Clements Anna Christina, Walsh Jonathan M, Dai Xi, Skinner Margaret L, Sterni Laura M, Tunkel David E, Boss Emily F, Ryan Marisa A
Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.
Laryngoscope. 2021 Oct;131(10):2361-2368. doi: 10.1002/lary.29480. Epub 2021 Mar 11.
OBJECTIVES/HYPOTHESIS: Adenotonsillectomy is first-line treatment for pediatric obstructive sleep apnea syndrome (OSAS) when not otherwise contraindicated. There is concern severe OSAS increases risk of comorbid cardiopulmonary abnormalities, such as ventricular hypertrophy or pulmonary hypertension, which preoperative testing could detect. Our objective is to determine if there is a severity of pediatric OSAS where previously undetected cardiopulmonary comorbidities are likely.
Retrospective chart review.
We performed a retrospective review of 358 patients ≤21 years with severe OSAS who underwent adenotonsillectomy at a tertiary hospital June 1, 2016 to June 1, 2018. We extracted demographics, comorbidities, polysomnography, and preoperative tests. Wilcoxon rank-sum and logistic regression estimated associations of OSAS severity (based on obstructive apnea-hypopnea index [OAHI], hypoxia, hypercarbia) with preoperative echocardiograms and chest X-rays (CXRs).
Mean age was 5.9 (±3.6) years and 52% were male. Mean OAHI and oxygen saturation nadir were 30.3 (±23.8) and 80.7% (±9.2), respectively. OAHI ≥60 was associated with having a preoperative echocardiogram (OR, 3.8; 95% CI, 1.7-8.5) or CXR (OR, 3.0; 95% CI, 1.4-6.8) compared to OAHI 10-59. There were no significant associations between OSAS severity and test abnormalities. The presence of previously diagnosed cardiopulmonary comorbidities was associated with abnormalities on echocardiogram (OR, 36; 95% CI, 4.1-320.1) and CXR (OR, 4.1; 95% CI, 1.2-14.4).
Although pediatric patients with very severe OSAS (OAHI ≥60) underwent more pre-adenotonsillectomy cardiopulmonary tests, OSAS severity did not predict abnormal findings. Known cardiopulmonary comorbidities may be a better indication for cardiopulmonary testing than polysomnographic parameters, which could streamline pre-adenotonsillectomy evaluation and reduce cost.
4 Laryngoscope, 131:2361-2368, 2021.
目的/假设：在无其他禁忌证的情况下，腺样体扁桃体切除术是小儿阻塞性睡眠呼吸暂停综合征（OSAS）的一线治疗方法。人们担心严重的OSAS会增加合并心肺异常的风险，如心室肥厚或肺动脉高压，而术前检查可以检测到这些情况。我们的目的是确定小儿OSAS是否存在某种严重程度，在此程度下可能存在之前未被检测到的心肺合并症。
回顾性病历审查。
我们对2016年6月1日至2018年6月1日在一家三级医院接受腺样体扁桃体切除术的358例年龄≤21岁的严重OSAS患者进行了回顾性研究。我们提取了人口统计学信息、合并症、多导睡眠图和术前检查结果。采用Wilcoxon秩和检验和逻辑回归分析评估OSAS严重程度（基于阻塞性呼吸暂停低通气指数[OAHI]、低氧血症、高碳酸血症）与术前超声心动图和胸部X线（CXR）之间的关联。
平均年龄为5.9（±3.6）岁，52%为男性。平均OAHI和最低氧饱和度分别为30.3（±23.8）和80.7%（±9.2）。与OAHI为10 - 59相比，OAHI≥60与进行术前超声心动图检查（比值比[OR]，3.8；95%置信区间[CI]，1.7 - 8.5）或CXR检查（OR，3.0；95% CI，1.4 - 6.8）相关。OSAS严重程度与检查异常之间无显著关联。既往诊断的心肺合并症与超声心动图异常（OR，36；95% CI，4.1 - 320.1）和CXR异常（OR，4.1；95% CI，1.2 - 14.4）相关。
虽然患有非常严重OSAS（OAHI≥60）的小儿患者在腺样体扁桃体切除术前接受了更多的心肺检查，但OSAS严重程度并不能预测异常结果。已知的心肺合并症可能比多导睡眠图参数更能作为心肺检查的指征，这可以简化腺样体扁桃体切除术前的评估并降低成本。
4 喉镜，131:2361 - 2368，2021年。
