疑似阻塞性睡眠呼吸暂停儿童中肺动脉高压的发病率低：一项前瞻性观察研究。
Low incidence of pulmonary hypertension in children with suspected obstructive sleep apnea: A prospective observational study.
机构信息
Department of Paediatrics and Child Health, University of Cape Town, South Africa.
Division of Otorhinolaryngology, Department of Surgery, University of Cape Town, South Africa.
出版信息
Int J Pediatr Otorhinolaryngol. 2023 Aug;171:111648. doi: 10.1016/j.ijporl.2023.111648. Epub 2023 Jul 4.
OBJECTIVES
Pulmonary hypertension (PH) secondary to obstructive sleep apnea (OSA) is an uncommon but serious perioperative risk factor in children undergoing surgery for adenotonsillar hypertrophy. Routine pre-operative echocardiography is commonly requested if severe OSA is suspected. We investigated the incidence of PH in children with suspected OSA and explored the association between PH and OSA severity.
METHODS
A prospective study of children aged 1-13 years with suspected OSA admitted for overnight oximetry (OO) and echocardiography at a pediatric referral hospital in Cape Town, South Africa from 2018 to 2019. OSA severity was defined by McGill Oximetry Score (MOS): MOS 1-2 (mild-moderate) and MOS 3-4 (severe). PH was defined as mean pulmonary arterial pressure (mPAP) ≥20 mmHg estimated on echocardiographic criteria. Children with congenital heart disease, underlying cardio-respiratory or genetic disorders, and severe obesity were excluded.
RESULTS
One hundred and seventy children median age 3.8 years (IQR 2.7-6.4) were enrolled and 103 (60%) were female. Twenty-two (14%) had a BMIz >1.0 and 99 (59%) had tonsillar enlargement grade 3/4. One hundred and twenty-two (71%) and 48 (28%) children had mild-moderate and severe OSA, respectively. Echocardiographic assessment for PH was successful in 160 (94%) children of which eight (5%) had PH with mPAP 20.8 mmHg (SD 0.9): six with mild-moderate OSA and two with severe OSA. No significant difference in mPAP and other echocardiographic indices was observed in children with mild-moderate (16.1 mmHg; SD 2.4) and severe OSA (15.7 mmHg; SD 2.1). Similarly, no clinical and OSA severity differences were observed in children with and without PH.
CONCLUSION
PH is uncommon in children with uncomplicated OSA and there is no association of PH with severity of OSA measured by OO. Routine echocardiographic screening for PH in children with clinical symptoms of OSA without co-morbidity is unwarranted.
目的
阻塞性睡眠呼吸暂停（OSA）引起的肺动脉高压（PH）在接受腺样体扁桃体肥大手术的儿童中是一种罕见但严重的围手术期危险因素。如果怀疑有严重的 OSA，通常会要求进行常规术前超声心动图检查。我们调查了怀疑患有 OSA 的儿童中 PH 的发生率，并探讨了 PH 与 OSA 严重程度之间的关系。
方法
这是一项在南非开普敦的一家儿科转诊医院进行的前瞻性研究，纳入了 2018 年至 2019 年间接受过夜血氧饱和度（OO）和超声心动图检查的年龄在 1 至 13 岁之间、疑似 OSA 的儿童。OSA 严重程度由麦吉尔血氧饱和度评分（MOS）定义：MOS 1-2（轻度至中度）和 MOS 3-4（重度）。PH 定义为超声心动图标准估计的平均肺动脉压（mPAP）≥20mmHg。患有先天性心脏病、心肺或遗传疾病以及严重肥胖的儿童被排除在外。
结果
共纳入 170 名儿童（中位年龄 3.8 岁[IQR 2.7-6.4]），其中 103 名（60%）为女性。22 名（14%）的 BMIz＞1.0，99 名（59%）的扁桃体肿大程度为 3/4。122 名（71%）和 48 名（28%）儿童分别患有轻度至中度和重度 OSA。160 名儿童（94%）成功进行了 PH 的超声心动图评估，其中 8 名（5%）有 PH，平均肺动脉压（mPAP）为 20.8mmHg（标准差 0.9）：6 名患有轻度至中度 OSA，2 名患有重度 OSA。在患有轻度至中度 OSA（16.1mmHg；标准差 2.4）和重度 OSA（15.7mmHg；标准差 2.1）的儿童中，mPAP 和其他超声心动图指标无显著差异。同样，在有和没有 PH 的儿童中，临床和 OSA 严重程度也没有差异。
结论
在没有合并症的单纯 OSA 儿童中，PH 并不常见，并且 PH 与 OO 测量的 OSA 严重程度之间没有关联。对于有 OSA 临床症状但无合并症的儿童，常规进行 PH 的超声心动图筛查是不必要的。
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