title: Tailoring therapy to improve the treatment of children with obstructive sleep apnea according to grade of adenotonsillar hypertrophy.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is a common disease in children with the major causes of hypertrophy of adenoid or tonsil and nasal diseases. The treatment methods for this disease include the resection of adenoid or tonsil, and drug therapy as well. However, no agreement on the selection of treatment method is available to date.
  
  
  OBJECTIVE
  To investigate the individualized treatment methods for children with OSA with different sizes of adenoids and tonsils.
  
  
  METHODS
  Children with OSA (diagnosed by polysomnography) were included into groups A (adenoid/tonsil grade ≤III) and B (adenoid/tonsil grade=IV), and further subdivided into subgroups A1 (3-month medication), A2 (3-month medication and negative-pressure sputum aspiration [NPSA]), B1 (3-month medication plus NPSA), B2 (coblation adenotonsillectomy with preoperative/postoperative medication for 3 days/2 weeks) and B3 (coblation adenotonsillectomy with preoperative/postoperative medication for 2 weeks/3 months). Six-month outcomes included quality of life for children with obstructive sleep apnea-18 item (OSA-18), obstructive apnea index (OAI), apnea hypopnea index (AHI) and lowest oxygen saturation (LSaO2).
  
  
  RESULTS
  Three hundred and eighty six patients (310 male; 6.70±2.44 years-old) were included. Preoperative OSA-18, OAI, AHI and LSaO2 were not significantly different. At all postoperative time points, subgroup A2 had significantly lower OSA-18 than subgroup A1; postoperative improvements in OAI, AHI and LSaO2 were also superior in subgroup A2 (P<0.05). The initial decrease in OSA-18 was not maintained in subgroups B1 and B2, whereas subgroup B3 showed a sustained reduction at 6 months. OAI and AHI were more improved in subgroup B3 (P<0.05). Surgical/anesthetic complications in subgroups B2 and B3 were 5.5% and 0%.
  
  
  CONCLUSIONS
  Conservative therapy could achieve satisfactory outcomes in children with grade III hypertrophy, while surgery and drugs could achieve good outcomes in grade IV.
authors: Department of Otolaryngology, Fuzhou Children's Hospital, Fujian Medical University Hospital, Fuzhou 350005, China. Electronic address: shenlingfz@126.com.
authors: Ling
authors: L
authors: Shen
authors: Department of Otolaryngology, Fuzhou Children's Hospital, Fujian Medical University Hospital, Fuzhou 350005, China.
authors: Bolu
authors: B
authors: Zheng
authors: Department of Otolaryngology, Fuzhou Children's Hospital, Fujian Medical University Hospital, Fuzhou 350005, China.
authors: Zongtong
authors: Z
authors: Lin
authors: Department of Otolaryngology, Fuzhou Children's Hospital, Fujian Medical University Hospital, Fuzhou 350005, China.
authors: Yangyang
authors: Y
authors: Xu
authors: Department of Otolaryngology, Fuzhou Children's Hospital, Fujian Medical University Hospital, Fuzhou 350005, China.
authors: Zhongjie
authors: Z
authors: Yang
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects*; D000234:Adenoids / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology* / Q000601:surgery; D017286:Polysomnography; D011788:Quality of Life; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000628:therapy*; D014068:Tonsillectomy / Q000009:adverse effects*
keywords: Child; Drug therapy; Obstructive sleep apnea; Polysomnography; Surgery