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Polysomnographic parameters and clinical risk factors predicting postoperative respiratory complications in children
Sawita Kanavitoon1,2, Pornswan Ngamprasertwong2, Neepa Gurbani3,4
1Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Children undergoing supraglottoplasty (SGP) for sleep apnea with an obstructive apnea-hypopnea index (AHI) over 10 events/h face a higher risk of postoperative respiratory complications (PORCs). Preoperative polysomnography aids in identifying these risks.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Respiratory Physiology
Background:
- Postoperative respiratory complications (PORCs) are a concern following supraglottoplasty (SGP) in children with obstructive sleep apnea.
- Identifying predictive risk factors for PORCs is crucial for optimizing surgical outcomes and patient safety.
Purpose of the Study:
- To evaluate the incidence of PORCs in children undergoing SGP.
- To identify clinical factors and polysomnographic parameters that predict PORCs after SGP.
Main Methods:
- Retrospective analysis of 400 children with laryngomalacia undergoing SGP.
- Preoperative polysomnography data were analyzed for all participants.
- Statistical analysis, including unadjusted odds ratios and multiple regression, was used to identify risk factors.
Main Results:
- 23.1% of patients experienced PORCs.
- Children with PORCs had higher rates of congenital heart disease, elevated obstructive apnea-hypopnea index (AHI), and lower oxygen saturation (SpO2).
- An obstructive AHI > 10 events/h was the sole independent predictor of PORCs.
Conclusions:
- Children with laryngomalacia undergoing SGP are at risk for PORCs, particularly those with congenital heart disease and abnormal polysomnography findings.
- An obstructive AHI > 10 events/h significantly increases the risk of PORCs post-SGP.
- Preoperative polysomnography is valuable for risk stratification and surgical planning in this patient population.
Study Objectives:
Postoperative respiratory complications (PORCs) can occur following supraglottoplasty (SGP) for obstructive sleep apnea. However, there are very limited data on risk factors associated with these complications. This study aims to evaluate the occurrence of PORC in children undergoing SGP and to assess clinical factors and polysomnographic parameters predicting these complications.
Methods:
A retrospective study was performed in children with laryngomalacia who underwent SGP with preoperative polysomnography.
Results:
400 children who underwent SGP met the criteria for entry into the analysis with a total of 416 surgeries with corresponding preoperative polysomnography. The median age (interquartile range) at the time of polysomnography was 0.4 (0.2, 1.5) years. A total of 96 (23.1%) PORCs were noted. Compared with those without complications, children with PORCs had a higher proportion of congenital heart disease (P < .05), higher median obstructive apnea-hypopnea index (obstructive AHI; median 16.0 vs 11.4 events/h; P < .01), and lower median oxygen saturation (SpO2) (P < .001). The unadjusted odd ratio indicated an increased risk of PORCs in children with congenital heart disease (odds ratio 1.66; P < .05) and those with an obstructive AHI > 10 events/h (odds ratio 2.06; P < .01). Multiple regression analysis demonstrated that an obstructive AHI > 10 events/h was the only independent risk factor for PORCs (P < .05).
Conclusions:
In our cohort of children with laryngomalacia undergoing SGP, those with underlying congenital heart disease, higher obstructive AHI, and lower SpO2 were more likely to develop PORCs. Only children with an obstructive AHI > 10 events/h were at significantly increased risk for PORCs following SGP. Preoperative polysomnography is useful in preoperative planning in children undergoing SGP.
Citation:
Kanavitoon S, Ngamprasertwong P, Gurbani N, et al. Polysomnographic parameters and clinical risk factors predicting postoperative respiratory complications in children undergoing supraglottoplasty. J Clin Sleep Med. 2024;20(1):9-16.
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