小儿多导睡眠图期间的呼气末二氧化碳测量：信号质量、与呼吸暂停严重程度的关联以及神经行为结果的预测
End-Tidal Carbon Dioxide Measurement during Pediatric Polysomnography: Signal Quality, Association with Apnea Severity, and Prediction of Neurobehavioral Outcomes.
作者信息
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
机构信息
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.
出版信息
Sleep. 2015 Nov 1;38(11):1719-26. doi: 10.5665/sleep.5150.
STUDY OBJECTIVES
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.
DESIGN
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.
SETTING
Multisite clinical referral settings.
PARTICIPANTS
Children, ages 5.0 to 9.9 y with suspected sleep apnea.
INTERVENTIONS
eAT or WWSC.
MEASUREMENTS AND RESULTS
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.
CONCLUSIONS
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.
CLINICAL TRIAL REGISTRATION
Childhood Adenotonsillectomy Study for Children with OSAS (CHAT). ClinicalTrials.gov Identifier #NCT00560859.
研究目的
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。
设计
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）。
设置
多地点临床转诊机构。
参与者
5.0至9.9岁疑似睡眠呼吸暂停的儿童。
干预措施
eAT或WWSC。
测量与结果
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。
结论
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。
临床试验注册
OSAS儿童腺样体扁桃体切除术研究（CHAT）。ClinicalTrials.gov标识符#NCT00560859。
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