Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, Texas, USA.
Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Pediatr Pulmonol. 2021 May;56(5):1103-1113. doi: 10.1002/ppul.25247. Epub 2021 Jan 11.
To determine the impact of obstructive sleep apnea (OSA) on asthma exacerbation severity in children hospitalized for asthma exacerbation.
OSA is associated with greater use of invasive mechanical ventilation (IMV) and noninvasive mechanical ventilation (NIMV) in children hospitalized for asthma exacerbation.
A retrospective cohort study.
PATIENT-SUBJECT SELECTION: Hospitalization records of children aged 2-18 years admitted for acute asthma exacerbation were obtained for 2000, 2003, 2006, 2009, and 2012 from the Kids' Inpatient Database.
The primary exposure was OSA, the primary outcome was IMV, and secondary outcomes were NIMV, length of hospital stay (LOS), and inflation-adjusted cost of hospitalization. Multivariable logistic regression, negative binomial, and linear regression were conducted to ascertain the impact of OSA on primary and secondary outcomes. Exploratory analyses investigated the impact of obesity on primary and secondary outcomes.
Among 564,467 hospitalizations for acute asthma exacerbation, 4209 (0.75%) had OSA. Multivariable regression indicated that OSA was associated with IMV (adjusted odds ratio [OR], 5.33 [95% confidence interval, CI: 4.35-6.54], p < .0001), NIMV (adjusted OR, 8.30 [95% CI: 6.56-10.51], p < .0001), longer LOS (adjusted incidence rate ratio, 1.34 [95% CI 1.28-1.43], p < .0001), and greater inflation-adjusted cost of hospitalization (adjusted β, 0.38 [95% CI: 0.33-0.43], p < .0001). Obesity was also significantly associated IMV, NIMV, longer LOS, and greater inflation-adjusted cost of hospitalization. There was no interaction between OSA and obesity.
OSA is an independent risk factor for IMV, NIMV, longer LOS, and elevated inflation-adjusted costs of hospitalization in children hospitalized for asthma exacerbation.
确定阻塞性睡眠呼吸暂停（OSA）对因哮喘加重而住院的儿童哮喘恶化严重程度的影响。
OSA 与因哮喘加重而住院的儿童中更频繁地使用有创机械通气（IMV）和无创机械通气（NIMV）相关。
回顾性队列研究。
患者/受试者选择：从儿童住院数据库中获取了 2000 年、2003 年、2006 年、2009 年和 2012 年期间，年龄在 2-18 岁之间因急性哮喘加重而住院的儿童的住院记录。
主要暴露因素是 OSA，主要结局是 IMV，次要结局是 NIMV、住院时间（LOS）和通货膨胀调整后的住院费用。多变量逻辑回归、负二项式和线性回归用于确定 OSA 对主要和次要结局的影响。探索性分析研究了肥胖对主要和次要结局的影响。
在 564467 例因急性哮喘加重而住院的患者中，有 4209 例（0.75%）患有 OSA。多变量回归表明，OSA 与 IMV（调整后的优势比 [OR]，5.33 [95%置信区间，CI：4.35-6.54]，p<.0001）、NIMV（调整后的 OR，8.30 [95% CI：6.56-10.51]，p<.0001）、更长的 LOS（调整后的发生率比，1.34 [95% CI 1.28-1.43]，p<.0001）和更高的通货膨胀调整后的住院费用（调整后的 β，0.38 [95% CI：0.33-0.43]，p<.0001）相关。肥胖也与 IMV、NIMV、更长的 LOS 和更高的通货膨胀调整后的住院费用显著相关。OSA 和肥胖之间没有相互作用。
OSA 是因哮喘加重而住院的儿童发生 IMV、NIMV、更长的 LOS 和住院费用增加的独立危险因素。
