【Abstract】Objective:To investigate the clinical manifestations and treatment methods of obstructive sleep apnea hypoventilation syndrome (OSAHS) in children. METHODS:We reviewed and analyzed the clinical characteristics and treatment methods of 110 children diagnosed with OSAHS in our hospital, and evaluated their efficacy. Results: The main symptoms of OSAHS in children are snoring and open-mouth breathing during sleep, and there are not many cases of apnea. 110 cases of snoring and apnea basically disappeared after surgery, with a cure rate of 93.6%. 4 cases were combined with middle-ear effusion, with a cure rate of 100%, and 20 cases were cured of nasal congestion and nasal secretions, with a cure rate of 100%. Conclusion: Children’s OSAHS has its own characteristics, adenoid and tonsil resection is the main treatment method, and the cure rate is satisfactory. 【Keywords】sleep apnea, children, polysomnography, adenoidectomy, tonsillectomy Children’s OSAHS is gradually being paid attention to, and children’s OSAHS has its own characteristics, which is obviously different from adults. Now, 110 cases of children diagnosed with OSAHS in our hospital from 2006, 8 to 2008, 8 are analyzed and reported as follows. 1, clinical information and methods 1, 1 general information in this group, 72 cases of male and 38 cases of female. Age maximum 15 years old, minimum 2,5 years old, average 8,8 years old. Age distribution, 2 cases below 3 years old, 12 cases 3-5 years old, 88 cases 5-10 years old, 18 cases above 10 years old. There were 36 cases of sleep snoring and open-mouth breathing. 50 cases with enlarged tonsils. There were 20 cases with nasal congestion and nasal discharge, and 4 cases with hearing loss. 12 The diagnosis of OSAHS in children is based on snoring during sleep, open-mouth breathing, and enlarged tonsils or adenoids as the clinical diagnosis. Tonsillar hypertrophy was defined as tonsils over II degrees and adenoid hypertrophy was measured by lateral nasopharyngeal x-ray. The vertical distance from the most prominent point of the adenoids to the bone surface of the skull base is the thickness of the adenoids (A), and the distance between the posterior end of the hard palate to the intersection of the pterygoid plate and the skull base is the width of the nasopharynx (N), and pathologic hypertrophy is defined as pathological hypertrophy if the ratio of A/N is R0,71. Fiber laryngoscope or nasal endoscopy to check the degree of adenoid blockage of the posterior nostril, blockage more than 50% is adenoid hypertrophy. 1,3 Treatment Surgery was performed under general anesthesia with tracheal intubation.10 cases of simple adenoidectomy were performed. First, two rubber catheters were used to reach the oropharyngeal cavity through the nasal cavity to the outside of the mouth, pulling the soft palate tightly and fixing it with vascular forceps, and the size of adenoids and nasopharyngeal part was clearly seen under the guidance of 70-degree nasal endoscopy, and a suitable adenoidal spatula was used to scrape the adenoids, which could be scraped in several times. Postoperatively with saline gauze compression hemostasis compression, if there are obvious bleeding points, can be used double plate electrocoagulation hemostasis. An infusion tube was applied to the surface of the curved suction head and extended to the bleeding site to stop bleeding. Another 100 cases of adenoid scraping and tonsillectomy were performed. Adenoid scraping was performed first, and postoperative hemostasis was achieved with saline gauze compression, while tonsillectomy was performed at the same time. Bleeding from tonsillectomy was stopped by double-plate electrocoagulation or suture to stop bleeding. Postoperative removal of nasopharyngeal gauze, no bleeding surgery was completed. 2.Results 110 cases underwent surgical treatment, of which 10 cases underwent simple adenoidectomy, and the remaining 100 cases underwent adenoidectomy and tonsillectomy. After the operation, snoring disappeared in 105 cases, with a cure rate of 93.6%. 4 cases of combined middle ear effusion underwent middle ear puncture, and all of them were cured after the operation, with a cure rate of 100%. 20 cases of nasal congestion and nasal secretion were cured in all cases, with a cure rate of 100%. 3 cases of postoperative hemorrhage, accounting for 1.8%. 