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

Autor: Ohn M; 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. Electronic address: mon.ohn@health.wa.gov.au., Sommerfield D; 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., Nguyen J; Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia; Perioperative Medicine Team, Peri-operative Care Programme, Telethon Kids Institute, Nedlands, WA, Australia; Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, WA, Australia., Evans D; Perioperative Medicine Team, Peri-operative Care Programme, Telethon Kids Institute, Nedlands, WA, Australia; Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, WA, Australia; School of Physics, Mathematics and Computing, University of Western Australia, Crawley, WA, Australia., Khan RN; Department of Mathematics and Statistics, University of Western Australia, Crawley, WA, Australia., Hauser N; 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., Herbert H; Division of Paediatrics, Medical School, University of Western Australia, Crawley, WA, Australia; Department of Otolaryngology/Head and Neck Surgery, Perth Children's Hospital, Nedlands, WA, Australia., Bumbak P; Department of Otolaryngology/Head and Neck Surgery, Perth Children's Hospital, Nedlands, WA, Australia., Wilson AC; 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; Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia., Eastwood PR; Health Futures Institute, Murdoch University, Perth, WA, Australia., Maddison KJ; West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia., Walsh JH; West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia., von Ungern-Sternberg BS; 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.
Jazyk: angličtina
Zdroj: British journal of anaesthesia [Br J Anaesth] 2023 Dec; Vol. 131 (6), pp. 1043-1052. Date of Electronic Publication: 2023 Oct 25.
DOI: 10.1016/j.bja.2023.09.021
Abstrakt: 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 CLOSE ) for predicting OSA and respiratory adverse events.
Methods: Children scheduled for elective adenotonsillectomy underwent in-laboratory polysomnography 2-12 weeks before surgery. P CLOSE 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 CLOSE 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 CLOSE 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 CLOSE measurements did not have OSA. P CLOSE 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 CLOSE threshold of -4.0 cm H 2 O (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 CLOSE (OR 1.0; 95% CI: 0.8-1.1; P=0.641).
Conclusions: Measurement of P CLOSE 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.
(Copyright © 2023 British Journal of Anaesthesia. All rights reserved.)
Databáze: MEDLINE
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