Reasons of multiple operations in children with airway foreign body / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the reasons of multiple operations in children with airway foreign body through analyzing the clinical data of children who received two or more operations.</p><p><b>METHODS</b>From 2003 to 2009, all children with airway foreign body who received two or more operations in hospital were enrolled. The clinical manifestations, image before and after operation and intraoperative conditions were retrospectively analyzed, in order to find the reasons of multiple operations.</p><p><b>RESULTS</b>All children fully recovered, no serious complications or death. The reasons of two or more operations were multiple: 21 cases (42.8%) were related to the factor of apparatus, 20 (40.8%) cases were related to the quality, surrounding conditions and location of the foreign body and experience and surgical skills of operator, 4 (8.2%) cases were due to incarceration of foreign body, another 4 (8.2%) cases were due to unstable intraoperative oxygen saturation.</p><p><b>CONCLUSIONS</b>Both subjective and objective factors (quality, surrounding conditions or location of foreign body, et al) were related to multiple operations. To reduce the chance of multiple operations, careful preoperative assessment and preparation are necessary.</p>

Correlation between serum uric acid levels and obstructive sleep apnea/hypopnea syndrome in children / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the level of serum uric acid (UA) in children with obstructive sleep apnea/hypopnea syndrome (OSAHS).</p><p><b>METHOD</b>Between Sep. 2008 and Mar. 2010, 138 children with OSAHS were enrolled in study group. Sixty-five children with accessory auricle or ptosis of upper lid were enrolled into the control group. Furthermore, according to apnea/hypopnea index (AHI) or obstructive apnea index (OAI) the study group was further divided into three subgroups (mild, moderate and severe group). At last, the study group and control group were divided into two groups according to the body mass index (BMI), separately. The fasting serum UA level was compared among the different groups. Then the correlation between the serum UA level and AHI, BMI, oxygen desaturation index, least arterial oxygen saturation (LSaO(2)) and the percentage of total sleep time with arterial oxygen saturation < 0.92 was also analyzed in OSAHS children with or without overweight and obesity respectively.</p><p><b>RESULT</b>The difference of serum UA level between the study group and control group (z = -0.443), and the difference among the three groups (χ(2) = 1.241) was not significant(P > 0.05). The serum UA level in overweight and obese children [study group, 273.0 (238.3 - 357.3); control group, 298.0 (253.0 - 336.0)] was significantly higher than that in children with normal BMI [study group, 246.5(215.8 - 300.0); control group, 266.0 (224.0 - 303.3)] (z = -2.084, -2.214, P < 0.05). That serum UA level did not correlate with the above index of OSAHS was observed in children with or without overweight and obesity in study group (P > 0.05).</p><p><b>CONCLUSION</b>Findings of higher serum UA level were not observed in children with OSAHS. There was no correlation between serum UA level and the above indices of OSAHS. The serum UA level in overweight and obese children was significantly higher than that in children with normal BMI.</p>

Study on periodic limb movement during sleep in children with sleep-disordered breathing / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the correlation between periodic limb movement index (PLMI) and the apnea-hypopnea index (AHI), apnea index (AI), hypopnea index (HI) and lowest oxygen saturation (LSaO₂) in sixty-four children with sleep-disordered breathing (SDB).</p><p><b>METHODS</b>Between March 2008 and May 2009, sixty-four children suspected of OSAHS underwent overnight polysomnogram monitoring in our medicine sleep center. OSAHS was diagnosed according to the general criterion. Sixty-four children were divided into two groups. Thirty children were diagnosed as OSAHS and 34 children were diagnosed as primary snoring (PS, 32 children) or upper airway resistance syndrome (UARS, 2 children). The difference of PLMI and periodic limb movement index during sleep associated with arousals (PLMI-arousal) were compared between the two groups. Besides this, the correlation between PLMI, periodic limb movement index during sleep associated with arousals and AHI, AI, HI and LSaO₂ were also analyzed in all SDB children. Furthermore, all SDB children were divided into two groups according to PLMI (< 5 events/h vs ≥ 5 events/h). AHI, AI, HI, LSaO₂ and sleep structure were compared between the two groups.</p><p><b>RESULTS</b>(1) The difference of PLMI and PLMI-arousal between the children with OSAHS and children with other SDB types (PS and UARS) were not significant (z value, -1.279, -1.490; P value, 0.201, 0.136, respectively). (2) The increased sleep stage I was significant as being compared between the two groups (< 5 events/h vs ≥ 5 events/h, t = -2.16, P < 0.05). However, other sleep stages and sleep efficiency were not significantly different (P value, all > 0.05). (3) The difference of HI, AI, AHI, arousals index (ArI) and LSaO₂ were not significant between the two groups (< 5 events/h vs ≥ 5 events/h, P value, all > 0.05). (4) PLMI and PLMI-arousal were not correlated with AHI, HI, AI, AHI and LSaO₂ (Spearman rank correlation analysis).</p><p><b>CONCLUSIONS</b>PLMS may be independent of SDB and PLMS had a little influence on sleep structure.</p>

