School of Medicine, Emory University, Atlanta, GA, USA.
School of Medicine, Department of Pediatrics, Emory University, Atlanta, GA, USA.
Sleep Breath. 2021 Dec;25(4):2171-2178. doi: 10.1007/s11325-021-02303-5. Epub 2021 Feb 19.
The purpose of this study was to determine the associations between cardiac function and postoperative adverse events in pediatric patients with obstructive sleep apnea (OSA).
Patients between birth and 18 years of age diagnosed with OSA between January 1, 2015, and December 31, 2018, who underwent echocardiographic evaluation within 6 months of surgery at a tertiary care children's hospital were evaluated. Exclusion criteria included history of neuromuscular disorders, tracheostomy placement, or a predominance of central apneic events recorded during polysomnography (PSG). Patients were grouped by OSA severity. Chi-squared analysis and logistic regression were utilized to determine associations between demographic characteristics, OSA severity, preoperative echocardiographic abnormalities, and postoperative adverse events.
One hundred ten children met inclusion criteria for the study, including 22 with mild OSA, 22 with moderate OSA, and 66 with severe OSA. Race and the presence of congenital heart disease (CHD) were significantly associated with differences in OSA severity. Echocardiographic abnormalities were found in 45 patients, but exclusion of patients with CHD revealed no significant associations with differences in OSA severity. Postoperative adverse events were identified in 18 (16%) patients, and only O saturation nadir was found to be a significant predictor of these complications.
Preoperative echocardiogram abnormalities are not commonly found in children with OSA and presence of abnormalities does not predict postoperative adverse events. O saturation nadir measured on preoperative PSG is a significant predictor of postoperative adverse events and should be examined as a clinical indicator of OSA severity.
本研究旨在确定心脏功能与阻塞性睡眠呼吸暂停（OSA）患儿术后不良事件之间的关联。
评估了 2015 年 1 月 1 日至 2018 年 12 月 31 日期间在一家三级儿童保健医院接受手术前 6 个月内接受超声心动图评估的患有 OSA 的出生至 18 岁的患者。排除标准包括神经肌肉疾病史、气管造口术安置史或多导睡眠图（PSG）记录的中枢性呼吸暂停事件占主导地位。患者根据 OSA 严重程度分组。采用卡方分析和逻辑回归来确定人口统计学特征、OSA 严重程度、术前超声心动图异常与术后不良事件之间的关联。
共有 110 名儿童符合研究纳入标准，其中轻度 OSA 22 例，中度 OSA 22 例，重度 OSA 66 例。种族和先天性心脏病（CHD）的存在与 OSA 严重程度的差异显著相关。45 名患者存在超声心动图异常，但排除 CHD 患者后，异常与 OSA 严重程度的差异无显著关联。18 名（16%）患者发生术后不良事件，仅氧饱和度最低点被发现是这些并发症的显著预测因子。
术前超声心动图异常在 OSA 患儿中并不常见，且异常的存在并不能预测术后不良事件。术前 PSG 测量的氧饱和度最低点是术后不良事件的显著预测因子，应作为 OSA 严重程度的临床指标进行检查。
