Magnusdottir Solveig, Hilmisson Hugi, Raymann Roy J E M, Witmans Manisha
MyCardio LLC, SleepImage, 3003 E 3rd Avenue, Denver, CO 80206, USA.
Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada.
Children (Basel). 2021 Oct 29;8(11):980. doi: 10.3390/children8110980.
To evaluate if cardiopulmonary coupling (CPC) calculated sleep quality (SQI) may have a role in identifying children that may benefit from other intervention than early adenotonsillectomy (eAT) in management of obstructive sleep apnea (OSA).
A secondary analysis of electrocardiogram-signals (ECG) and oxygen saturation-data (SpO) collected during polysomnography-studies in the prospective multicenter Childhood Adenotonsillectomy Trial (CHAT) to calculate CPC-SQI and apnea hypopnea index (AHI) was executed. In the CHAT, children 5-9 years with OSA without prolonged oxyhemoglobin desaturations were randomly assigned to adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC). The primary outcomes were to document change in attention and executive function evaluated with the Developmental Neuropsychological Assessment (NEPSY). In our analysis, children in the WWSC-group with spontaneous resolution of OSA (AHI < 1.0) and high-sleep quality (SQI ≥ 75) after 7-months were compared with children that showed residual OSA.
Of the 227 children randomized to WWSC, 203 children had available data at both baseline and 7-month follow-up. The group that showed resolution of OSA at month 7 ( = 43, 21%) were significantly more likely to have high baseline SQI 79.96 [CI 75.05, 84.86] vs. 72.44 [CI 69.50, 75.39], = 0.005, mild OSA AHI 4.01 [CI 2.34, 5.68] vs. 6.52 [CI 5.47, 7.57], = 0.005, higher NEPSY-attention-executive function score 106.22 [CI 101.67, 110.77] vs. 101.14 [CI 98.58, 103.72], = 0.038 and better quality of life according to parents 83.74 [CI 78.95, 88.54] vs. 77.51 [74.49, 80.53], = 0.015. The groups did not differ when clinically evaluated by Mallampati score, Friedman palate position or sleep related questionnaires.
Children that showed resolution of OSA were more likely to have high-SQI and mild OSA, be healthy-weight and have better attention and executive function and quality of life at baseline. As this simple method to evaluate sleep quality and OSA is based on analyzing signals that are simple to collect, the method is practical for sleep-testing, over multiple nights and on multiple occasions. This method may assist physicians and parents to determine the most appropriate therapy for their child as some children may benefit from WWSC rather than interventions. If the parameters can be used to plan care a priori, this would provide a fundamental shift in how childhood OSA is diagnosed and managed.
评估通过心肺耦合（CPC）计算得出的睡眠质量指数（SQI）在识别那些在阻塞性睡眠呼吸暂停（OSA）管理中可能从早期腺样体扁桃体切除术（eAT）以外的其他干预措施中获益的儿童方面是否具有作用。
对在前瞻性多中心儿童腺样体扁桃体切除术试验（CHAT）的多导睡眠图研究期间收集的心电图信号（ECG）和血氧饱和度数据（SpO）进行二次分析，以计算CPC-SQI和呼吸暂停低通气指数（AHI）。在CHAT中，将5至9岁无长时间氧合血红蛋白饱和度降低的OSA儿童随机分配至腺样体扁桃体切除术（eAT）组或观察等待并给予支持性护理（WWSC）组。主要结局是记录通过发育神经心理评估（NEPSY）评估的注意力和执行功能的变化。在我们的分析中，将7个月后OSA自发缓解（AHI < 1.0）且睡眠质量高（SQI≥75）的WWSC组儿童与仍有残余OSA的儿童进行比较。
在随机分配至WWSC组的227名儿童中，203名儿童在基线和7个月随访时均有可用数据。在第7个月显示OSA缓解的组（n = 43，21%）更有可能具有较高的基线SQI，分别为79.96 [CI 75.05, 84.86] 对比72.44 [CI 69.50, 75.39]，P = 0.005；轻度OSA，AHI分别为4.01 [CI 2.34, 5.68] 对比6.52 [CI 5.47, 7.57]，P = 0.005；NEPSY注意力-执行功能得分更高，分别为106.22 [CI 101.67, 110.77] 对比101.14 [CI 98.58, 103.72]，P = 0.038；并且根据家长评估的生活质量更好，分别为83.74 [CI 78.95, 88.54] 对比77.51 [74.49, 80.53]，P = 0.015。通过Mallampati评分、Friedman腭位置或睡眠相关问卷进行临床评估时，两组没有差异。
显示OSA缓解的儿童更有可能具有高SQI和轻度OSA，体重正常，并且在基线时具有更好的注意力、执行功能和生活质量。由于这种评估睡眠质量和OSA的简单方法基于分析易于收集的信号，该方法对于多晚和多次的睡眠测试是实用的。这种方法可能有助于医生和家长为他们的孩子确定最合适的治疗方法，因为一些儿童可能从WWSC而非干预措施中获益。如果这些参数可以用于预先规划护理，这将为儿童OSA的诊断和管理方式带来根本性转变。
