Adenotonsillectomy for childhood obstructive sleep apnoea reduces thoraco-abdominal asynchrony but spontaneous apnoeaxe2x88x92hypopnoea index normalisation does not

[摘要] The efficacy of adenotonsillectomy for treating obstructive sleep apnoea syndrome (OSAS) in children has been established; but its precise effects on inspiratory effort are not well documented.In 353 children enrolled in the Childhood Adenotonsillectomy Trial; randomised to undergo either early adenotonsillectomy (n=182) or a strategy of watchful waiting with supportive care (WWSC) (n=171); thoraco-abdominal asynchrony (TAA) was analysed during quiet; non-apnoeic and non-hypopnoeic breathing during sleep at baseline and at 7xe2x80x85months using overnight polysomnography.Children who underwent early adenotonsillectomy demonstrated a reduction in TAA post-surgery while the WWSC arm showed no change. On assessing TAA with regard to normalisation of clinical polysomnography findings at follow-up; TAA was reduced in children who had surgical resolution of OSAS (based on apnoeaxe2x80x93hypopnoea index); but not in children who displayed spontaneous normalisation of apnoeaxe2x80x93hypopnoea index. In the latter group; TAA was inversely correlated with quality of life.We conclude that adenotonsillectomy reduces TAA during quiet sleep. Monitoring of instantaneous TAA may yield additional insight in the dynamic changes of inspiratory effort. In combination with traditional indices of obstruction; TAA may more accurately characterise the degree of sleep-disordered breathing in children.

[学科分类] 呼吸医学