极端儿科阻塞性睡眠呼吸暂停:临床特征,管理,长期结果和死亡率
Kantisa Sirianansopa1, Colin Massicotte2, Sundeep Bola3
1Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; Division of Pulmonary and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand.
Sleep medicine
|July 1, 2025
概括
儿童的极端阻塞性睡眠呼吸暂停 (OSA) 带来了重大挑战. 早期识别和多学科护理对于管理这种严重疾病和改善患者的治疗结果至关重要.
科学领域:
- 儿科肺病学 儿科肺病学
- 睡眠医学 睡眠医学
- 耳鼻喉科 耳鼻喉科 耳鼻喉科
背景情况:
- 极度阻塞性睡眠呼吸暂停 (OSA),定义为阻塞性呼吸暂停-呼吸暂停指数 (OAHI) ≥100次/小时,在儿科患者中提出了重大管理挑战.
- 极端OSA的严重程度通常与严重的并发症有关,需要专门的临床治疗.
研究的目的:
- 审查诊断为极端OSA的儿科患者的临床特征.
- 分析在儿童极端OSA中使用的管理策略.
- 评估结果并确定影响该患者群体预后的因素.
主要方法:
- 对于在2010年至2024年期间接受过多睡眠图 (PSG) 的极端OSA的儿科患者 (≤18岁) 的回顾性评估.
- 后勤回归分析,以确定与手术管理,残留OSA和修复手术相关的因素.
- 卡普兰-梅尔分析估计5年死亡率.
主要成果:
- 分析了50名患者,平均年龄为4.9岁;64%是男性. 中位数OAHI为123.2事件/小时,中位数最低点SpO2为65.5%.
- 在初始手术后的77.8%患者中观察到剩余的OSA. 与结果相关的因素包括手术管理的BMI Z-score < -2,残留OSA的nadir SpO2 ≤ 60%,修复手术的SpO2 < 90%的时间延长.
- 五年死亡率为8%,在2岁以下的儿童和患有面异常或喉病的儿童中死亡率更高.
结论:
- 警护理和早期识别极端OSA的高风险儿科患者是必不可少的.
- 多学科后续对优化管理和改善极端OSA儿童的结果至关重要.
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