Khatana Jasmine, Thavamani Aravind, Umapathi Krishna Kishore, Sankararaman Senthilkumar, Roy Aparna
Department of Pediatrics, Metro Health Medical Center, Case Western Reserve University School of Medicine, 2500 Metrohealth Dr, Cleveland, OH 44109, USA.
Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Adelbert Rd 2101, Cleveland, OH 44106, USA.
Children (Basel). 2024 Aug 22;11(8):1029. doi: 10.3390/children11081029.
Studies have shown a bidirectional relationship between asthma and obstructive sleep apnea (OSA). However, there is a paucity of national-level data evaluating the impact of OSA on hospital outcomes in pediatric hospitalizations for asthma.
We analyzed the National Inpatient Sample and Kids Inpatient Database to include all pediatric hospitalizations with a primary diagnosis of asthma between 2003-2016. Using ICD codes, the pediatric asthma cohort was divided into two groups: those with and those without a concomitant diagnosis of OSA. The primary outcomes were in-hospital mortality and the need for mechanical ventilation. The secondary outcomes were the lengths of each hospital stay and total hospitalization charges.
We analyzed 1,606,248 hospitalizations during the 14-year study period. The overall prevalence rate of OSA was 0.7%. Patients with asthma and OSA were significantly older (8.2 versus 5.9 years) and were more often male, < 0.001. The OSA group had several increased comorbidities. The overall mortality rate was 0.03%, and multivariate regression analysis showed that OSA was associated with 4.3 times higher odds of in-hospital mortality (95% CI: 2.4 to 7.6, < 0.001). Furthermore, OSA was associated with a 5.2 times greater need for mechanical ventilation (95% CI: 4.8 to 5.5, < 0.001). Linear regression analyses demonstrated that OSA independently contributed an additional 0.82 days to the hospital stay length (95% CI: 0.79 to 0.86, < 0.001) and an extra 10,479 USD (95% CI: 10,110 to 10,848, < 0.001) in hospitalization charges.
OSA in children admitted with asthma is associated with poor hospital outcomes such as increased mortality risk, the need for mechanical ventilation, and increased healthcare utilization.
研究表明哮喘与阻塞性睡眠呼吸暂停（OSA）之间存在双向关系。然而，缺乏国家级数据来评估OSA对儿科哮喘住院患者医院结局的影响。
我们分析了全国住院患者样本和儿童住院患者数据库，纳入2003年至2016年间所有以哮喘为主要诊断的儿科住院病例。使用国际疾病分类代码，将儿科哮喘队列分为两组：伴有和不伴有OSA合并诊断的患者。主要结局为住院死亡率和机械通气需求。次要结局为每次住院的时长和总住院费用。
在14年的研究期间，我们分析了1,606,248例住院病例。OSA的总体患病率为0.7%。患有哮喘和OSA的患者年龄显著更大（8.2岁对5.9岁），且男性更为常见，P<0.001。OSA组有多种合并症增加。总体死亡率为0.03%，多变量回归分析显示OSA与住院死亡率高4.3倍的几率相关（95%置信区间：2.4至7.6，P<0.001）。此外，OSA与机械通气需求高5.2倍相关（95%置信区间：4.8至5.5，P<0.001）。线性回归分析表明，OSA独立导致住院时长额外增加0.82天（95%置信区间：0.79至0.86，P<0.001），住院费用额外增加10,479美元（95%置信区间：10,110至10,848，P<0.001）。
哮喘患儿合并OSA与不良医院结局相关，如死亡风险增加、机械通气需求增加和医疗保健利用率提高。