A preliminary study of the secondary postoperative haemorrhage in pediatric coblation adenotonsillectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare secondary postoperative haemorrhage rate of coblation with the conventional pediatric adenotonsillectomy. And to analyze possible reasons which cause the secondary bleeding after coblation adenotonsillectomy.</p><p><b>METHODS</b>A retrospective study was applied to compare the secondary postoperative haemorrhage rate and the bleeding moment between two groups in which 1-14 years old children from April 2005 to September 2009 in Guangzhou Children's Hospital were included. Group A was pediatric patients who had conventional adenoidectomy and/or tonsillectomy (dissection, without heat damage to the tissue) from April 2005 to July 2006 in Department of Otorhinolaryngology. Group B was pediatric patients who had coblation adenoidectomy and/or tonsillectomy from April 2008 to September 2009 in Department of Otorhinolaryngology.</p><p><b>RESULTS</b>Two of 484 cases in group A had secondary postoperative bleeding, the rate was 0.4%. One happened 2 days after operation, another after 3 days. Eleven of 502 cases in group B had secondary postoperative bleeding, the rate was 2.2%. Secondary bleeding happened 2 to 12 days after surgery, median 6.0 days. The secondary postoperative haemorrhage rate of operating by the freshman was 2.6%(10/385), and it was 0.9%(1/117) by the senior. The rate of secondary bleeding was higher in group B than group A (chi(2) = 5.987, P < 0.05). There was no significant difference of secondary bleeding time in both groups (Mann-Whitney U score was 2.500, P > 0.05). Six of 13 cases who had secondary bleeding suffered wound or upper respiratory tract infection. Three of 13 ate inappropriately after the operation.</p><p><b>CONCLUSIONS</b>Pediatric coblation adenotonsillectomy is a new method. The most possible reasons of secondary bleeding are poor surgery skills and ill experience. And, infection, inappropriate eating after the operation may be the other reasons of secondary bleeding.</p>

Diagnostic role of pulse transit time in children with sleep disordered breathing / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the diagnostic value of pulse transit time (PTT) in children with sleep disordered breathing(SDB).</p><p><b>METHODS</b>Forty eight randomly selected snorers (2 - 13 years) with SDB were examined by PSG and PTT in the same time. Data obtained were analyzed by different technicians respectively. Statistics and analysis of the data were performed.</p><p><b>RESULTS</b>Apnea hypopnea index (AHI), obstructive apnea index (OAI), the lowest oxygen and micro-arousal index were obtained by PSG and PTT. The results was described as M [25 percentile; 75 percentile]: 4.9[1.3;10.1], 4.6[1.5;11.8]; 1.2[0.7;4.9], 1.3[0.6;5.0]; 0.93[0.85;0.95], 0.93[0.84;0.95]; 14.5[12.6;16.4], 26.0[17.4;30.6]. The difference of AHI, OAI, and the lowest oxygen were not significant (P > 0.05), while the PTT arousal index detection rate was higher than PSG (Z = -5.19, P < 0.01). There was no significant difference in the diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) and determination of degree of patient's condition (P > 0.05). PTT could identify upper airway resistance syndrome in children without OASHS.</p><p><b>CONCLUSIONS</b>Both methods can be used to diagnose SDB. However, PTT is easy to use and suitable for the diagnosis of SDB in children, especially for UARS.</p>

