Saied Nancy, Solis Roberto Noel, Funamura Jamie, Chen Joy, Lammers Cathleen, Nandalike Kiran
Department of Anesthesiology and Pain Medicine, University of California, Davis, CA 95817, USA.
Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, CA 95817, USA.
Children (Basel). 2022 Sep 15;9(9):1396. doi: 10.3390/children9091396.
Available information on clinical characteristics and post-operative outcomes in children with very severe obstructive sleep apnea (OSA) is limited. Our study evaluates the clinical features and polysomnographic (PSG) variables that predict post-operative outcomes in children with an obstructive apneal hypopnea index (AHI) of more than 25 events/hr. In this study from a single tertiary care center, we performed a retrospective chart review of patients with an AHI > 25/hr, who underwent tonsillectomy and adenoidectomy (T&A) between January 2016 and September 2021. In total, 50 children were included in the study: 26.0% (13/50) of children experienced post-operative respiratory events and four children needed intubation and ventilator support. Compared with children without respiratory events, children requiring post-operative respiratory interventions were younger (4.4 ± 5.2 vs. 8.0 ± 5.2 years; p = 0.04), had higher pre-operative AHI (73.6 ± 27.4 vs. 44.8 ± 24.9; p < 0.01), lower oxygen nadirs (70.0 ± 13.0% vs. 83.0 ± 7.0%; p < 0.01), and had lower body metabolic index Z-scores (−0.51 ± 2.1 vs. 0.66 ± 1.5; p < 0.04). Moderate to severe residual OSA was identified in 70% (24/34) of children with available post-operative PSG; younger children had better PSG outcomes. Our study shows that post-operative respiratory events are frequent in children with very severe OSA, particularly with an AHI > 40/h, younger children (<2 years of age), lower oxygen saturation (SpO2), and poor nutritional status, necessitating close monitoring.
关于患有极重度阻塞性睡眠呼吸暂停（OSA）儿童的临床特征和术后结果的现有信息有限。我们的研究评估了阻塞性呼吸暂停低通气指数（AHI）超过25次/小时的儿童术后结果的临床特征和多导睡眠图（PSG）变量。在这项来自单一三级医疗中心的研究中，我们对2016年1月至2021年9月期间接受扁桃体切除术和腺样体切除术（T&A）且AHI>25/小时的患者进行了回顾性病历审查。该研究共纳入50名儿童：26.0%（13/50）的儿童术后出现呼吸事件，4名儿童需要插管和呼吸机支持。与未发生呼吸事件的儿童相比，需要术后呼吸干预的儿童更年幼（4.4±5.2岁 vs. 8.0±5.2岁；p = 0.04），术前AHI更高（73.6±27.4 vs. 44.8±24.9；p < 0.01），最低血氧饱和度更低（70.0±13.0% vs. 83.0±7.0%；p < 0.01），且身体代谢指数Z评分更低（−0.51±2.1 vs. 0.66±1.5；p < 0.04）。在有术后PSG数据的儿童中，70%（24/34）被确定存在中度至重度残余OSA；年龄较小的儿童PSG结果更好。我们的研究表明，极重度OSA儿童术后呼吸事件频发，尤其是AHI>40/h、年龄较小（<2岁）、血氧饱和度（SpO2）较低且营养状况较差的儿童，需要密切监测。