1 case of adenoidectomy and unilateral tonsillectomy was performed one year after the operation, and then the other side of tonsils was performed again, and the symptoms disappeared after the operation. One case of adenoidectomy with unilateral tonsillectomy was performed one year after the operation, and the symptoms recurred one year after the operation. Discussion 3.1 Clinical characteristics of children’s OSAHS Children’s OSAHS is different from adults. Children’s OSAHS is characterized by snoring and open-mouth breathing during sleep, with very few daytime sleepiness and low apnea. In this data, none of the 110 children had daytime sleepiness, but most of them had daytime inattention. In addition, the obstruction site of children’s OSAHS is different from that of adults, and the obstruction site of children’s OSAHS is in the adenoids and tonsils. In adults, the obstruction site is in the plane of the soft palate or the root of the tongue. 3,2 Diagnosis of OSAHS in children Diagnosis of OSAHS is currently based on polysomnography (PSG) and can be performed at any age. Diagnosis is made when two of the following are met: (1) Obstructive apnea index greater than 1 apnea/h or apnea hypopnea index greater than 5 apneas/h during 7 hours of sleep at night.(2) Minimum arterial oxygen saturation less than 0, 92,. Children are sometimes uncooperative or some units do not have polysomnography, so the Chinese Medical Association Otolaryngology Branch in the development of guidelines for obstructive sleep apnea hypopnea syndrome in children [1], it is stated that children who do not have the conditions to perform a PSG examination can be referred to the history, physical examination, nasopharyngeal X-lateral radiographs, nasopharyngeal endoscopy, and snoring recordings to assist in the diagnosis. 3,3 The cause of OSAHS in children is adenoid and tonsil hypertrophy, so the treatments are adenoid curettage and tonsil removal. There are many methods of adenoid curettage. Our method is to use a rubber tube to penetrate into the oropharyngeal cavity through the nasopharynx, pull up the soft palate, and remove the adenoids with an adenoidal spatula under a 70° endoscope. In our experience, this method provides a clear view of any part of the nasopharynx and the posterior part of the nasal septum, leaving no dead space. The nasopharynx becomes shallow after the soft palate is pulled up, so it is easier to scrape the adenoids with a spatula, which is a better method. If combined with tonsil removal, we first do adenoid scraping, after surgery, we use gauze to compress the nasopharynx to stop bleeding, we withdraw the rubber tube to do tonsil removal, and at the end of the tonsil surgery, we remove the gauze from the nasopharynx, and if there is no bleeding, the surgery is over. This saves surgical time, the adenoids are compressed for a long time, and the bleeding is stopped completely. Adenoid surgery is generally less chance of bleeding, if the adenoid hemorrhage is encountered during the operation can be used to stop bleeding by electrocoagulation, we should apply a curved suction head, the surface of the tube with a sleeve, expose the head, and see the bleeding part of the bleeding site of electrocoagulation to stop hemorrhage. In this data, there are 2 cases of bleeding which were successfully hemostatized by this method. There is a case of bleeding after returning to the ward, we use 1/2 width expansion sponge through the nasal cavity blocked to the nasopharynx, the use of sponge expansion compression hemostasis, a successful hemostasis. When the application of the above methods are unsuccessful, we can use petroleum jelly gauze rolled into a small cylinder to press the nasopharynx, and use the silk thread from both nostrils to fix it. Tonsillar hemorrhage can be stopped by bipolar electrocoagulation or suture hemostasis. For adenoid hypertrophy combined with secretory otitis media, tympanocentesis can be performed at the end of surgery. In some children, the middle ear fluid is highly viscous, and after puncture, the viscous fluid can be suctioned out with suction, and the puncture can be performed under the endoscope or under the operating microscope. In this study, four patients with secretory otitis media were cured by one puncture. Unilateral tonsillectomy is not recommended. In our hospital, there was a case of adenoidectomy plus unilateral tonsillectomy, the result is that the symptoms recurred one year later, without tonsillectomy side, the tonsils have increased significantly, and have crossed the suspensory pituitary. The symptoms disappeared after tonsillectomy on that side. For children with OSAHS, it is recommended that the age of tonsillectomy be relaxed to 3 years. In conclusion, surgical treatment of pediatric OSAHS patients is effective, and the cure rate of this data is 93,6%, mainly because the etiology of pediatric OSAHS is clear. It is recommended that children diagnosed with OSAHS may prefer surgical treatment.