The Role of Sleep Studies to Predict Post-Operative Outcomes in Children with Medical Complexity

Background: In children with medical complexity (CMC), respiratory involvement represents one of the main causes of morbidity. Early recognition of nocturnal hypoventilation or sleep-disordered breathing (SDB) may allow timely intervention and reduce perioperative respiratory complications. This study aimed to evaluate the role of sleep studies in guiding clinical decision-making and perioperative respiratory management in CMC patients undergoing spinal arthrodesis for scoliosis correction. Methods: We retrospectively analysed clinical data from 357 patients (196 females) who underwent scoliosis surgery between 20 November 2012 and 11 June 2024. All patients received a standardized preoperative respiratory assessment at the Pulmonology Unit of IRCCS Burlo Garofolo. Results: Patients were classified into seven diagnostic groups, including neurological, neuromuscular, cerebral palsy, malformative, and other complex conditions. Median age at surgery was 12 years (range 2-22). Sleep studies were performed in 119 patients and identified abnormalities suggestive of sleep-disordered breathing or nocturnal hypoventilation, including elevated apnea-hypopnea index, oxygen desaturation, or abnormal transcutaneous carbon dioxide levels. Before surgery, 20 patients were receiving non-invasive ventilation nIV), initiated based on sleep study findings or pulmonary function impairment, while two patients were supported with continuous positive airway pressure (CPAP). Median Paediatric Intensive Care Unit (PICU) stay was 4.0 days (IQR 3.0-5.5 days; range 1-23), with no statistically significant differences across diagnostic categories (p = 0.12). Postoperatively, respiratory support was frequently required, including invasive mechanical ventilation, NIV, or CPAP, but the duration of invasive ventilation was 15.5 h (range 1-36). Only one patient required tracheostomy, and no perioperative deaths occurred. Conclusions: In CMC undergoing spinal arthrodesis, preoperative sleep studies significantly influence the clinical decision-making process and support perioperative respiratory assessment by identifying occult respiratory vulnerability and informing tailored ventilatory strategies. While associated with structured management pathways, the prospective impact of sleep-guided interventions on postoperative clinical outcomes remains to be confirmed through controlled studies.