Boston University School of Medicine, Boston, MA, USA.
Boston University School of Public Health, Boston, MA, USA.
Ann Otol Rhinol Laryngol. 2021 Sep;130(9):1029-1035. doi: 10.1177/0003489421990156. Epub 2021 Feb 5.
To determine the prevalence and characteristics of children with normal elective polysomnography for obstructive sleep disordered breathing (oSDB) based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines.
In this retrospective cohort study, we identified patients ages 2 to 18 who underwent diagnostic polysomnography (PSG) ordered by our otolaryngology department for SDB between 2012 and 2018.
All patients were seen by otolaryngologists at an urban tertiary safety net hospital.
There were a total of 456 patients studied (average age 5.66 ± 3.19; 263 (57.7%) males, 193 (42.3%) females. Demographic factors (age, gender, race, ethnicity, language, insurance status) and clinical findings (symptom severity, tonsil size) were recorded. The data were analyzed by univariate and multivariate analysis.
Two hundred four patients (44.7%) had no obstructive sleep apnea (OSA) based on AHI<2 on PSG. Children with a larger tonsil size had 3.18 times the odds of OSA compared to those with a medium tonsil size (95% CI 1.64, 6.19) when adjusting for symptoms, age category, and race ( = .0007). Children ages 4 to 6 years had 0.25 times the odds of OSA compared to those ages 2-3 years (95% CI 0.12, 1.54) when adjusting for symptoms, tonsil size, and race ( = .0011). White children had 0.28 times the odds of OSA compared to Black children (95% CI 0.14, 0.57) when adjusting for symptoms, tonsil size, and age category ( = .0004).
Among our patient population, 44.7% had normal sleep studies. Younger children (ages 2-3) were less likely to have normal polysomnography. This research demonstrates that obtaining sleep studies in otherwise healthy children with SDB can affect management decisions, and they should be discussed with families with a focus on patient centered decision making.
根据美国耳鼻喉科学-头颈外科学会（AAO-HNS）指南，确定阻塞性睡眠呼吸暂停（oSDB）的正常选择性多导睡眠图（PSG）的儿童的患病率和特征。
在这项回顾性队列研究中，我们鉴定了 2012 年至 2018 年间耳鼻喉科部门为 SDB 安排诊断性 PSG 的年龄在 2 至 18 岁的患者。
所有患者均在城市三级安全网医院由耳鼻喉科医生就诊。
共有 456 名患者（平均年龄 5.66 ± 3.19 岁；263 名男性（57.7%），193 名女性（42.3%））。记录了人口统计学因素（年龄、性别、种族、民族、语言、保险状况）和临床发现（症状严重程度、扁桃体大小）。通过单变量和多变量分析对数据进行分析。
根据 PSG 上 AHI<2，204 名患者（44.7%）没有阻塞性睡眠呼吸暂停（OSA）。调整症状、年龄类别和种族后，扁桃体较大的儿童患 OSA 的几率是扁桃体中等大小的儿童的 3.18 倍（95%CI 1.64，6.19）（ = .0007）。与 2-3 岁的儿童相比，4-6 岁的儿童患 OSA 的几率低 0.25 倍（95%CI 0.12，1.54），同时调整症状、扁桃体大小和种族（ = .0011）。与黑人儿童相比，白人儿童患 OSA 的几率低 0.28 倍（95%CI 0.14，0.57），同时调整症状、扁桃体大小和年龄类别（ = .0004）。
在我们的患者人群中，44.7%的睡眠研究正常。年龄较小的儿童（2-3 岁）不太可能有正常的多导睡眠图。这项研究表明，在 otherwise healthy 儿童中进行睡眠研究可能会影响管理决策，应与家属讨论，以患者为中心的决策。
