[Collaborative diagnosis and treatment of children with extremely severe obstructive sleep apnea involving...

Objective: To explore the multidisciplinary collaborative diagnosis and treatment for children with extremely severe obstructive sleep apnea (OSA) complicated by multisystem injuries. Methods: Clinical data of 3 children with extremely severe OSA who were admitted to our hospital from July 2024 to December 2024 were retrospectively analyzed. The patients were aged 7 years and 9 months, 12 years, and 8 years and 3 months respectively, including 2 males and 1 female. All these children had more than 2 systems involved and an obstructive apnea-hypopnea index (OAHI) exceeding 30 events/h. Comprehensive auxiliary examinations, including polysomnography (PSG) or percutaneous oxygen saturation (SpO₂) monitoring, nasopharyngoscopy and imaging tests, were performed for all cases. The clinical characteristics, multisystem injury conditions, multidisciplinary treatment regimens, selection of surgical timing and treatment outcomes were analyzed to evaluate the treatment priority. Results: The 3 children all presented with a body mass index (BMI) above 28 kg/m², and with clinical manifestations, such as severe sleep snoring, apnea and mouth breathing, along with significant tonsillar and adenoidal hypertrophy. One child who had a SpO₂ of 60% during outpatient consultation was admitted to the pediatric intensive care unit (PICU) for tracheal intubation and mechanical ventilation due to acute respiratory failure, without undergoing preoperative PSG. For the other two children, PSG results showed an OAHI of 33.5 events/h with a lowest oxygen saturation (LSaO₂) of 38%, and an OAHI of 179 events/h with an LSaO₂ of 27%, respectively. Multisystem injuries involved cardiovascular, respiratory, endocrine and other systems. Multidisciplinary collaborative evaluation confirmed that airway obstruction was the underlying cause. All children underwent tonsillectomy and adenoidectomy as a priority after their oxygenation was stabilized with ventilator support, with corresponding perioperative medical treatment. All children were successfully extubated within 24 hours after surgery. During the 1-year follow-up, the symptoms of sleep snoring and apnea were completely relieved in all 3 children, and their daily learning and living functions returned to normal levels without significant impairment. Conclusion: Extremely severe OSA in children can cause multisystem injuries, which requires multidisciplinary evaluation. Under the premise of ensuring ventilation and oxygenation, priority should be given to surgical intervention to resolve airway obstruction. Meanwhile, multidisciplinary collaborative diagnosis and treatment is conducive to reducing treatment risks and improving clinical efficacy.