DOI QR코드

DOI QR Code

학령 전기 폐쇄수면무호흡증과 재발성부비동염

Factors associated with chronic and recurrent rhinosinusitis in preschool children with obstructive sleep apnea syndrome

  • 윤형호 (을지대학교 을지병원 소아청소년과) ;
  • 안영민 (을지대학교 을지병원 소아청소년과) ;
  • 김현정 (을지대학교 을지병원 소아청소년과)
  • Yun, Hyung Ho (Department of Pediatrics, Nowon Eulji Medical Center, Eulji University) ;
  • Ahn, Young Min (Department of Pediatrics, Nowon Eulji Medical Center, Eulji University) ;
  • Kim, Hyun-Jung (Department of Pediatrics, Nowon Eulji Medical Center, Eulji University)
  • 투고 : 2017.09.12
  • 심사 : 2017.10.28
  • 발행 : 2018.05.31

초록

Purpose: Obstructive sleep apnea syndrome (OSAS) in young children is frequently caused by adenoid and/or tonsillar hypertrophy. Adenoidectomy is the first operative method for childhood chronic rhinosinusitis (CRS). We investigated factors associated with recurrent rhinosinusitis in preschool aged children with OSAS to determine the association of 2 common diseases. Methods: One hundred forty-six children aged 2-5 years who were diagnosed as having OSAS after polysomnography between December 2003 and April 2016 were enrolled in this study. Children were divided into 2 groups with and without CRS. The 2 groups were compared in the severity of OSAS and allergy diseases and were evaluated for recurrent rhinosinusitis during the follow-up period, 1 year after diagnosis. Results: Among 108 patients with OSAS who were followed up, 81 patients (75%) were diagnosed with CRS. There were no significant difference clinical and allergic characteristics between groups with and without CRS. However, bronchial asthma and otitis media was significantly more prevalent in patients with CRS than in those without (P= 0.045 and P= 0.000, respectively). Bronchial asthma and adenotonsillectomy was significantly associated with recurrent rhinosinusitis (P= 0.005 and P= 0.04, respectively) during the 1-year follow-up. Conclusion: Approximately 75% of preschool children with OSAS have suffered from CRS. Bronchial asthma is associated with CRS among OSAS children. Recurrent rhinosinusitis is decreased after adenotonsillectomy, and bronchial asthma is an associated factor for recurrent rhinosinusitis after a follow-up. This close relationship childhood OSAS and recurrent rhinosinusitis/bronchial asthma needs further studies to investigate their role in the association.

