Teplitzky Taylor B, Pereira Kevin D, Isaiah Amal
Department of Otorhinolaryngology - Head and Neck Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
Department of Otorhinolaryngology - Head and Neck Surgery, University of Maryland Medical Center, Baltimore, MD, USA; Department of Otorhinolaryngology - Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Int J Pediatr Otorhinolaryngol. 2019 Nov;126:109626. doi: 10.1016/j.ijporl.2019.109626. Epub 2019 Aug 8.
(i) To determine the prevalence of echocardiographic abnormalities in children with very severe OSA defined by an apnea hypopnea index (AHI) ≥ 30 events/hour. (ii) To test the hypothesis that polysomnographic parameters predict echocardiographic variables in this population.
Children aged 1-17 years presenting with polysomnography demonstrating an AHI ≥30 and referred for pre-operative echocardiography performed within the 6 months prior to tonsillectomy and adenoidectomy (T&A), over a two-year period (January 1, 2016 to December 31, 2018) were evaluated. The exclusion criteria were the presence of (i) unrepaired congenital cardiac disease, (ii) tracheostomy, (iii) poorly controlled asthma, or (iv) neuromuscular disorder. The prevalence of echocardiographic abnormalities was determined for the study population. The impact of the severity of OSA on echocardiographic parameters was evaluated using Student's t-test. The relationships between polysomnographic variables and biventricular function as well as pulmonary hemodynamics were measured. A penalized regression model was used to identify the contributions of polysomnographic variables to each echocardiographic parameter by mitigating inter-variable relationships. P < .05 was considered significant.
Eighty-nine children were screened, of whom 47 were included for analysis. The mean age was 68.8 months [95% confidence interval, 56.0 to 81.6]. Thirty-three (70.2%) were boys. Twenty (42.6%) were obese. All children had normal echocardiograms. The differences in echocardiographic variables between children grouped by the severity of OSA were not statistically significant (P: 0.18-0.98). Polysomnographic variables predicted only 4 out of 13 studied echocardiographic parameters.
Pre-operative echocardiography did not identify significant abnormalities in children with very severe OSA. Majority of the echocardiographic variables were not predicted by polysomnographic parameters. This study demonstrates the limited benefit associated with routine echocardiographic screening of children with very severe OSA solely based on polysomnographic indices.
（i）确定呼吸暂停低通气指数（AHI）≥30次/小时定义的极重度阻塞性睡眠呼吸暂停（OSA）儿童的超声心动图异常患病率。（ii）检验多导睡眠图参数可预测该人群超声心动图变量的假设。
对2016年1月1日至2018年12月31日期间年龄在1至17岁、多导睡眠图显示AHI≥30且在扁桃体切除术和腺样体切除术（T&A）前6个月内接受术前超声心动图检查的儿童进行评估。排除标准包括：（i）未修复的先天性心脏病；（ii）气管切开术；（iii）控制不佳的哮喘；（iv）神经肌肉疾病。确定研究人群中超声心动图异常的患病率。使用学生t检验评估OSA严重程度对超声心动图参数的影响。测量多导睡眠图变量与双心室功能以及肺血流动力学之间的关系。采用惩罚回归模型，通过减轻变量间关系来确定多导睡眠图变量对每个超声心动图参数的贡献。P<0.05被认为具有统计学意义。
筛查了89名儿童，其中47名纳入分析。平均年龄为68.8个月[95%置信区间，56.0至81.6]。33名（70.2%）为男孩。20名（42.6%）肥胖。所有儿童超声心动图均正常。按OSA严重程度分组的儿童超声心动图变量差异无统计学意义（P：0.18 - 0.98）。多导睡眠图变量仅预测了13个研究的超声心动图参数中的4个。
术前超声心动图未发现极重度OSA儿童有明显异常。大多数超声心动图变量不能由多导睡眠图参数预测。本研究表明，仅基于多导睡眠图指标对极重度OSA儿童进行常规超声心动图筛查的益处有限。
