预测儿童阻塞性睡眠呼吸暂停和围手术期呼吸不良事件：上呼吸道塌陷程度测量的作用。

Predicting obstructive sleep apnoea and perioperative respiratory adverse events in children: role of upper airway collapsibility measurements.

机构信息

Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia; Division of Paediatrics, Medical School, University of Western Australia, Crawley, WA, Australia; Perioperative Medicine Team, Peri-operative Care Programme, Telethon Kids Institute, Nedlands, WA, Australia.

Perioperative Medicine Team, Peri-operative Care Programme, Telethon Kids Institute, Nedlands, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Crawley, WA, Australia; Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, WA, Australia.

出版信息

Br J Anaesth. 2023 Dec;131(6):1043-1052. doi: 10.1016/j.bja.2023.09.021. Epub 2023 Oct 25.

DOI:10.1016/j.bja.2023.09.021

PMID:37891122

Abstract

BACKGROUND

Obstructive sleep apnoea (OSA) and perioperative respiratory adverse events are significant risks for anaesthesia in children undergoing adenotonsillectomy. Upper airway collapse is a crucial feature of OSA that contributes to respiratory adverse events. A measure of upper airway collapsibility to identify undiagnosed OSA can help guide perioperative management. We investigated the utility of pharyngeal closing pressure (P) for predicting OSA and respiratory adverse events.

METHODS

Children scheduled for elective adenotonsillectomy underwent in-laboratory polysomnography 2-12 weeks before surgery. P measurements were obtained while the child was anaesthetised and breathing spontaneously just before surgery. Logistic regression was used to assess the predictive performance of P for detecting OSA and perioperative respiratory adverse events after adjusting for potential covariates.

RESULTS

In 52 children (age, mean [standard deviation] 5.7 [1.8] yr; 20 [38%] females), airway collapse during P was observed in 42 (81%). Of these, 19 of 42 (45%) patients did not have OSA, 15 (36%) had mild OSA, and eight (19%) had moderate-to-severe OSA. All 10 children with no evidence of airway collapse during the P measurements did not have OSA. P predicted moderate-to-severe OSA (odds ratio [OR] 1.71; 95% confidence interval [CI]: 1.2-2.8; P=0.011). All children with moderate-to-severe OSA could be identified at a P threshold of -4.0 cm HO (100% sensitivity), and most with no or mild OSA were ruled out (64.7% specificity; receiver operating characteristic/area under the curve=0.857). However, there was no significant association between respiratory adverse events and P (OR 1.0; 95% CI: 0.8-1.1; P=0.641).

CONCLUSIONS

Measurement of P after induction of anaesthesia can reliably identify moderate or severe OSA but not perioperative respiratory adverse events in children before adenotonsillectomy.

CLINICAL TRIAL REGISTRATION

ANZCTR ACTRN 12617001503314.

摘要

背景

阻塞性睡眠呼吸暂停（OSA）和围手术期呼吸不良事件是小儿腺样体扁桃体切除术麻醉的重大风险。上气道塌陷是 OSA 的一个关键特征，导致呼吸不良事件。测量上气道塌陷度以确定未诊断的 OSA 可以帮助指导围手术期管理。我们研究了咽闭合压（P）预测 OSA 和围手术期呼吸不良事件的效用。

方法

计划行择期腺样体扁桃体切除术的儿童在手术前 2-12 周进行实验室多导睡眠图检查。在儿童麻醉并在手术前自主呼吸时获得 P 测量值。使用逻辑回归来评估 P 预测 OSA 和围手术期呼吸不良事件的预测性能，同时调整潜在的协变量。

结果

在 52 名儿童（年龄，平均值[标准差]5.7[1.8]岁；20[38%]名女性）中，在 P 期间观察到气道塌陷 42 例（81%）。其中，42 例中的 19 例（45%）患者无 OSA，15 例（36%）为轻度 OSA，8 例（19%）为中重度 OSA。所有在 P 测量期间没有气道塌陷证据的 10 名儿童均无 OSA。P 预测中重度 OSA（优势比[OR]1.71；95%置信区间[CI]：1.2-2.8；P=0.011）。所有中重度 OSA 儿童都可以在 P 阈值为-4.0cm HO 时识别出来（100%的敏感性），而大多数轻度或无 OSA 的儿童都被排除在外（64.7%的特异性；接收者操作特征/曲线下面积=0.857）。然而，呼吸不良事件与 P 之间没有显著关联（OR 1.0；95%CI：0.8-1.1；P=0.641）。