Hsieh Hui-Shan, Chuang Hai-Hua, Hsin Li-Jen, Lin Wan-Ni, Kang Chung-Jan, Zhuo Ming-Ying, Chuang Li-Pang, Huang Yu-Shu, Li Hsueh-Yu, Fang Tuan-Jen, Lee Li-Ang
Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.
Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China.
Otolaryngol Head Neck Surg. 2023 May;168(5):1197-1208. doi: 10.1002/ohn.184. Epub 2023 Jan 29.
To investigate the risk factors of postoperative elevated blood pressure (BP) in children with childhood obstructive sleep apnea syndrome (OSAS) after adenotonsillectomy (AT).
Case series with planned data collection.
Tertiary referral center.
Two hundred forty-five consecutive children (180 boys and 65 girls, median age 6.6 years) with polysomnography-diagnosed OSAS who underwent AT between January 2010 and August 2019. Clinical, polysomnographic, and evening BP data were assessed preoperatively and postoperatively (≥3 months after AT). Changes in the variables before and after AT and between individuals with and without hypertension were compared.
Postoperatively, the median (interquartile range) apnea-hypopnea index significantly decreased from 10.4 (5.3-22.6) to 2.2 (1.0-3.8) events/h. In addition, the mean (standard deviation) evening diastolic BP z-score significantly decreased from 0.7 (0.94) to 0.5 (0.81) in the overall cohort, and both systolic (2.1 [0.94]-1.0 [1.31]) and diastolic BP z-scores (1.6 [0.98]-0.7 [0.85]) significantly decreased in the preoperative elevated BP subgroup. Multivariate logistic regression analysis showed that preoperative obesity (adjusted odds ratio = 4.36, 95% confidence interval = 2.24-8.49) and mean peripheral oxygen saturation <95% during sleep (adjusted odds ratio = 2.73, 95% confidence interval = 1.29-5.79) were independently associated with postoperative elevated BP.
Preoperative obesity and mean peripheral oxygen saturation <95% during sleep were significantly associated with postoperative elevated BP in the children with OSAS, further indicating the importance of careful BP monitoring in this subgroup despite AT treatment.
探讨儿童阻塞性睡眠呼吸暂停综合征（OSAS）患儿行腺样体扁桃体切除术（AT）后血压升高的危险因素。
有计划数据收集的病例系列研究。
三级转诊中心。
2010年1月至2019年8月期间连续纳入245例经多导睡眠图诊断为OSAS并行AT的儿童（180例男孩和65例女孩，中位年龄6.6岁）。术前及术后（AT后≥3个月）评估临床、多导睡眠图及夜间血压数据。比较AT前后变量的变化以及高血压患儿与非高血压患儿之间的差异。
术后，呼吸暂停低通气指数中位数（四分位间距）从10.4（5.3 - 22.6）显著降至2.2（1.0 - 3.8）次/小时。此外，总体队列中夜间舒张压z评分均值（标准差）从0.7（0.94）显著降至0.5（0.81），术前血压升高亚组的收缩压（2.1 [0.94] - 1.0 [1.31]）和舒张压z评分（1.6 [0.98] - 0.7 [0.85]）均显著下降。多因素logistic回归分析显示，术前肥胖（调整比值比 = 4.36，95%置信区间 = 2.24 - 8.49）和睡眠期间平均外周血氧饱和度<95%（调整比值比 = 2.73，95%置信区间 = 1.29 - 5.79）与术后血压升高独立相关。
术前肥胖和睡眠期间平均外周血氧饱和度<95%与OSAS患儿术后血压升高显著相关，进一步表明尽管进行了AT治疗，但对该亚组患儿进行仔细的血压监测非常重要。
