打呼要開刀嗎?

 

 
 
 
 
 
孩子睡眠打呼其實不少見,但是為了打呼去開刀是值得的嗎?不是說長大一點就會好嗎?
2015年在頂級醫學期刊 NEJM上曾經登載一篇關於有阻塞性呼吸中止症的孩子開刀是否會改善功能的研究(CHAT study),結論是會改善部分功能,但針對只有輕微打呼的孩子呢?

所以有了以下這篇研究(PATS study),也是登在頂級期刊 jama
 
 

the Pediatric Adenotonsillectomy Trial for Snoring (PATS)  

 

 458 名參與者(一星期7天至少打呼超過3個晚上),美國7家醫學中心收案
  • 231 名接受腺樣體切除術,237 名選擇觀察等待;平均年齡 6.1 歲(範圍3-12.9歲);
  • 230 名女性[占 50%];123 名黑人/非洲裔美國人[占 26.9%];75 名西班牙裔[占 16.3%];
  • 呼吸暫停指數(AHI)的中位數為 0.5 [四分位數範圍 0.2-1.1])
  • 共有 394 名兒童(占 86%)完成了 12 個月的隨訪訪視
  • 排除肥胖的小孩

 

結果是…


 
 
 

 

研究結果表明,接受腺樣體切除術的孩童在多項重要健康指標上顯示出顯著改善。首先,在行為與情緒方面,根據家長報告的兒童行為檢查表(CBCL)總分顯示,這些孩子的總體問題分數有所降低。此外,睡眠相關呼吸障礙問卷(PSQ-SRBD)的分數也顯著降低,這反映了睡眠品質的改善。

在生理健康方面,腺樣體切除術後的孩童在睡眠呼吸質量評估量表(OSA-18)得分上也有所減少,這意味著他們的睡眠呼吸問題有所緩解。此外,接受手術的孩子在兒童健康問卷(PedsQL)的總分、身體健康分數及心理社會健康分數上均顯示出改善。

值得注意的是,接受腺樣體切除術的孩童在血壓方面也有顯著的改善。他們的收縮壓和舒張壓均有下降。最後,腺樣體切除術後孩童的呼吸暫停指數(AHI)也顯著減少,這表明他們的睡眠呼吸中止症狀有顯著改善。



疾病或量表盛行率的變化(分數高是不好的)

 

具體來說,研究發現,在接受腺樣體切除術的孩童群體,相對於觀察對照組而言,他們在12個月後的
  • 兒童行為檢查表(CBCL)總問題得分上有 7.6%(95%CI,-14.6%至-0.7%)的降低。
  • 睡眠相關呼吸障礙問卷(PSQ-SRBD)高得分也降低了 30.9%(95%CI,-39.1%至-22.8%)。
  • 兒童嗜睡量表(mESS)高得分的比例減少了 5.9%(95% CI,-12.7%至1.0%)
  • 兒童睡眠呼吸障礙問卷(OSA-18)高得分的比例也降低了 13.0%(95%CI,-19.1%至-7.0%)。
  • 頻繁大聲打呼的盛行率方面有 27.3%(95% CI,-34.5%至-20.1%)的下降
 

 

 
 
 

CHAT 和 PATS 的比較




 

個人看法

雖然這兩個大型研究數據清楚地表明,對於患有阻塞性睡眠呼吸中止症或打呼的孩童,腺樣體切除術在一年後不僅能夠顯著改善行為和情緒問題,還能改善睡眠品質和減少睡眠中的呼吸問題。但是缺乏和其它治療方法的成果比較,加上亞洲人的生理結構和西方人也有所差異,這樣的結果是不是就能說是開刀一定是最好的治療方法呢? 或許還是要等時間來證明了。
 
 
 
參考資料
https://jamanetwork.com/journals/jama/article-abstract/2812479





-----------------English version----------------------

Children's snoring and mild obstructive sleep apnea (OSA) are not uncommon, but is surgery like adenotonsillectomy really worth it for snoring? Isn't it often said that such conditions improve as children grow older? A landmark study published in 2015 in the prestigious New England Journal of Medicine (NEJM), the CHAT study, examined whether surgery would improve functionality in children with OSA, concluding that it does improve some aspects. But what about children who primarily snore?

 

Thus, the Pediatric Adenotonsillectomy Trial for Snoring (PATS) was conducted, also published in a top-tier journal, JAMA. This study included 458 participants from 7 medical centers in the United States, comprising:

  • 231 children underwent adenotonsillectomy, and 237 were in the watchful waiting group.
  • The average age was 6.1 years (ranging from 3 to 12.9 years).
  • The group was evenly divided by gender with 230 females (50%).
  • Racial composition included 123 Black/African American (26.9%) and 75 Hispanic (16.3%) children.
  • The median Apnea-Hypopnea Index (AHI) was 0.5 [interquartile range (IQR), 0.2-1.1].
  • A total of 394 children (86%) completed the 12-month follow-up.
  • Obese children were excluded from the study.

 

 Results demonstrated significant improvements in various health indicators for children undergoing adenotonsillectomy. Behaviorally and emotionally, as reported in the Child Behavior Checklist (CBCL) total scores, there was a noticeable reduction in overall problem scores. Additionally, there was a significant decrease in scores on the Sleep-Related Breathing Disorder questionnaire (PSQ-SRBD), reflecting improved sleep quality.

 

Physiologically, post-surgery children showed reductions in OSA-18 scores, indicating alleviation of sleep-breathing issues. Moreover, improvements were observed in the Pediatric Quality of Life Inventory (PedsQL) total, physical, and psychosocial health scores. Notably, improvements were also seen in blood pressure readings, both systolic and diastolic, as well as a significant decrease in the Apnea-Hypopnea Index (AHI), signifying substantial improvement in sleep apnea symptoms.

 

Specifically, the study found that in children who underwent adenotonsillectomy, compared to the watchful waiting group, there were:

  • A 7.6% reduction (95% CI, -14.6% to -0.7%) in the prevalence of CBCL total problem scores.
  • A 30.9% reduction (95% CI, -39.1% to -22.8%) in PSQ-SRBD scores.
  • A 5.9% reduction (95% CI, -12.7% to 1.0%) in mESS scores.
  • A 13.0% reduction (95% CI, -19.1% to -7.0%) in OSA-18 scores.
  • A 27.3% reduction (95% CI, -34.5% to -20.1%) in the prevalence of frequent loud snoring.

 

While these two large studies, CHAT and PATS, clearly show that adenotonsillectomy can significantly improve behavioral issues, emotional problems, sleep quality, and reduce breathing problems during sleep in children with OSA or who snore, they lack comparison with other treatment methods. Additionally, physiological differences between Asian and Western populations may affect the applicability of these results. Therefore, whether surgery is the best treatment method remains a question that might require more time and research to answer definitively.

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