Khan Adil Y, Curry Brian, Jergel Andrew, Keesari Rohali, Prosky Jordan, Garcia Richard U
Emory University School of Medicine, Atlanta, GA, USA.
Children's Healthcare of Atlanta, Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine Children's Healthcare of Atlanta, 2835 Brandywine Rd, Suite 400, Atlanta, 30341, GA, USA.
Pediatr Cardiol. 2024 Jul 15. doi: 10.1007/s00246-024-03583-w.
Obstructive sleep apnea (OSA) has been associated with negative cardiovascular effects and negative outcomes following cardiovascular surgery in the adult population. Our objective was to evaluate if there is a similar association in children. Single center retrospective matched cohort study, we collected data on patients aged 1-18 who were admitted to the cardiac intensive care unit (CICU) between Jan 2012 and Dec 2021. We used a 3:1 propensity score matching for cases not diagnosed with OSA. Primary outcome was a composite variable: "adverse outcome," consisting of prolonged hospital and CICU stay, prolonged duration of mechanical ventilation, need for extracorporeal membrane oxygenation, and death. The study comprised 80 patients diagnosed with OSA and 240 patients without a diagnosis of OSA before cardiac surgery. The median age was 5.3 years (IQR 2.7-11.2). There were 184 (57.5%) males, and 102 (31.9%) had chromosomal and genetic abnormalities. There was a difference in "adverse outcome" between the OSA and non-OSA groups [34 (42.50%) vs 68 (28.33%), p = 0.027]. Moreover, bivariate analysis revealed that CICU length of stay, and chromosomal anomalies were statistically different between the groups. By logistic regression the composite variable "adverse outcome" remained associated to the OSA group (p = 0.009) with an adjusted odds ratio (OR) of 4.09 (1.83-9.18), p < 0.001. Children diagnosed with OSA had a higher risk of "adverse outcome" following cardiac surgery. The risk disappeared if the patient had Tonsillectomy and Adenoidectomy before cardiac surgery. Further studies should explore a proactive treatment for OSA in pediatric patients who need cardiac surgery.
阻塞性睡眠呼吸暂停（OSA）与成年人心血管手术的不良心血管影响及不良后果相关。我们的目的是评估儿童中是否存在类似关联。在单中心回顾性匹配队列研究中，我们收集了2012年1月至2021年12月间入住心脏重症监护病房（CICU）的1至18岁患者的数据。对于未诊断为OSA的病例，我们采用3:1的倾向评分匹配。主要结局是一个复合变量：“不良结局”，包括住院时间和CICU住院时间延长、机械通气时间延长、需要体外膜肺氧合以及死亡。该研究包括80例在心脏手术前被诊断为OSA的患者和240例未诊断为OSA的患者。中位年龄为5.3岁（四分位间距2.7 - 11.2）。有184例（57.5%）男性，102例（31.9%）有染色体和基因异常。OSA组和非OSA组之间在“不良结局”方面存在差异[34例（42.50%）对68例（28.33%），p = 0.027]。此外，双变量分析显示两组之间CICU住院时间和染色体异常在统计学上存在差异。通过逻辑回归分析，复合变量“不良结局”仍与OSA组相关（p = 0.009），调整后的优势比（OR）为4.09（1.83 - 9.18），p < 0.001。被诊断为OSA的儿童在心脏手术后发生“不良结局”的风险更高。如果患者在心脏手术前进行了扁桃体切除术和腺样体切除术，该风险则消失。进一步的研究应探索对需要心脏手术的儿科患者OSA的积极治疗方法。