키워드

참고문헌

  1. Castronovo V, Zucconi M, Nosetti L, Marazzini C, Hensley M, Veglia F, et al. Prevalence of habitual snoring and sleep-disordered breathing in preschool-aged children in an Italian community. J Pediatr 2003;142:377-82. https://doi.org/10.1067/mpd.2003.118
  2. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012;130:e714-55. https://doi.org/10.1542/peds.2012-1672
  3. Choi SH, Han MY, Ahn YM, Park YM, Kim CK, Kim HH, et al. Predisposing factors associated with chronic and recurrent rhinosinusitis in childhood. Allergy Asthma Immunol Res 2012;4:80-4. https://doi.org/10.4168/aair.2012.4.2.80
  4. Gozal D, Kheirandish-Gozal L. New approaches to the diagnosis of sleep-disordered breathing in children. Sleep Med 2010;11:708-13. https://doi.org/10.1016/j.sleep.2009.12.012
  5. Deniz M, Gultekin E, Ciftci Z, Alp R, Ozdemir DN, Isik A, et al. Nasal mucociliary clearance in obstructive sleep apnea syndrome patients. Am J Rhinol Allergy 2014;28:178-80. https://doi.org/10.2500/ajra.2014.28.4094
  6. American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 2nd ed. Westchester (IL): American Academy of Sleep Medicine, 2012.
  7. Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol 2005;116(6 Suppl):S13-47. https://doi.org/10.1016/j.jaci.2005.09.048
  8. Chandran SK, Higgins TS. Chapter 5: Pediatric rhinosinusitis: definitions, diagnosis and management--an overview. Am J Rhinol Allergy 2013;27 Suppl 1:S16-9. https://doi.org/10.2500/ajra.2013.27.3896
  9. Pedersen SE, Hurd SS, Lemanske RF Jr, Becker A, Zar HJ, Sly PD, et al. Global strategy for the diagnosis and management of asthma in children 5 years and younger. Pediatr Pulmonol 2011;46:1-17.
  10. Arens R, Sin S, Willen S, Bent J, Parikh SR, Freeman K, et al. Rhino-sinus involvement in children with obstructive sleep apnea syndrome. Pediatr Pulmonol 2010;45:993-8. https://doi.org/10.1002/ppul.21284
  11. Kirk V, Baughn J, D'Andrea L, Friedman N, Galion A, Garetz S, et al. American academy of sleep medicine position paper for the use of a home sleep apnea test for the diagnosis of OSA in children. J Clin Sleep Med 2017;13:1199-203. https://doi.org/10.5664/jcsm.6772
  12. Aitken M, Taylor JA. Prevalence of clinical sinusitis in young children followed up by primary care pediatricians. Arch Pediatr Adolesc Med 1998;152:244-8.
  13. Huang SW, Giannoni C. The risk of adenoid hypertrophy in children with allergic rhinitis. Ann Allergy Asthma Immunol 200187:350-5. https://doi.org/10.1016/S1081-1206(10)62251-X
  14. Kohler MJ, van den Heuvel CJ. Is there a clear link between overweight/obesity and sleep disordered breathing in children? Sleep Med Rev 2008; 12:347-61. https://doi.org/10.1016/j.smrv.2008.04.008
  15. Bonuck KA, Freeman K, Henderson J. Growth and growth biomarker changes after adenotonsillectomy: systematic review and meta-analysis. Arch Dis Child 2009;94:83-91.
  16. Suzuki M, Watanabe T, Mogi G. Clinical, bacteriological, and histological study of adenoids in children. Am J Otolaryngol 1999;20:85-90. https://doi.org/10.1016/S0196-0709(99)90016-9
  17. Lombardi E, Stein RT, Wright AL, Morgan WJ, Martinez FD. The relation between physician-diagnosed sinusitis, asthma, and skin test reactivity to allergens in 8-year-old children. Pediatr Pulmonol 1996;22:141-6. https://doi.org/10.1002/(SICI)1099-0496(199609)22:3<141::AID-PPUL1>3.0.CO;2-S
  18. Gutman M, Torres A, Keen KJ, Houser SM. Prevalence of allergy in patients with chronic rhinosinusitis. Otolaryngol Head Neck Surg 2004;130: 545-52. https://doi.org/10.1016/j.otohns.2004.02.007
  19. Berrettini S, Carabelli A, Sellari-Franceschini S, Bruschini L, Abruzzese A, Quartieri F, et al. Perennial allergic rhinitis and chronic sinusitis: correlation with rhinologic risk factors Allergy 1999;54:242-8. https://doi.org/10.1034/j.1398-9995.1999.00813.x
  20. Kim EJ, Kwon JW, Lim YM, Yoon D, Seo JH, Chang WS, et al. Assessment of total/specific IgE levels against 7 inhalant allergens in children aged 3 to 6 years in Seoul, Korea. Allergy Asthma Immunol Res 2013;5: 162-9. https://doi.org/10.4168/aair.2013.5.3.162
  21. Huang SW. The risk of sinusitis in children with allergic rhinitis. Allergy Asthma Proc 2000;21:85-8. https://doi.org/10.2500/108854100778250905
  22. Leo G, Piacentini E, Incorvaia C, Consonni D, Frati F. Chronic sinusitis and atopy: a cross-sectional study. Eur Ann Allergy Clin Immunol 2006; 38:361-3.
  23. Tuncer U, Aydogan B, Soylu L, Simsek M, Akcali C, Kucukcan A. Chronic rhinosinusitis and adenoid hypertrophy in children. Am J Otolaryngol 2004;25:5-10. https://doi.org/10.1016/j.amjoto.2003.10.003
  24. Kao LT, Hung SH, Lin HC, Liu CK, Huang HM, Wu CS. Obstructive sleep apnea and the subsequent risk of chronic rhinosinusitis: a population-based study. Sci Rep 2016 10;6:20786.
  25. Prasad B, Nyenhuis SM, Weaver TE. Obstructive sleep apnea and asthma: associations and treatment implications. Sleep Med Rev 2014;18:165-71. https://doi.org/10.1016/j.smrv.2013.04.004
  26. Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 2010;182:676-83. https://doi.org/10.1164/rccm.200912-1930OC
  27. Anfuso A, Ramadan H, Terrell A, Demirdag Y, Walton C, Skoner DP, et al. Sinus and adenoid inflammation in children with chronic rhinosinusitis and asthma. Ann Allergy Asthma Immunol 2015;114:103-10. https://doi.org/10.1016/j.anai.2014.10.024
  28. Ponikau JU, Sherris DA, Kephart GM, Kern EB, Gaffey TA, Tarara JE, et al. Features of airway remodeling and eosinophilic inflammation in chronic rhinosinusitis: is the histopathology similar to asthma? J Allergy Clin Immunol 2003;112:877-82. https://doi.org/10.1016/j.jaci.2003.08.009
  29. Jiang RS, Liang KL, Hsin CH, Su MC. The impact of chronic rhinosinusitis on sleep-disordered breathing. Rhinology 2016;54:75-9. https://doi.org/10.4193/Rhin15.204
  30. Gozal D, Serpero LD, Sans Capdevila O, Kheirandish-Gozal L. Systemic inflammation in non-obese children with obstructive sleep apnea. Sleep Med 2008;9:254-9. https://doi.org/10.1016/j.sleep.2007.04.013
  31. Huo Z, Shi J, Shu Y, Xiang M, Lu J, Wu H. The relationship between allergic status and adenotonsillar regrowth: a retrospective research on children after adenotonsillectomy. Sci Rep 2017;7:46615. https://doi.org/10.1038/srep46615
  32. Meng W, Zhou W, Li G, Zhagn Q, Li G, Zhou H, et al. The analysis of surgery effect of OSAHS children accompanied with sinusitis. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014;28:462-4.