Risk factors for postoperative persistence of obstructive sleep apnea in children: a systematic review and meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

NIE Xiaolu ^1,2 , LI Jianrong ² , LI Xiaodan ³ , LIU Yali ¹ ,  XU Zhifei ⁴ ,  SUN Feng ^2,5

1. Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, P.R.China;
2. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, P.R.China;
3. Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, P.R.China;
4. First Department of Pneumology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, P.R.China;
5. Center for Evidence-based Medicine, Peking University, Beijing 100191, P.R.China;

Corresponding author：

XU Zhifei, Email: zhifeixu@aliyun.com; SUN Feng, Email: sunfeng@bjmu.edu.cn

Keywords：

Obstructive sleep apnea; Postoperative persistence; Children; Risk factor; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.202104138

Video：

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Objective To systematically review the risk factors leading to postoperative persistence of children diagnosed with obstructive sleep apnea (OSA) after adenoidectomy and tonsillectomy. Methods PubMed, EMbase, The Cochrane Library, ClinicalTrials.gov, CNKI, VIP, WanFang Data and SinoMed databases were electronically searched to collect case-control studies and cohort studies related to risk factors for postoperative persistence of OSA in children from inception to July 2019. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 12 cohort studies involving 1 659 OSA patients were included. Meta-analysis results showed that the risk of postoperative persistence of OSA in children with preoperative obesity was 3.47 times higher than that in non-obese children (RR=3.47, 95%CI 2.04 to 5.92, P<0.000 01). Compared with normal-weight children, obese children had 4.11 times higher risk of postoperative residual OSA (RR=4.11, 95%CI 1.68 to 10.07, P<0.000 01).Conclusions Preoperative obesity is a risk factor for postoperative persistence of OSA in children. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verity the above conclusions.

Citation： NIE Xiaolu, LI Jianrong, LI Xiaodan, LIU Yali, XU Zhifei, SUN Feng. Risk factors for postoperative persistence of obstructive sleep apnea in children: a systematic review and meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(10): 1179-1186. doi: 10.7507/1672-2531.202104138 Copy

