多导睡眠图参数评估气体交换可更好预测重度阻塞性睡眠呼吸暂停低通气综合征患儿腺样体扁桃体切除术后的呼吸并发症。
Polysomnography Parameters Assessing Gas Exchange Best Predict Postoperative Respiratory Complications Following Adenotonsillectomy in Children With Severe OSA.
机构信息
Deparment of Pediatrics, Division of Pediatric Pulmonology, University of Minnesota, Minneapolis, Minnesota.
Spectrum Health-Michigan State University, Grand Rapids, Michigan.
出版信息
J Clin Sleep Med. 2019 Sep 15;15(9):1251-1259. doi: 10.5664/jcsm.7914.
STUDY OBJECTIVES
Adenotonsillectomy (AT) is the treatment of choice for obstructive sleep apnea (OSA) in children with adenotonsillar hypertrophy. Severe OSA, identified by the apnea-hypopnea index (AHI), is a risk factor for surgical complications and AHI thresholds are used by surgeons to decide elective postoperative hospital admissions. The objective of this study was to identify the prevalence of surgical complications of AT in children with severe OSA and determine their association with specific parameters of polysomnography (PSG).
METHODS
Retrospective evaluation of respiratory and nonrespiratory complications in children undergoing AT for severe OSA was performed. Events were then compared to several individual PSG indices. PSG indices included classic parameters such as AHI, and obstructive apnea indexes (OAI) as well as gas exchange parameters including the oxygen desaturation index (ODI), lowest oxyhemoglobin saturation (lowest SpO₂), peak end-tidal CO₂ (peak ETCO₂), the percentage of the total sleep time (%TST) with ETCO₂ > 50 mmHg (%TST ETCO₂ > 50 mmHg) and oxygen saturation < 90% (%TST O₂ < 90%).
RESULTS
A total of 158 children were identified with severe OSA. Major respiratory complications occurred in 21.5% and were only associated with the ODI (P = .014), lowest SpO₂ (P = .001) and %TST O₂ < 90% (P < .001). Minor respiratory complications occurred in 19.6% and these were not associated with any PSG parameters. Major nonrespiratory complications occurred in 4.4% and also were not associated with any PSG parameters; however, minor nonrespiratory complications occurring in 37.3%, and were associated with %TST O₂ < 90% (P < 0.001).
CONCLUSIONS
PSG measures of gas exchange are strongly associated with postoperative complications of AT and are better suited for postoperative planning than classic indices such as AHI.
CITATION
Molero-Ramirez H, Tamae Kakazu M, Baroody F, Bhattacharjee R. Polysomnography parameters assessing gas exchange best predict postoperative respiratory complications following adenotonsillectomy in children with severe OSA. J Clin Sleep Med. 2019;15(9):1251-1259.
研究目的
腺样体扁桃体切除术（AT）是治疗伴有腺样体扁桃体肥大的阻塞性睡眠呼吸暂停（OSA）患儿的首选方法。通过呼吸暂停低通气指数（AHI）确定的重度 OSA 是手术并发症的危险因素，且外科医生使用 AHI 阈值来决定择期术后住院。本研究的目的是确定伴有重度 OSA 的患儿行 AT 术后的手术并发症发生率，并确定其与多导睡眠图（PSG）的特定参数之间的关联。
方法
回顾性评估因重度 OSA 而行 AT 的患儿的呼吸和非呼吸并发症。然后，将这些事件与多个 PSG 指标进行比较。PSG 指标包括经典参数，如 AHI 和阻塞性呼吸暂停指数（OAI），以及气体交换参数，包括氧减饱和指数（ODI）、最低血氧饱和度（最低 SpO₂）、呼气末二氧化碳峰值（peak ETCO₂）、总睡眠时间中 ETCO₂＞50mmHg 的百分比（%TST ETCO₂＞50mmHg）和氧饱和度＜90%的总睡眠时间百分比（%TST O₂＜90%）。
结果
共纳入 158 例重度 OSA 患儿。主要的呼吸系统并发症发生率为 21.5%，仅与 ODI（P=0.014）、最低 SpO₂（P=0.001）和%TST O₂＜90%（P＜0.001）相关。次要的呼吸系统并发症发生率为 19.6%，与任何 PSG 参数均无关。主要的非呼吸系统并发症发生率为 4.4%，也与任何 PSG 参数均无关；然而，次要的非呼吸系统并发症发生率为 37.3%，与%TST O₂＜90%（P＜0.001）相关。
结论
PSG 气体交换测量值与 AT 术后并发症密切相关，且比 AHI 等经典指标更适合术后计划。
引文
Molero-Ramirez H, Tamae Kakazu M, Baroody F, Bhattacharjee R. 多导睡眠图评估气体交换参数可预测重度 OSA 患儿行腺样体扁桃体切除术后的呼吸并发症。J Clin Sleep Med. 2019;15(9):1251-1259.
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