用于检测儿童阻塞性睡眠呼吸暂停的三个核心问题的麻醉前评估：一项观察性研究。
Pre-anesthetic assessment with three core questions for the detection of obstructive sleep apnea in childhood: An observational study.
作者信息
Schnoor Joerg, Busch Thilo, Turemuratov Nazar, Merkenschlager Andreas
机构信息
Department of Anesthesia and Intensive Care Medicine, Collm-Klinik-Oschatz, Parkstr. 1, 03435, Oschatz, Germany.
Department of Anesthesia and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
出版信息
BMC Anesthesiol. 2018 Feb 20;18(1):25. doi: 10.1186/s12871-018-0483-y.
BACKGROUND
Children with obstructive sleep apnea are at high risk for perioperative airway obstruction. Many "at risk" children may remain unrecognized. The aim of this study is to find a clinically practicable test to identify obstructive sleep apnea in childhood.
METHODS
In this pilot study, we prospectively compared four parental questionnaires with the respective findings of subsequent sleep laboratory testing in children. Right before sleep laboratory testing, children's parents answered both the Pediatric Sleep Questionnaire, a subscale of the Sleep Related Breathing Disorder questionnaire (PSQ-SRBD-Subscale), and an eight-item questionnaire derived from it. Finally, we condensed the eight-item questionnaire to three core issues: Does your child regularly snore at night? Does your child demonstrate labored breathing during sleep? Does your child have breathing pauses during sleep? With it, two similar questionnaires were generated that differed in the formation of the resulting score. One questionnaire was built by a quotient comparable to the abovementioned questionnaires and a second as quick test that functioned as a simple sum score. Both sensitivity and specificity were determined by using a Receiver Operating Characteristic analysis.
RESULTS
In total, 53 children were included in the study. Both the PSQ-SRBD-questionnaire and self-derived eight-item questionnaire failed to reach statistically significant results in detecting obstructive sleep apnea. The set of three core questions with a score built by a quotient was statistically significant and provided sensitivity and a moderate specificity of 0.944 and 0.543, respectively. This could be slightly optimized by creating a simple sum-score (specificity of 0.571).
CONCLUSIONS
The use of three core-questions may facilitate the detection of pediatric obstructive sleep apnea within the scope of the anesthesia survey. While the study has some limitations, future studies with both unselective collectives and older children might prove this ultra-short questionnaire to be advantageous in detecting pediatric OSA in clinical practices.
TRIAL REGISTRATION
German Clinical Trial Register ( DRKS00010408 , https://www.drks.de ); date of registration 26.07.2016.
背景
患有阻塞性睡眠呼吸暂停的儿童围手术期气道阻塞风险很高。许多“高危”儿童可能未被识别。本研究的目的是找到一种临床可行的测试方法来识别儿童阻塞性睡眠呼吸暂停。
方法
在这项初步研究中，我们前瞻性地比较了四份家长问卷与随后儿童睡眠实验室测试的各自结果。就在睡眠实验室测试之前，儿童的父母回答了儿科睡眠问卷、睡眠相关呼吸障碍问卷的一个子量表（PSQ-SRBD-子量表）以及由此衍生的一份八项问卷。最后，我们将八项问卷浓缩为三个核心问题：您的孩子晚上经常打鼾吗？您的孩子在睡眠中呼吸费力吗？您的孩子在睡眠中有呼吸暂停吗？据此生成了两份相似的问卷，它们在得分形成方式上有所不同。一份问卷是通过与上述问卷类似的商数构建的，另一份是作为快速测试，以简单的总分形式呈现。通过使用受试者工作特征分析来确定敏感性和特异性。
结果
该研究共纳入53名儿童。PSQ-SRBD问卷和自行设计的八项问卷在检测阻塞性睡眠呼吸暂停方面均未达到统计学显著结果。由商数构建得分的三个核心问题组具有统计学显著性，敏感性和中等特异性分别为0.944和0.543。通过创建简单总分（特异性为0.571）可对此进行轻微优化。
结论
使用三个核心问题可能有助于在麻醉评估范围内检测儿童阻塞性睡眠呼吸暂停。虽然该研究有一些局限性，但未来对非选择性人群和年龄较大儿童的研究可能会证明这份超短问卷在临床实践中检测儿童阻塞性睡眠呼吸暂停方面具有优势。
试验注册
德国临床试验注册中心（DRKS00010408，https://www.drks.de）；注册日期2016年7月26日。
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