1.	Kaditis AG, Alonso Alvarez ML, Boudewyns A, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J, 2016, 47(1): 69-94.
2.	Tagaya M, Nakata S, Yasuma F, et al. Children with severe or moderate obstructive sleep apnoea syndrome show a high incidence of persistence after adenotonsillectomy. Acta Otolaryngol, 2012, 132(11): 1208-1214.
3.	Li AM, So HK, Au CT, et al. Epidemiology of obstructive sleep apnoea syndrome in Chinese children: a two-phase community study. Thorax, 2010, 65(11): 991-997.
4.	El-Kersh K, Cavallazzi R, Senthilvel E. Outcomes of adenotonsillectomy in severe pediatric obstructive sleep apnea. Ear Nose Throat J, 2017, 96(12): E6-E9.
5.	Cielo CM, Keenan BT, Wiemken A, et al. Neck fat and obstructive sleep apnea in obese adolescents. Sleep. 2021. DOI: 10.1093/sleep/zsab158.
6.	邹凤. 儿童阻塞性睡眠呼吸暂停低通气综合征的研究进展. 中国医药指南, 2012, 10(17): 445-446.
7.	Costa DJ, Mitchell R. Adenotonsillectomy for obstructive sleep apnea in obese children: a meta-analysis. Otolaryngol Head Neck Surg, 2009, 140(4): 455-460.
8.	Marcus CL, Moore RH, Rosen CL, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med, 2013, 368(25): 2366-2376.
9.	Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 2012, 130(3): 576-584.
10.	Brietzke SE, Gallagher D. The effectiveness of tonsillectomy and adenoidectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a meta-analysis. Otolaryngol Head Neck Surg, 2006, 134(6): 979-984.
11.	Ottawa Hospital Research Institute. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Avaiable at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
12.	Hsu WC, Kang KT, Weng WC, et al. Impacts of body weight after surgery for obstructive sleep apnea in children. Int J Obes (Lond), 2013, 37(4): 527-531.
13.	Ye J, Liu H, Zhang GH, et al. Outcome of adenotonsillectomy for obstructive sleep apnea syndrome in children. Ann Otol Rhinol Laryngol, 2010, 119(8): 506-513.
14.	Esteller Moré E, Santos Acosta P, Segarra Isern F, et al. Long-term persistence of obstructive sleep apnoea-hypopnoea syndrome in children treated with adenotonsillectomy. Analysis of prognostic factors. Acta Otorrinolaringol Esp, 2012, 63(2): 85-92.
15.	Schaeg LE, Kaiser JL, Crow ME. Telephone Screening to Identify Children at Risk for Persistent Obstructive Sleep Apnea After Adenotonsillectomy. J Pediatr Health Care, 2016, 30(6): e17-e25.
16.	Mitchell RB, Kelly J. Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg, 2007, 137(1): 43-48.
17.	郭向东, 张治成, 李莹, 等. 肥胖对儿童OSAHS手术疗效的影响. 临床耳鼻咽喉头颈外科杂志, 2014, 28(1): 29-31.
18.	王瑾, 孙欣, 李君. 手术治疗儿童阻塞性睡眠呼吸暂停综合征的疗效分析. 中国医科大学学报, 2012, 41(1): 80-82, 86.
19.	Imanguli M, Ulualp SO. Risk factors for residual obstructive sleep apnea after adenotonsillectomy in children. Laryngoscope, 2016, 126(11): 2624-2629.
20.	Tauman R, Gulliver TE, Krishna J, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr, 2006, 149(6): 803-808.
21.	Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med, 2010, 182(5): 676-683.
22.	Koren D, Gozal D, Bhattacharjee R, et al. Impact of Adenotonsillectomy on Insulin Resistance and Lipoprotein Profile in Nonobese and Obese Children. Chest, 2016, 149(4): 999-1010.
23.	O'Brien LM, Sitha S, Baur LA, et al. Obesity increases the risk for persisting obstructive sleep apnea after treatment in children. Int J Pediatr Otorhinolaryngol, 2006, 70(9): 1555-1560.
24.	王扬, 朱鲁平, 陈仁杰. 阻塞性睡眠呼吸暂停低通气综合征与肥胖相关的研究进展. 中国中西医结合耳鼻咽喉科杂志, 2019, 27(2): 156-160.
25.	彭万达. 肥胖与非肥胖OSAHS患者的临床特点与危险因素分析. 中国继续医学教育, 2017, 9(26): 45-47.
26.	张晓英, 徐佩茹, 多力坤. 儿童阻塞性睡眠呼吸暂停综合征的诊断和治疗进展. 国外医学(儿科学分册), 2004, (S1): 95-97.
27.	中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版). 中华结核和呼吸杂志, 2012, 35(1): 9-12.

