患者相比（无改变），这些患儿在AAE频率、急性皮质激素使用频率、哮喘症状发生频率显著下降。
结论：PCA患儿其OSA的发生率显著增加，OSA的治疗可能与哮喘严重程度显著改善相关。
（苏楠 审校）
Pediatr Pulmonol. 2011 Apr 4. doi: 10.1002/ppul.21451. [Epub ahead of print]
Obstructive sleep apnea in poorly controlled asthmatic children: Effect of adenotonsillectomy.
Kheirandish-Gozal L, Dayyat EA, Eid NS, Morton RL, Gozal D.
Sections of Pediatric Pulmonology and Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, Illinois. lgozal@peds.bsd.uchicago.edu.
Abstract
BACKGROUND: Asthma and obstructive sleep apnea (OSA) in children share multiple epidemiological risk factors and the prevalence of snoring is higher in asthmatic children, suggesting that the latter may be at increased risk for OSA. Since both asthma and OSA are inflammatory disorders, we hypothesized that polysomnographically demonstrated OSA would be more frequent among poorly controlled asthmatics (PCA), and that treatment of OSA, if present, would ameliorate the frequency of acute asthmatic exacerbations (AAE).
METHODS: Children with PCA were referred for an overnight sleep study, and adenotonsillectomy (tonsillectomy and adenoidectomy, T&A) was performed if OSA was present. Frequency of asthma symptoms and exacerbations were compared.
RESULTS: Ninety-two PCA children, ages 3-10 years, with a mean frequency of AAE of 3.4 ± 0.4/year were prospectively referred for a sleep study. OSA (i.e., AHI > 5/hrTST) was present in 58 patients (63.0%; OR: 40.9, 12.9-144.1, P < 0.000001 compared to the prevalence of OSA in a non-asthmatic population). Information at 1-year follow-up was available for 35 PCA children after T&A. The annual frequency of AAE, rescue inhaled use, and asthma symptoms in this sub-group decreased compared to no changes in the group without OSA.
CONCLUSIONS: The prevalence of OSA is markedly increased among PCA children and treatment of OSA appears to be associated with substantial improvements in the severity of the underlying asthmatic condition
Pediatr Pulmonol. 2011 Apr 4. doi: 10.1002/ppul.21451. [Epub ahead of print]
背景：流行病学研究显示，儿童哮喘和阻塞性睡眠呼吸暂停(OSA)具有某些相似的危险因素，哮喘儿童打鼾的发生率较高，表明哮喘能增加OSA的风险。既然哮喘和OSA均为炎症性疾病，我们认为多导睡眠仪诊断的OSA在哮喘控制较差的患者(PCA)中更为常见，而且OSA治疗能降低急性哮喘恶化(AAE)的频率。
方法：对PCA患儿进行夜间睡眠研究，若同时存在OSA，则患儿接受增殖腺扁桃体切除手术（扁桃腺切除术和增殖腺切除术，T&A）。比较哮喘症状和恶化频率。
结果：年龄为3～10岁的92名PCA患者入选睡眠质量前瞻性研究，平均AAE频率为3.4 ± 0.4/年。58名患者出现OSA (i.e., AHI>5/hr TST)，与非哮喘患者相比，哮喘患者OSA的发生率显著增加（63.0%; OR: 40.9, 12.9-144.1, P<0.000001）。35名患儿接受T&A 并进行了为期1年的随访。与无OSA的患者相比（无改变），这些患儿在AAE频率、急性皮质激素使用频率、哮喘症状发生频率显著下降。
结论：PCA患儿其OSA的发生率显著增加，OSA的治疗可能与哮喘严重程度显著改善相关。
（苏楠 审校）
Pediatr Pulmonol. 2011 Apr 4. doi: 10.1002/ppul.21451. [Epub ahead of print]
Obstructive sleep apnea in poorly controlled asthmatic children: Effect of adenotonsillectomy.
Kheirandish-Gozal L, Dayyat EA, Eid NS, Morton RL, Gozal D.
Sections of Pediatric Pulmonology and Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, Illinois. lgozal@peds.bsd.uchicago.edu.
Abstract
BACKGROUND: Asthma and obstructive sleep apnea (OSA) in children share multiple epidemiological risk factors and the prevalence of snoring is higher in asthmatic children, suggesting that the latter may be at increased risk for OSA. Since both asthma and OSA are inflammatory disorders, we hypothesized that polysomnographically demonstrated OSA would be more frequent among poorly controlled asthmatics (PCA), and that treatment of OSA, if present, would ameliorate the frequency of acute asthmatic exacerbations (AAE).
METHODS: Children with PCA were referred for an overnight sleep study, and adenotonsillectomy (tonsillectomy and adenoidectomy, T&A) was performed if OSA was present. Frequency of asthma symptoms and exacerbations were compared.
RESULTS: Ninety-two PCA children, ages 3-10 years, with a mean frequency of AAE of 3.4 ± 0.4/year were prospectively referred for a sleep study. OSA (i.e., AHI > 5/hrTST) was present in 58 patients (63.0%; OR: 40.9, 12.9-144.1, P < 0.000001 compared to the prevalence of OSA in a non-asthmatic population). Information at 1-year follow-up was available for 35 PCA children after T&A. The annual frequency of AAE, rescue inhaled use, and asthma symptoms in this sub-group decreased compared to no changes in the group without OSA.
CONCLUSIONS: The prevalence of OSA is markedly increased among PCA children and treatment of OSA appears to be associated with substantial improvements in the severity of the underlying asthmatic condition
Pediatr Pulmonol. 2011 Apr 4. doi: 10.1002/ppul.21451. [Epub ahead of print]
