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药物诱导睡眠内镜导向的舌头手术治疗持续的儿科阻塞性睡眠呼吸暂停:系统性审查和元分析
R Kenneth Sims1, Alexander Leeds1, Grace Johnson1
1Department of Otolaryngology - Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
药物诱导睡眠内镜 (DISE) 指导的舌头手术有效地治疗持续阻塞性睡眠呼吸暂停 (OSA) 在腺切除术后的儿童. 这种方法显著降低了呼吸暂停-呼吸暂停指数 (AHI),并改善了最低氧和度 (LSAT).
科学领域:
- 耳鼻喉科 耳鼻喉科 耳鼻喉科
- 儿科睡眠医学 儿科睡眠医学
- 手术结果研究研究.
背景情况:
- 儿童的阻塞性睡眠呼吸暂停 (OSA) 在腺切除术后经常持续或复发.
- 以药物诱导睡眠内镜 (DISE) 为指导的舌头手术是治疗儿科持续性OSA的一个选择.
- 评估DISE指导的舌头手术的疗效对于治疗规划至关重要.
研究的目的:
- 系统地审查关于DISE指导的舌头手术结果的文献,在腺切除术后患有持续性OSA的儿童中.
- 进行有关研究中的多睡眠图 (PSG) 数据的元分析.
- 评估这种手术方法在改善OSA参数方面的有效性.
主要方法:
- 按照PRISMA指南进行系统审查和元分析.
- 包括评估儿童OSA患者的DISE导向舌头手术的研究.
- 分析了主要结果:术后呼吸暂停-呼吸暂停指数 (AHI) 和最低氧和度 (LSAT),以及次要结果:手术响应率.
主要成果:
- 系统性审查包括7项研究 (283名患者).
- 整体外科反应率为70.0%±17.0%.
- 六项研究的元分析 (270名患者) 显示AHI显著下降 (平均差异-5.13事件/小时,p < 0.00001) 和LSAT的改善 (平均差异2.71%,p < 0.0001).
结论:
- 在患有持续性OSA的儿童中,DISE指导的舌头手术在减少AHI约50%和改善LSAT近3%的有效性.
- 集体证据支持DISE指导的舌头手术的疗效,其阳性反应率为70%.
- 局限性包括报告结果的异质性和潜在的混因素,需要进一步研究.
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