Is there an OAHI or O 2 nadir that predicts the need for preoperative echocardiogram prior to adenotonsillectomy for children with severe obstructive sleep apnea?

Autor: Poupore NS; Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, MSC550, 29425, USA. poupore@musc.edu., Smaily H; Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, MSC550, 29425, USA., Sullivan JD; Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, MSC550, 29425, USA., Myint CW; Department of Otolaryngology - Head and Neck Surgery, Medical College of Georgia, 1120 15th Street, BP 4109, Augusta, GA, 30912, USA., Prosser JD; Department of Otolaryngology - Head and Neck Surgery, Medical College of Georgia, 1120 15th Street, BP 4109, Augusta, GA, 30912, USA., Carroll WW; Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, MSC550, 29425, USA.
Jazyk: angličtina
Zdroj: Sleep & breathing = Schlaf & Atmung [Sleep Breath] 2024 Mar; Vol. 28 (1), pp. 411-418. Date of Electronic Publication: 2023 Sep 09.
DOI: 10.1007/s11325-023-02910-4
Abstrakt: Purpose: To investigate threshold values for obstructive apnea-hypopnea index (OAHI) and nadir oxygen saturation (NspO 2 ) in children with severe obstructive sleep apnea (OSA) to identify children most appropriate for preoperative echocardiography.
Methods: 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 2  < 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 2 for right heart strain (RHS) on echocardiography.
Results: 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 2 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).
Conclusion: In children with severe OSA, evidence of RHS is low. Postpubertal children with OAHI > 55 and NspO 2  < 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.
(© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
Databáze: MEDLINE
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