Clinical analysis of upper airway resistance syndrome and obstructive sleep apnea-hypopnea syndrome in children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the similarities and differences of the clinical manifestations between the children with upper airway resistance syndrome (UARS) and obstructive sleep apnea-hypopnea syndrome (OSAHS), and to explore the clinical features and characteristics of sleep respiratory parameters.</p><p><b>METHODS</b>Using the double-blind method, all children were diagnosed as UARS or OSAHS through the polysomnography test and the results of all children were analyzed by a sleep technician and an otolaryngologist. Another ENT doctor recorded their clinical and physical examination in detail.</p><p><b>RESULTS</b>Polysomnography showed that the apnea-hypopnea index (AHI) and the lowest oxygen in 253 children with OSAHS were 3.60[2.00;7.55] times/h and 0.90[0.85;0.91], and were 0.90[0.50;1.10] times/h and 0.95[0.92;0.96] in 102 children with UARS, the difference of the two groups by rank test was statistically significant. The proportion of UARS and OSAHS was more common during preschool period than during school-age period. The chief complaint in two groups was sleep snoring, and the main symptoms were sleep restless, attention deficit/hyperactivity and breath with mouth open. The incidence rate of above symptoms were as follows, 94.1%, 72.5%, 62.7% and 37.3% in children with UARS, 92.9%, 78.7%, 57.7% and 45.5% in children with OSAHS. The difference was not significant by chi-square test (P>0.05). Tonsil and adenoid hypertrophy were also observed in the two groups, the difference was not significant (chi2 = 0.27, P= 0.87). However, the children with OSAHS were more apt to have the sleep apnea than with UARS, the difference was statistically significant (chi2 = 34.07, P<0.001).</p><p><b>CONCLUSIONS</b>The clinical manifestations of two groups are similar, the difference between UARS and OSAHS can not be determined by the patient's clinical performance. Sleep apnea can be more easily observed in children with OSAHS than that in UARS, the final diagnosis is based on polysomnography.</p>

Comparison of the sleep architecture and symptom of inattention-hyperactivity in children with obstructive sleep apnea hypopnea syndrome before and after surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the symptoms of inattention, hyperactivity among obstructive sleep apnea hypopnea syndrome (OSAHS) children, also to investigate the effects of surgery (tonsillectomy and adenoidectomy or adenoidectomy alone) on the changes of sleep architecture and inattention-hyperactivity score (IHS).</p><p><b>METHODS</b>Between June 2004 and may 2007, eighty children diagnosed as OSAHS with overnight polysomnography (PSG) were included in this study, only sixteen children had complete pre-op and post-op PSG data. Thirty children with vocal cord nodules were selected as control group. DSM-IV-derived IHS was evaluated by neurologist. All OSAHS children accepted surgery (tonsillectomy and adenoidectomy or adenoidectomy alone) and IHS evaluation. The pre-op and post-op sleep architecture and IHS were compared with that of control group.</p><p><b>RESULTS</b>(1) The median IHS 80 OSAHS children was higher than that it in control group (0.89 vs 0.17) and the difference was significant (Z = -4. 276, P < 0.05). After surgery, it showed a significant reduction in IHS (0.44 vs 0.89, t = 6.219, P < 0.05). (2) Twenty-five OSAHS children had pre-op IHS greater than 1.25 and nine had post-op IHS greater than 1.25, while only three children in control group had IHS greater than 1.25. The difference was statistically significant (chi2 = 5.192, 9.56 respectively, P < 0.05). (3) For sixteen OSAHS children who had both pre-op and post-op PSG data, a decrease in the percentage of phase 1 sleep and an increase in the percentage of phase 2 sleep, slow wave sleep (SWS) and rapid eye movement (REM) sleep were observed in six months after surgery and the difference was significant (t = 12.2, -5.4, -6.3, - 8.1 respectively, P < 0.001). After surgery, apnea-hypopnea index (AHI) decreased from 13.9 times/h to 1.5 times/h while lowest saturation of blood oxygen (LSaO2) increased from 0.855 to 0.940 (t = 5.3, - 3.7 respectively, P < 0.01). REM sleep percentage and LSaO2 was still lower than that of control group six months after surgery.</p><p><b>CONCLUSIONS</b>Children with OSAHS showed significantly impaired attention and hyperactivity as compared with control group. Improvement of behavior and sleep architecture were observed after adenoidectomy and tonsillectomy.</p>

