用藥物治療唐氏症的阻塞性呼吸中止症

 

 

唐氏症 (DS) 是最常見的遺傳性智能障礙原因,它也伴隨著許多獨特的健康挑戰,包括較高的阻塞性睡眠呼吸中止症 (OSA) 風險。OSA 在唐氏綜合症兒童中的發病率約為 50% 至 79%,遠高於非唐氏症兒童(只有2-5%)。


 

常見的治療方法都不一定能改善osa 


  • 腺樣體扁桃體切除術是治療 OSA 的常見方法,但在唐氏綜合症兒童中效果有限,許多(65-73%)孩子手術後仍然有症狀。 
  • 正壓呼吸器 (PAP) 治療雖然有益,但兒童持續使用上往往面臨挑戰。
  • 舌下神經刺激治療,在減少唐氏綜合症青少年的睡眠呼吸中止症狀上顯示了有希望的結果。然而,這種方法屬於外科手術,可能不適合預期會有顯著成長的年幼兒童,並且在唐氏綜合症青少年中與成人相比,手術併發症更為常見。

 

 

藥物治療能有效嗎?

 

近期一項臨床試驗發現,併用atomoxetine 和 oxybutynin的組合顯示了潛在的治療效果。

該試驗針對6至7歲的11位唐氏症兒童進行,參與者隨機接受了兩種不同劑量的ato-oxy治療,每種劑量治療持續一個月。

試驗結果表明

 


 

這兩種劑量的ato-oxy治療都能顯著降低阻塞性睡眠呼吸中止症指數。在低劑量ato-oxy治療下,睡眠呼吸中止指數(ahi)從平均7.4降至3.6;而在高劑量治療下,該指數進一步降至3.9。

 

 


 

此外,ato-oxy治療並未對睡眠結構造成顯著影響。

在生活品質方面,以OSA-18量表測量,ato-oxy治療前後的總分沒有顯著差異。最常見的副作用是易怒和疲勞,但這些症狀通常輕微。

綜上所述,ato-oxy治療對於唐氏綜合症兒童的OSA表現出了積極的潛力。

 

 

有其它考慮嗎? 

這個研究有先排除扁桃腺腫大程度3級以上的病人,而呼吸中止症輕度(ahi<5)的患者也沒有加入研究,所以適合開刀的病人可能還是要先去開刀,症狀情微的兒童在這種治療方式之下會不會得到好處也不知道。
 
此外,這個研究沒有長期追蹤,所以我們也不知道只要吃一個月就好?效果可以維持多久?但我個人覺得如果藥物治療是有成效的,那麼是不是未來在其它因為上呼吸道肌肉肌張力不足造成的呼吸中止症也可以使用這樣的治療方式呢?就等進一步的研究囉
 
 
 
 
參考資料

英文版 translated by chat-gpt

Down syndrome (DS) is the most common genetic cause of intellectual disability and comes with many unique health challenges, including a higher risk of Obstructive Sleep Apnea (OSA). OSA prevalence in children with Down syndrome is about 50% to 79%, much higher than in non-Down syndrome children (only 2-5%).

 

Common treatments are not necessarily effective for OSA:

  1. Adenotonsillectomy is a common treatment for OSA but has limited effects in children with Down syndrome. Many (65-73%) still have symptoms after surgery.
  2. Positive Airway Pressure (PAP) therapy is beneficial but often challenging for children to continue using.
  3. Hypoglossal nerve stimulation therapy has shown promising results in reducing sleep apnea symptoms in adolescents with Down syndrome. However, this surgical method may not be suitable for young children expected to grow significantly and has more common complications in adolescents with Down syndrome compared to adults
 

 

Can medication be effective?

A recent clinical trial found that a combination of atomoxetine and oxybutynin (ato-oxy) showed potential therapeutic effects.
The trial involved 11 children with Down syndrome aged 6 to 7, randomly receiving two different doses of ato-oxy treatment, each lasting one month.

 

Trial results indicate:

Both doses of ato-oxy treatment significantly reduced the Obstructive Sleep Apnea Index. Under the low dose ato-oxy treatment, the apnea-hypopnea index (AHI) decreased from an average of 7.4 to 3.6; with the high dose, it further reduced to 3.9.

 

Additionally, ato-oxy treatment did not significantly impact sleep structure.

 

In terms of quality of life, measured by the OSA-18 scale, there was no significant difference in total scores before and after ato-oxy treatment. The most common side effects were irritability and fatigue, but these were generally mild.

 

In summary, ato-oxy treatment shows positive potential for treating OSA in children with Down syndrome.

 

 

In my opinion

The study excluded patients with grade 3 or higher tonsil enlargement and did not include patients with mild apnea (AHI < 5). Therefore, patients suitable for surgery might still need it, and it's unknown if children with mild symptoms will benefit from this treatment.
 

Moreover, the study did not have long-term follow-up, so it's unclear if a one-month treatment is sufficient or how long the effects last. However, if medication proves effective, it could potentially be used in other cases of sleep apnea caused by insufficient upper airway muscle tone, pending further research.




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