Article record

儿童阻塞性睡眠呼吸暂停：通过加权分析预测手术成功的因素

Pediatric Obstructive Sleep Apnea: Predictors of Surgical Success via Weighted Analysis.

临床研究咽喉科IF 2.3Q2

文献信息

PMID	42924857
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Zoe Zhang 查看其他 5 位作者 Austin Bridges；Varun Pasapula；Ron B Mitchell；Seckin Ulualp；Romaine F Johnson
作者单位	Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 查看其他 3 条单位信息 Texas Tech University Health Sciences Center El Paso-Paul L. Foster School of Medicine, El Paso, Texas, USA.；Department of Pediatric Otolaryngology, Children's Medical Center of Dallas, Dallas, Texas, USA.；Department of Biostatistics and Data Science, O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
期刊	The Laryngoscope
SCI 分区	Q2
IF	2.3
研究类型	临床研究 · 临床
所属专科	咽喉科

中文摘要

目的： 识别儿童因阻塞性睡眠呼吸暂停（OSA）行扁桃体切除术后手术成功的预测因素，并估计非随机进入术后多导睡眠监测（PSG）对结局关联的扭曲程度。
方法： 在四级儿童中心开展的回顾性嵌套队列研究（2016-2024）。在940例因OSA行扁桃体切除术的儿童中，389例有术前PSG，174例同时有术前和术后PSG。采用逆概率加权（IPW）校正进入随访PSG的非随机选择。手术成功定义为术后AHI < 5次/小时。
结果： 结局队列包括174例儿童（中位年龄6.0岁；62%男性；45%肥胖；中位术前AHI 16.5次/小时）。122例（70.1%）达到手术成功。随访PSG与较高的术前AHI（每增加1次/小时，OR 1.06）、医学复杂性（OR 2.22）和多种合并症（OR 1.86）相关，判别能力良好（AUROC 0.795）。在IPW校正分析中，术前AHI每增加1次/小时与手术成功几率降低相关（每增加1次/小时，OR 0.96；p < 0.001）。肥胖的估计效应在加权后增强（OR 0.53 vs 未加权0.66），但该关联未达到统计学显著性（p = 0.15）。非常严重OSA（AHI > 30）的儿童手术成功率仅为41.7%。
结论： 较高的术前AHI与扁桃体切除术后手术成功几率降低相关。加权后肥胖估计值未达到统计学显著性，但这是否反映真实无效应、把握度有限或受AHI严重程度混杂，无法从该数据集确定。对于非常严重OSA的儿童，应告知单纯手术不太可能治愈。

英文摘要

OBJECTIVE: To identify predictors of surgical success after pediatric tonsillectomy for obstructive sleep apnea (OSA) and estimate the degree to which non-random selection into postoperative polysomnography (PSG) distorts outcome associations.
METHODS: Retrospective nested cohort study at a quaternary pediatric center (2016-2024). From 940 children undergoing tonsillectomy for OSA, 389 had preoperative PSG and 174 had both preoperative and postoperative PSG. Inverse probability weighting (IPW) corrected for non-random selection into follow-up PSG. Surgical success was defined as postoperative AHI < 5 events/h.
RESULTS: The outcome cohort included 174 children (median age 6.0 years; 62% male; 45% obese; median preoperative AHI 16.5 events/h). Surgical success was achieved in 122 (70.1%). Follow-up PSG was associated with higher preoperative AHI (OR 1.06 per event/h), medical complexity (OR 2.22), and multiple comorbidities (OR 1.86), with good discrimination (AUROC 0.795). In IPW-adjusted analysis, each additional event/h of preoperative AHI was associated with lower odds of surgical success (OR 0.96 per event/h; p < 0.001). The estimated effect of obesity strengthened after weighting (OR 0.53 vs. 0.66 unweighted), though the association did not reach statistical significance (p = 0.15). Children with very severe OSA (AHI > 30) achieved success in only 41.7%.
CONCLUSION: Higher preoperative AHI was associated with lower odds of surgical success after tonsillectomy. The obesity estimate did not reach statistical significance after weighting, but whether this reflects a true absence of effect, limited power, or confounding by AHI severity cannot be determined from this dataset. Children with very severe OSA should be counseled that surgery alone is unlikely curative.