Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Division of Neurology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Pediatr Int. 2021 Nov;63(11):1376-1380. doi: 10.1111/ped.14663. Epub 2021 Sep 22.
The polysomnogram (PSG) is the "gold standard" for diagnosing obstructive sleep apnea (OSA). However, nocturnal oximetry is a practical screening tool for children with adenotonsillar hypertrophy (ATH). This study aimed to investigate the incidence of, and predictive factors for, OSA in children with ATH and normal / inconclusive overnight oximetry.
The prospective study enrolled children aged 3-15 years with ATH and normal / inconclusive overnight oximetry. All participants underwent full-night PSG. To evaluate the predictors of OSA, we used logistic regression analysis, including sex, history of allergic rhinitis, body mass index z-score, neck circumference-height ratio, and polysomnographic parameters (obstructive apnea-hypopnea index (OAHI), nadir oxygen saturation (SpO2), peak end-tidal CO , and arousal index).
The participants were 189 children; 167 (88%) were diagnosed with OSA by PSG. A history of allergic rhinitis (P = 0.033), and the PSG findings for nadir SpO (P = 0.027) and arousal index (P = <0.001) predicted the diagnosis of OSA. We divided patients with OSA into two groups (mild versus moderate to severe OSA). Patients with OAHI ≥5/h were defined as having moderate-to-severe OSA. No clinical factors significantly predicted OAHI ≥5. Of the 189 participants, 58 children (31%) were diagnosed with severe OSA (OAHI ≥10). The only PSG factor that predicted severe OSA was the arousal index (P < 0.001).
The observed incidence of OSA in children aged 3-15 years with ATH and normal/inconclusive overnight oximetry was very high. A history of allergic rhinitis may help to triage the patients. The arousal index was a predictor of pediatric OSA.
多导睡眠图（PSG）是诊断阻塞性睡眠呼吸暂停（OSA）的“金标准”。然而，夜间血氧仪是评估腺样体扁桃体肥大（ATH）儿童的实用筛查工具。本研究旨在探讨夜间血氧正常/不确定的 ATH 儿童中 OSA 的发生率和预测因素。
前瞻性研究纳入了年龄在 3-15 岁、患有 ATH 且夜间血氧正常/不确定的儿童。所有参与者均进行了整夜 PSG。为了评估 OSA 的预测因素，我们使用逻辑回归分析，包括性别、变应性鼻炎史、体重指数 z 评分、颈围身高比以及多导睡眠图参数（阻塞性呼吸暂停低通气指数（OAHI）、最低血氧饱和度（SpO2）、呼气末二氧化碳峰值和觉醒指数）。
共有 189 名参与者；167 名（88%）经 PSG 诊断为 OSA。变应性鼻炎史（P = 0.033）和最低 SpO2 的 PSG 发现（P = 0.027）以及觉醒指数（P < 0.001）预测了 OSA 的诊断。我们将 OSA 患者分为两组（轻度与中重度 OSA）。将 OAHI≥5/h 的患者定义为中重度 OSA。没有临床因素能显著预测 OAHI≥5。在 189 名参与者中，有 58 名儿童（31%）被诊断为严重 OSA（OAHI≥10）。唯一能预测严重 OSA 的 PSG 因素是觉醒指数（P<0.001）。
患有 ATH 且夜间血氧正常/不确定的 3-15 岁儿童中 OSA 的发生率非常高。变应性鼻炎史可能有助于对患者进行分诊。觉醒指数是儿童 OSA 的预测因素。
