Adenotonsillectomy for obstructive sleep apnoea in children

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Abstract
Current treatment of sleep apnoea in children consists of largely surgical based treatments. Adenotonsillectomy is the most commonly used intervention to treat sleep apnoea in children. To determine the efficacy of adenotonsillectomy in the treatment of obstructive sleep apnoea in children. The Cochrane Airways Group Specialised Register was searched with pre‐specified terms. Searches were current as of August 2010. Randomised trials recruiting children with a diagnosis of obstructive sleep apnoea. Two reviewers examined the search results and collected data from the studies in terms of their characteristics before deciding which ones would be included in the review. One study met the review entry criteria. This study addressed the relative merits of two surgical techniques in treating OSA in children (temperature controlled radiofrequency tonsillectomy and adenoidectomy, and complete tonsillectomy and adenoidectomy). No significant difference was apparent for either symptoms or respiratory disturbance index. More children in the TCFR&A group were able to return to normal diet at seven days compared with complete T&A. No significant complications were observed in the study. One small study failed to find a difference between two surgical techniques, although return to normal diet was more frequent in the group treated by temperature controlled radiofrequency tonsillectomy and adenoidectomy. At present there is still debate as to the criteria required to diagnose significant obstructive sleep apnoea in children. Also the natural history of the condition has not been fully delineated. There is an absence of randomised controlled trials investigating the efficacy of treatment of confirmed obstructive sleep apnoea with adenotonsillectomy in children. Research is required before recommendations for the treatment of obstructive sleep apnoea in children can be formulated. The quality of research in this area could be improved with the use of sleep studies at baseline to determine the extent of severity of sleep apnoea in children who are recruited to studies in this area. Long‐term follow up is also required in order to explore the effect of adenotonsillectomy on paediatric sleep apnoea. 以扁桃腺及增殖體切除術治療兒童阻塞性睡眠窒息症 目前對兒童阻塞性睡眠窒息症(obstructive sleep apnoea)的治療大多以手術為主。其中以扁桃腺及增殖體切除術(adenotonsillectomy)為最常用的方法。 判斷以扁桃腺及增殖體切除術治療兒童阻塞性睡眠窒息症的效益。 我們以先設定之專有字彙搜尋Cochrane Airways Group Specialised Register。搜尋日期為2008年8月。 納入罹患阻塞性睡眠窒息症兒童為受試者之隨機試驗。 由兩位評論者審閱搜尋結果，並先行收集各試驗特質之數據以決定要納入哪些研究。 有一項研究符合納入標準，此項研究著眼於兩項治療兒童阻塞性睡眠窒息症的手術(?度控制射頻扁桃腺及增殖體切除術﹝temperature controlled radiofrequency tonsillectomy and adenoidectomy，簡稱TCFR&A﹞與全扁桃腺及增殖體切除術)之相對優點。兩組受試者在症狀及呼吸干擾指數(respiratory disturbance index)並無顯著差異。與接受全扁桃腺及增殖體切除術的受試者相較，TCFR&A組有較多兒童能在術後7日內回復正常飲食。兩組受試者在研究均無嚴重的併發症。 除了TCFR&A組在術後較快回復正常飲食之外，此項小規模的研究並未顯示兩種手術有任何其他的差異。兒童顯著性阻塞性睡眠窒息症的診斷標準至今仍有爭議。此一病症之自然病史仍未完全被勾畫出來。目前並未有隨機控制試驗評估扁桃腺及增殖體切除術對確認的阻塞性睡眠窒息症兒童的治療效益。必須經過更多的研究之後?能對阻塞性睡眠窒息症兒童的治療提出推薦。在治療前作仔細的睡眠檢查以確認兒童受試者睡眠窒息的嚴重程度，將可改善此領域的研究品質。要對扁桃腺及增殖體切除術對兒童睡眠窒息症的效應有更多了解，亦需作長期的追蹤。 本摘要由中國醫藥大學附設醫院陳祖裕翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 基於先前認為療效、成本效益及兒童增殖體和扁桃腺的相對較大等因素，目前對兒童阻塞性睡眠窒息症(睡眠時鼻和口的氣流減低)的首選外科治療是扁桃腺及增殖體切除術(切除增殖體和扁桃腺)。雖然有些數據指出切除部分增殖體的手術(TCFR&A)較全扁桃腺及增殖體切除術能在術後較快回復正常飲食，但卻缺少強有力的證據支持使用扁桃腺及增殖體切除術來治療兒童睡眠窒息症。目前仍有一些爭議，如對於兒童阻塞性睡眠窒息症的診斷以及未來的研究須作廣泛性檢查來作出合宜的診斷等。 Adéno-amygdalectomie dans l'apnée obstructive du sommeil chez l'enfant Actuellement, le traitement de l'apnée du sommeil chez l'enfant est principalement chirurgical. L'adéno‐amygdalectomie est l'intervention la plus fréquente pour traiter l'apnée du sommeil chez l'enfant. Déterminer l'efficacité de l'adéno‐amygdalectomie dans le traitement de l'apnée obstructive du sommeil chez l'enfant. Le registre spécialisé du groupe Cochrane sur les voies respiratoires a été consulté en utilisant des termes prédéfinis. Les recherches étaient à jour en août 2010. Les essais randomisés portant sur des enfants présentant une apnée obstructive du sommeil diagnostiquée. Deux évaluateurs ont examiné les résultats des recherches et recueilli des données concernant les caractéristiques des études avant de décider de les inclure ou non dans la revue. Une étude remplissait les critères d'inclusion dans la revue. Cette étude examinait les mérites relatifs...