Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, MSC550, 29425, USA.
Department of Otolaryngology - Head and Neck Surgery, Medical College of Georgia, 1120 15th Street, BP 4109, Augusta, GA, 30912, USA.
Sleep Breath. 2024 Mar;28(1):411-418. doi: 10.1007/s11325-023-02910-4. Epub 2023 Sep 9.
To investigate threshold values for obstructive apnea-hypopnea index (OAHI) and nadir oxygen saturation (NspO) in children with severe obstructive sleep apnea (OSA) to identify children most appropriate for preoperative echocardiography.
A multi-institutional retrospective chart review was performed on children who underwent echocardiography and polysomnogram within a year. Children with severe OSA as defined by OAHI > 10 or NspO < 80% were included. Receiver operator curves and Youden's J index were used to assess the discriminatory ability and threshold values of OAHI and NspO for right heart strain (RHS) on echocardiography.
A total of 173 prepubertal (< 10 years) children and 71 postpubertal (≥ 10 years) children of age were included. RHS was seen in 9 (5%) prepubertal children and 4 (6%) postpubertal children. In prepubertal children, OAHI and NspO were poor predictors of RHS (area under the curve [AUC] 0.53 [95%CI 0.45-0.61], p = 0.748; AUC 0.56 [95%CI 0.48-0.64], p = 0.609). In postpubertal children, threshold values of 55 events/hour and 69% were strong predictors for RHS (AUC 0.88 [95%CI 0.78-0.95], p < 0.001; AUC 0.92 [95%CI 0.83-0.97], p < 0.001).
In children with severe OSA, evidence of RHS is low. Postpubertal children with OAHI > 55 and NspO < 69% appear most appropriate for echocardiography. Clinicians should weigh the risks and benefits of preoperative echocardiography for each child with these threshold values in mind.
研究严重阻塞性睡眠呼吸暂停（OSA）患儿阻塞性睡眠呼吸暂停低通气指数（OAHI）和最低血氧饱和度（NspO）的截断值，以确定最适合行术前超声心动图检查的患儿。
对一年内接受超声心动图和多导睡眠图检查的患儿进行多机构回顾性图表审查。纳入 OAHI>10 或 NspO<80%的严重 OSA 患儿。使用受试者工作特征曲线和 Youden's J 指数评估 OAHI 和 NspO 对超声心动图右心应变（RHS）的区分能力和截断值。
共纳入 173 名青春期前（<10 岁）和 71 名青春期后（≥10 岁）患儿。9 名（5%）青春期前患儿和 4 名（6%）青春期后患儿出现 RHS。在青春期前患儿中，OAHI 和 NspO 对 RHS 的预测作用较差（曲线下面积 [AUC] 0.53[95%CI 0.45-0.61]，p=0.748；AUC 0.56[95%CI 0.48-0.64]，p=0.609）。在青春期后患儿中，55 次/小时和 69%是 RHS 的强预测因素（AUC 0.88[95%CI 0.78-0.95]，p<0.001；AUC 0.92[95%CI 0.83-0.97]，p<0.001）。
在严重 OSA 的患儿中，RHS 的证据很少。OAHI>55 和 NspO<69%的青春期后患儿最适合行超声心动图检查。临床医生应考虑每个患儿的风险和获益，根据这些截断值决定是否行术前超声心动图检查。
