在儿童中治疗打和轻度睡眠呼吸暂停的腺切除术:随机临床试验
Susan Redline1, Kaitlyn Cook2,3, Ronald D Chervin4
1Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA
|December 5, 2023
概括
在患有轻度睡眠呼吸障碍 (SDB) 的儿童中,早期腺切除并没有改善执行功能或注意力. 然而,手术导致了更好的行为,生活质量和降低了血压.
科学领域:
- 儿童睡眠医学
- 耳鼻喉科
- 儿童神经发育
背景情况:
- 在有习惯性打但没有频繁阻塞事件的儿童中,腺切除治疗轻度睡眠呼吸障碍 (SDB) 的有效性尚不清楚.
- 轻度SDB的特点是没有显著阻塞呼吸的打,使治疗决策复杂.
研究的目的:
- 将早期腺切除术与对轻度SDB儿童神经发育,行为,健康和多睡眠结果的警等待进行比较.
- 评估腺切除术对执行功能,注意力和整体幸福感的影响.
主要方法:
- 一项随机临床试验,涉及459名3至12.9岁的儿童,他们的打和呼吸暂停指数 (AHI) 低于3.
- 参与者被随机分为早期腺切除术 (n=231) 或警等待 (n=228),随访时间为12个月.
- 主要结局包括执行功能的变化 (BRIEF GEC T-score) 和注意力 (Go/No-go测试d-prime).
主要成果:
- 在12个月的执行功能或注意力主要结果中,没有观察到群体之间的统计学意义上的差异.
- 腺切除术显著改善了二次结果:行为问题,嗜睡,症状和生活质量.
- 经过腺切除术的儿童血压百分位数下降较大,AHI进展较小,超过3次/小时.
结论:
- 与警等待相比,早期腺切除没有显著改善执行功能或注意力.
- 然而,腺切除术在二次结果中提供了好处,包括改善行为,生活质量和降低血压.
- 这些发现表明,对治疗轻度SDB的治疗方法有细微差别,考虑主要和次要结果的改善.
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