Diagnosis and treatment of obstructive sleep apnea hypopnea syndrome in children with risk factors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyse the clinical features of children with obstructive sleep apnea-hypopnea syndrome (OSAHS), accompanying with risk factors.</p><p><b>METHODS</b>The clinic data of 19 patients treated in the Department of Otorhinolaryngology of Guangzhou Children's Hospital between January 2005 to January 2008 were investigated retrospectively. Among them, 5 were < 2 years old, 6 with craniofacial deformity: small mandible and (or) mandibular retrusion (5 cases), transverse facial cleft (1 case), Down's syndrome (2 cases), cerebral palsy (2 cases), chronic bronchitis (3 cases) and mucopolysaccharidoses (1 case). Nineteen patients with symptoms of snoring, mouth breathing, were diagnosed as OSAHS by polysomnography (PSG) and treated by tonsillectomy and (or) adenoidectomy in hospital. All patients were closely followed-up.</p><p><b>RESULTS</b>Fourteen patients underwent PSG 6 months to 1 year after operation, 11 patients recovered, the median [percentiles 25; percentiles 75] apnea-hypopnea index (AHI) decreased from the pre-operative 22.5 [16.5; 24.3] times/h to 2.0 [1.5; 4.3] times/h, and the lowest oxygen saturation (LSaO(2)) before operation was 0.63, and was higher than 0.92 after operation, 1 case accompanying with chronic bronchitis, the pulmonary hypertension was improved after operation. One case with Down's syndrome was not significantly improved, preoperative AHI and LSaO(2) was 22.4 times/h and 0.67, and after operation was 14.2 and 0.84; 2 cases accepted adenoidectomy only, snoring, mouth breathing reappeared 3 months after operation, pre-operative PSG results showed AHI 24.6 times/h and 26.6 times/h, LSaO(2) was 0.69 and 0.73, after operation the AHI was 10.6 times/h and 8.5 times/h, LSaO(2) was 0.90 and 0.88, the symptoms disappeared after adenotonsillectomy. Five cases did not have PSG because they lived far away in the other cities, their pre-operative PSG showed AHI 16.4 to 26.2 times/h, LSaO(2) was 0.65 to 0.76. One year after operation, these patients were followed-up by telephone, 4 children were significantly improved, 1 case with mandibular symptoms showed no improvement.</p><p><b>CONCLUSIONS</b>For OSAHS children accompanying with risk factors, if they have adenoid and tonsil hypertrophy, adenotonsillectomy is the major treatment. Because of the existence of risk factors, perioperative risk increased, even the failure of operation. so these patients must be comprehensively assessed before operation. Satisfied results can be achieved by close observation after operation and management of complications as soon as possible.</p>