1. Kaditis AG, Alonso Alvarez ML, Boudewyns A, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J, 2016, 47(1): 69-94.
2. Tagaya M, Nakata S, Yasuma F, et al. Children with severe or moderate obstructive sleep apnoea syndrome show a high incidence of persistence after adenotonsillectomy. Acta Otolaryngol, 2012, 132(11): 1208-1214.
3. Li AM, So HK, Au CT, et al. Epidemiology of obstructive sleep apnoea syndrome in Chinese children: a two-phase community study. Thorax, 2010, 65(11): 991-997.
4. El-Kersh K, Cavallazzi R, Senthilvel E. Outcomes of adenotonsillectomy in severe pediatric obstructive sleep apnea. Ear Nose Throat J, 2017, 96(12): E6-E9.
5. Cielo CM, Keenan BT, Wiemken A, et al. Neck fat and obstructive sleep apnea in obese adolescents. Sleep. 2021. DOI: 10.1093/sleep/zsab158.
6. 邹凤. 儿童阻塞性睡眠呼吸暂停低通气综合征的研究进展. 中国医药指南, 2012, 10(17): 445-446.
7. Costa DJ, Mitchell R. Adenotonsillectomy for obstructive sleep apnea in obese children: a meta-analysis. Otolaryngol Head Neck Surg, 2009, 140(4): 455-460.
8. Marcus CL, Moore RH, Rosen CL, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med, 2013, 368(25): 2366-2376.
9. Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 2012, 130(3): 576-584.
10. Brietzke SE, Gallagher D. The effectiveness of tonsillectomy and adenoidectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a meta-analysis. Otolaryngol Head Neck Surg, 2006, 134(6): 979-984.
11. Ottawa Hospital Research Institute. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Avaiable at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
12. Hsu WC, Kang KT, Weng WC, et al. Impacts of body weight after surgery for obstructive sleep apnea in children. Int J Obes (Lond), 2013, 37(4): 527-531.
13. Ye J, Liu H, Zhang GH, et al. Outcome of adenotonsillectomy for obstructive sleep apnea syndrome in children. Ann Otol Rhinol Laryngol, 2010, 119(8): 506-513.
14. Esteller Moré E, Santos Acosta P, Segarra Isern F, et al. Long-term persistence of obstructive sleep apnoea-hypopnoea syndrome in children treated with adenotonsillectomy. Analysis of prognostic factors. Acta Otorrinolaringol Esp, 2012, 63(2): 85-92.
15. Schaeg LE, Kaiser JL, Crow ME. Telephone Screening to Identify Children at Risk for Persistent Obstructive Sleep Apnea After Adenotonsillectomy. J Pediatr Health Care, 2016, 30(6): e17-e25.
16. Mitchell RB, Kelly J. Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg, 2007, 137(1): 43-48.
17. 郭向东, 张治成, 李莹, 等. 肥胖对儿童OSAHS手术疗效的影响. 临床耳鼻咽喉头颈外科杂志, 2014, 28(1): 29-31.
18. 王瑾, 孙欣, 李君. 手术治疗儿童阻塞性睡眠呼吸暂停综合征的疗效分析. 中国医科大学学报, 2012, 41(1): 80-82, 86.
19. Imanguli M, Ulualp SO. Risk factors for residual obstructive sleep apnea after adenotonsillectomy in children. Laryngoscope, 2016, 126(11): 2624-2629.
20. Tauman R, Gulliver TE, Krishna J, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr, 2006, 149(6): 803-808.
21. Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med, 2010, 182(5): 676-683.
22. Koren D, Gozal D, Bhattacharjee R, et al. Impact of Adenotonsillectomy on Insulin Resistance and Lipoprotein Profile in Nonobese and Obese Children. Chest, 2016, 149(4): 999-1010.
23. O'Brien LM, Sitha S, Baur LA, et al. Obesity increases the risk for persisting obstructive sleep apnea after treatment in children. Int J Pediatr Otorhinolaryngol, 2006, 70(9): 1555-1560.
24. 王扬, 朱鲁平, 陈仁杰. 阻塞性睡眠呼吸暂停低通气综合征与肥胖相关的研究进展. 中国中西医结合耳鼻咽喉科杂志, 2019, 27(2): 156-160.
25. 彭万达. 肥胖与非肥胖OSAHS患者的临床特点与危险因素分析. 中国继续医学教育, 2017, 9(26): 45-47.
26. 张晓英, 徐佩茹, 多力坤. 儿童阻塞性睡眠呼吸暂停综合征的诊断和治疗进展. 国外医学(儿科学分册), 2004, (S1): 95-97.
27. 中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版). 中华结核和呼吸杂志, 2012, 35(1): 9-12.

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Risk factors for postoperative persistence of obstructive sleep apnea in children: a systematic review and meta-analysis

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