Keamy Donald G, Chhabra Karan R, Hartnick Christopher J
Massachusetts Eye and Ear Infirmary, Pediatric Otolaryngology, Boston, MA, USA.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Int J Pediatr Otorhinolaryngol. 2015 Nov;79(11):1838-41. doi: 10.1016/j.ijporl.2015.08.021. Epub 2015 Aug 19.
To identify pre-operative risk factors predicting complications following adenotonsillectomy in children with severe OSA.
Retrospective chart review in an academic tertiary care center. Children with symptoms of OSA with overnight polysomnography (PSG) revealing apnea-hypopnea index (AHI) >10, who underwent adenotonsillectomy with overnight postoperative observation between 2008 and 2012. Univariate logistic regression was used to assess odds ratio (OR) of individual risk factors versus postoperative complications such as overnight desaturations <90%, length of stay (LOS)>24 h, supplemental oxygen requirement, and transfer to a higher level of care.
All patients (n=157) with severe OSA were observed overnight. Mean age was 5.3±3.7 years. Twenty-five (15.9%) patients had LOS>24 h. Forty-two (26.8%) had overnight desaturations <90%. AHI ≥15 and O2 saturation nadir <80% on preop polysomnography (PSG) were independent predictors of post-op O2 saturation <90% and LOS>24 h. (p<0.05). PSG minimum saturation <80% was the strongest predictor of all variables examined with an OR of 6.98 (3.15-15.48, 95% CI) for desaturation <90% and 5.19 (2.11-12.75, 95% CI) for LOS>24 h. Preop PSG O2 saturation<90% predicted overnight post op oxygen requirement with an OR of 3.38 (1.39-8.25, 95%CI).
Preoperative polysomnography yields significant independent predictors of post-op complications in children with OSA. While AHI is a significant independent predictor, minimum O2 saturation on preop PSG appeared the strongest predictor when <80%. Patients with these risk factors, especially low O2 on PSG, warrant overnight observation with continuous pulse oximetry.
确定重度阻塞性睡眠呼吸暂停（OSA）患儿腺样体扁桃体切除术后并发症的术前危险因素。
在一家学术性三级医疗中心进行回顾性病历审查。2008年至2012年间，对有OSA症状且夜间多导睡眠图（PSG）显示呼吸暂停低通气指数（AHI）>10，并接受腺样体扁桃体切除术且术后夜间观察的患儿进行研究。采用单因素逻辑回归分析评估各危险因素与术后并发症（如夜间血氧饱和度<90%、住院时间（LOS）>24小时、需补充氧气以及转至更高护理级别）的比值比（OR）。
对所有157例重度OSA患儿进行了夜间观察。平均年龄为5.3±3.7岁。25例（15.9%）患儿住院时间>24小时。42例（26.8%）患儿夜间血氧饱和度<90%。术前多导睡眠图（PSG）显示AHI≥15以及最低血氧饱和度<80%是术后血氧饱和度<90%和住院时间>24小时的独立预测因素（p<0.05）。PSG最低饱和度<80%是所有研究变量中最强的预测因素，对于血氧饱和度<90%，OR为6.98（3.15 - 15.48，95%置信区间）；对于住院时间>24小时，OR为5.19（2.11 - 12.75，95%置信区间）。术前PSG血氧饱和度<90%预测术后夜间需补充氧气，OR为3.38（1.39 - 8.25，95%置信区间）。
术前多导睡眠图可得出OSA患儿术后并发症的显著独立预测因素。虽然AHI是一个显著的独立预测因素，但术前PSG最低血氧饱和度<80%时似乎是最强的预测因素。有这些危险因素的患儿，尤其是PSG显示低氧的患儿，需要通过持续脉搏血氧饱和度监测进行夜间观察。