Arousals in children with obstructive sleep apnea-hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the difference of arousal index between the children with obstructive sleep apnea-hypopnea syndrome (OSAHS) and children with primary snoring. Furthermore, to explore the correlation between the above mentioned arousals and the apnea-hypopnea index (AHI) and lowest oxygen saturation (LSaO(2)).</p><p><b>METHODS</b>Between March 2007 and February 2008, 102 children suspected of OSAHS underwent overnight polysomnogram monitoring in our medicine sleep center. OSAHS was diagnosed according to the general criterion [Draft of guidelines for the diagnosis and treatment of pediatric sleep apnea hypopnea syndrome (Urumqi) which was published in Chin J Otorhinolaryngol Head Neck Surg in February, 2007]. One-hundred and two children were divided into two groups according to the guidelines. Sixty six children [56 boys, 10 girls; aged 4 - 17 years, (7.01 +/- 2.24) years (x(-) +/- s)] who were diagnosed as OSAHS were enrolled in study group and 36 children [29 boys, 7 girls; aged 4 - 13 years, (7.44 +/- 2.68) years] who were diagnosed as primary snoring made up control group. The difference of spontaneous arousal index, total arousal index and arousal index related to respiratory stimuli and limb movement were compared between the two groups. Besides this, the correlation between spontaneous arousal index, total arousal index and arousal index related to respiratory stimuli and limb movement and AHI and LSaO(2) were also analyzed. Furthermore, the study group were divided into three subgroups according to AHI (< or = 10 times/h, 10 times/h < AHI < or = 20 times/h, > 20 times/h). Spontaneous arousal index, total arousal index and arousal index related to respiratory stimuli and limb movement were compared among the three groups.</p><p><b>RESULTS</b>The increased total arousal index and arousal index related to respiratory stimuli and the decreased spontaneous arousal index of study group were significant as compared to those of control group (Mann-Whitney U, z value, -3.148, -3.866, -2.791; P value, 0.002, 0.000, 0.005, respectively). The increased arousal index related to respiratory stimuli were significant as being compared among the three groups. Arousal index related to respiratory stimuli was correlated with AHI (coefficient correlation: 0.734, P = 0.000). Other kinds of arousals and arousal index related to respiratory stimuli were not correlated with LSaO(2) (Spearman rank correlation analysis). When compared to control group, stage I increased and stage REM decreased and the difference was significant (z were -2.423, -3.519; P were 0.015, 0.000).</p><p><b>CONCLUSIONS</b>The arousal index related to respiratory stimuli were increased and spontaneous arousal index were decreased in children with OSAHS. Arousal index related to respiratory stimuli is more suitable to show the degree of sleep fragment than other arousal index.</p>

Analyses of polysomnogram in children suspected of obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze polysomnogram characteristics of children with suspected obstructive sleep apnea hypopnea syndrome (OSAHS) and to explore the role of obstructive apnea index (OAI), apnea hypopnea index (AHI) and arousal index for pediatric OSAHS diagnosis.</p><p><b>METHODS</b>Sixty one suspected pediatric OSAHS cases had overnight polysomnography for at least 8 h in a quiet, dark room. Sleep studies were interpreted according to diagnostic criteria of Guangzhou Children's Hospital (Obstructive apnea was defined as cessation of nose and mouth airflow, while the respiratory effort continues for any duration. Hypopnea was defined as reduction of oronasal flow > 50% accompanied by a desaturation of 0. 04 or greater) and Urumqi diagnostic criteria (Obstructive apnea was defined as cessation of airflow at the nose and the mouth, while the respiratory effort continues for at least two breaths. Hypopnea was defined as reduction of oronasal flow > 50% accompanied by a desaturation of more than 0.03, or/and by an arousal) respectively. The OAI, AHI and arousal index were recorded and analyzed according to the two different diagnostic criteria respectively.</p><p><b>RESULTS</b>(1) Forty - one children (67.2%) had 206 obstructive apneas. Fifty - four children (88.5%) had 2249 obstructive hypopneas. Apnea - hypopnea events mainly occurred during rapid eye movement sleep. (2) OAI and AHI were analyzed by diagnostic criteria of Guangzhou Children's Hospital and Urumqi diagnostic criteria respectively. OAI < 1 was observed in 68. 9% and 75.4% children respectively and AHI < 5 occurred in 34.4% and 24.6% children respectively. (3) Statistically significant difference found between spontaneous arousal index and respiratory - related arousal index (z = -5.787, P = 0.000).</p><p><b>CONCLUSIONS</b>As the criteria of pediatric OSAHS, arbitrary OAI number should be determined on the basis of large sample investigation, the significance of spontaneous arousal index still needs further investigation.</p>