早产儿：小儿阻塞性睡眠呼吸暂停严重程度增加的一个预测因素。

Prematurity: A Prognostic Factor for Increased Severity of Pediatric Obstructive Sleep Apnea.

机构信息

Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, U.S.A.

Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A.

出版信息

Laryngoscope. 2021 Aug;131(8):1909-1914. doi: 10.1002/lary.29473. Epub 2021 Feb 25.

DOI:10.1002/lary.29473

PMID:33629766

Abstract

OBJECTIVE/HYPOTHESIS: Studies have suggested preterm birth, defined as gestational age (GA) <37 weeks, is a risk factor for obstructive sleep apnea (OSA) in later childhood. However, little is known about the characteristics, severity, and degree of intervention of childhood OSA in former preterm infants compared to term infants. This study compares polysomnographic characteristics and surgical interventions in former preterm and term infants presenting with sleep disordered breathing.

STUDY DESIGN

Retrospective cohort study from 2015 to 2019 at a single tertiary referral center.

METHODS

Electronic Medical Records of pediatric patients ages 0 to 18 presenting with sleep disordered breathing were reviewed for gestational age, polysomnographic findings, clinical characteristics, and OSA surgical interventions. Association between gestational age, polysomnographic characteristics, and surgical interventions for OSA were reported.

RESULTS

A total of 615 patient records were analyzed. Adjusting for covariates, prematurity was associated with a 2.97× higher likelihood of development of severe OSA (aOR (95%CI): 2.97 (1.40-6.32)), increased apneic-hypoxic index (AHI) (mean (SD): 6.5 (9.8) vs. 4.6 (6.4), P < .05), increased end tidal CO (50.5 (5.11) vs. 48.5 (5.8), P < .05), decreased REM latency (116 (64.7) vs. 132.4 (69.9), P < .05), and increased number of surgeries for OSA (0.65 (.95) vs. 0.45 (0.69), P < .05) compared to children born at term. Children born with GA < 32 weeks presented at a significantly later age with sleep disordered breathing (7.04 (.80) vs. 5.1 (0.15), P < .05) than children born at term.

CONCLUSIONS

Prematurity was associated with increased likelihood of severe OSA, increased AHI, as well as increased number of surgical interventions for OSA compared to children born at term. These results suggest an association with preterm birth and increased severity of childhood OSA.

LEVEL OF EVIDENCE

3 Laryngoscope, 131:1909-1914, 2021.

摘要

目的/假设：研究表明，早产（定义为妊娠年龄<37 周）是儿童后期阻塞性睡眠呼吸暂停（OSA）的危险因素。然而，与足月婴儿相比，对于前早产儿中儿童 OSA 的特征、严重程度和干预程度知之甚少。本研究比较了有睡眠障碍呼吸的前早产儿和足月婴儿的多导睡眠图特征和手术干预。

研究设计

2015 年至 2019 年在一家三级转诊中心进行的回顾性队列研究。

方法

对年龄在 0 至 18 岁的患有睡眠障碍呼吸的儿科患者的电子病历进行了回顾，以评估胎龄、多导睡眠图结果、临床特征和 OSA 手术干预情况。报告了胎龄、多导睡眠图特征和 OSA 手术干预之间的关联。

结果

共分析了 615 例患者记录。调整协变量后，早产与严重 OSA 发展的可能性高 2.97 倍（调整后的比值比（95%CI）：2.97（1.40-6.32）），呼吸暂停-低通气指数（AHI）增加（平均（SD）：6.5（9.8）比 4.6（6.4），P<.05），呼气末 CO2 增加（50.5（5.11）比 48.5（5.8），P<.05），快速眼动潜伏期减少（116（64.7）比 132.4（69.9），P<.05），以及 OSA 手术数量增加（0.65（0.95）比 0.45（0.69），P<.05）与足月出生的儿童相比。胎龄<32 周的儿童出生后出现睡眠障碍呼吸的年龄明显较晚（7.04（0.80）比 5.1（0.15），P<.05），与足月出生的儿童相比。