Department of Neonatology and Pediatric Sleep Lab, Tübingen; University Children's Hospital, Tübingen, Germany; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
Department of Neonatology and Pediatric Sleep Lab, Tübingen; University Children's Hospital, Tübingen, Germany.
Sleep Med. 2022 Oct;98:9-12. doi: 10.1016/j.sleep.2022.06.010. Epub 2022 Jun 16.
We have used an obstructive apnea index of ≥3 as treatment indication for infants with Robin sequence (RS), while the obstructive apnea-hypopnea index (OAHI) and a threshold of ≥5 is often used internationally. We wanted to know whether these two result in similar indications, and what the interobserver variability is with either asessement.
Twenty lab-based overnight sleep recordings from infants with isolated RS (median age: 7 days, range 2-38) were scored based on the 2020 American Academy of Sleep Medicine guidelines, including or excluding obstructive hypopneas.
Median obstructive apnea index (OAI) was 18 (interquartile range: 7.6-38) including only apneas, and 35 (18-54) if obstructive hypopneas were also considered as respiratory events (OAHI). Obstructive sleep apnea (OSA) severity was re-classified from moderate to severe for two infants when obstructive hypopneas were also considered, but this did not lead to a change in clinical treatment decisions for either infant. Median interobserver agreement was 0.86 (95% CI 0.70-0.94) for the OAI, and 0.60 (0.05-0.84) for the OAHI.
Inclusion of obstructive hypopneas when assessing OSA severity in RS infants doubled the obstructive event rate, but impaired interobserver agreement and would not have changed clinical management.
我们曾将阻塞性呼吸暂停指数（obstructive apnea index，OAI）≥3 作为瑞氏综合征（Robin sequence，RS）婴儿的治疗指征，而国际上常用的是阻塞性呼吸暂停-低通气指数（obstructive apnea-hypopnea index，OAHI）和≥5 的阈值。我们想知道这两种方法是否会导致相似的治疗指征，以及两种方法的观察者间变异性如何。
对 20 例孤立性 RS 婴儿的实验室夜间睡眠记录进行评估（中位年龄：7 天，范围 2-38 天），评估方法基于 2020 年美国睡眠医学学会指南，包括或不包括阻塞性低通气。
仅包括呼吸暂停时，中位 OAI 为 18（四分位间距：7.6-38），如果同时考虑阻塞性低通气，则 OAI 为 35（18-54）（OAHI）。当同时考虑阻塞性低通气时，有 2 例婴儿的阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）严重程度从中度重新分类为重度，但这并未导致对这 2 例婴儿的临床治疗决策发生变化。OAI 的观察者间中位数一致性为 0.86（95%可信区间：0.70-0.94），OAHI 的观察者间中位数一致性为 0.60（0.05-0.84）。
在评估 RS 婴儿的 OSA 严重程度时，如果同时考虑阻塞性低通气，阻塞性事件发生率会增加一倍，但会降低观察者间一致性，且不会改变临床管理。
