Paruthi Shalini, Rosen Carol L, Wang Rui, Weng Jia, Marcus Carole L, Chervin Ronald D, Stanley Jeffrey J, Katz Eliot S, Amin Raouf, Redline Susan
Department of Pediatrics, Saint Louis University, St. Louis, MO.
Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
Sleep. 2015 Nov 1;38(11):1719-26. doi: 10.5665/sleep.5150.
To identify the role of end-tidal carbon dioxide (EtCO2) monitoring during polysomnography in evaluation of children with obstructive sleep apnea syndrome (OSAS), including the correlation of EtCO2 with other measures of OSAS and prediction of changes in cognition and behavior after adenotonsillectomy.
Analysis of screening and endpoint data from the Childhood Adenotonsillectomy Trial, a randomized, controlled, multicenter study comparing early adenotonsillectomy (eAT) to watchful waiting/supportive care (WWSC) in children with OSAS.
Multisite clinical referral settings.
Children, ages 5.0 to 9.9 y with suspected sleep apnea.
eAT or WWSC.
Quality EtCO2 waveforms were present for ≥ 75% of total sleep time (TST) in 876 of 960 (91.3%) screening polysomnograms. Among the 322 children who were randomized, 55 (17%) met pediatric criteria for hypoventilation. The mean TST with EtCO2 > 50 mmHg was modestly correlated with apnea-hypopnea index (AHI) (r = 0.33; P < 0.0001) and with oxygen saturation ≤ 92% (r = 0.26; P < 0.0001). After adjusting for AHI, obesity, and other factors, EtCO2 > 50 mmHg was higher in African American children than others. The TST with EtCO2 > 50 mmHg decreased significantly more after eAT than WWSC. In adjusted analyses, baseline TST with EtCO2 > 50 mmHg did not predict postoperative changes in cognitive and behavioral measurements.
Among children with suspected obstructive sleep apnea syndrome, overnight end-tidal carbon dioxide (EtCO2) levels are weakly to modestly correlated with other polysomnographic indices and therefore provide independent information on hypoventilation. EtCO2 levels improve with adenotonsillectomy but are not as responsive as AHI and do not provide independent prediction of cognitive or behavioral response to surgery.
Childhood Adenotonsillectomy Study for Children with OSAS (CHAT). ClinicalTrials.gov Identifier #NCT00560859.
确定在多导睡眠图检查期间监测呼气末二氧化碳（EtCO2）在评估阻塞性睡眠呼吸暂停综合征（OSAS）儿童中的作用，包括EtCO2与OSAS其他指标的相关性以及腺样体扁桃体切除术后认知和行为变化的预测。
对儿童腺样体扁桃体切除术试验的筛查和终点数据进行分析，该试验是一项随机对照多中心研究，比较了OSAS儿童早期腺样体扁桃体切除术（eAT）与观察等待/支持性护理（WWSC）。
多地点临床转诊机构。
5.0至9.9岁疑似睡眠呼吸暂停的儿童。
eAT或WWSC。
在960份筛查多导睡眠图中的876份（91.3%）中，高质量EtCO2波形出现时间占总睡眠时间（TST）的≥75%。在322名随机分组的儿童中，55名（17%）符合小儿通气不足标准。EtCO2>50 mmHg的平均TST与呼吸暂停低通气指数（AHI）（r = 0.33；P < 0.0001）以及血氧饱和度≤92%（r = 0.26；P < 0.0001）呈中度相关。在调整AHI、肥胖和其他因素后，非裔美国儿童EtCO2>50 mmHg的情况比其他儿童更高。eAT后EtCO2>50 mmHg的TST下降幅度明显大于WWSC。在调整分析中，基线EtCO2>50 mmHg的TST不能预测术后认知和行为测量的变化。
在疑似阻塞性睡眠呼吸暂停综合征的儿童中，夜间呼气末二氧化碳（EtCO2）水平与其他多导睡眠图指标呈弱至中度相关，因此可提供关于通气不足的独立信息。EtCO2水平在腺样体扁桃体切除术后有所改善，但不如AHI反应明显，也不能独立预测手术对认知或行为的反应。
OSAS儿童腺样体扁桃体切除术研究（CHAT）。ClinicalTrials.gov标识符#NCT00560859。
