Sleep medicine · 2025
Extreme pediatric obstructive sleep Apnea: Clinical Features, management, long-term outcomes and mortality.
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Sirianansopa Kantisa, Massicotte Colin, Bola Sundeep, Chiang Jackie, Narang Indra, Wolter Nikolaus E, Propst Evan J, Amin Reshma
Аннотация
OBJECTIVES: Extreme obstructive sleep apnea (OSA), defined by an obstructive apnea-hypopnea index (OAHI) ≥100 events/hr, presents management challenges in pediatric patients due to its severity and associated comorbidities. This study aims to review the clinical characteristics, management strategies, and outcomes in this population.
METHODS: Retrospective reviewed patients aged ≤18 years with extreme OSA who underwent level 1 polysomnography (PSG) from 2010 to 2024. Logistic regression was performed to identify factor associated with surgical management, residual OSA, and revision surgery. Kaplan-Meier analysis was used to estimate 5-year mortality.
RESULTS: Fifty patients were reviewed, with a median (IQR) age: 4.9 (1.9, 12.8) years and 32 (64 %) were male. Median (IQR) OAHI was 123.2 (112, 143.1) events/hour, with median (IQR) nadir SpO2 of 65.5 % (52.3, 74.3). The residual OSA was noted 77.8 % on follow-up PSG after initial surgery. A BMI Z-score < -2 was significantly associated with surgical management [OR 19.8, 95 % CI 1.9-21.7, p = 0.013]. A nadir SpO2 ≤ 60 % was associated with residual OSA [OR 12.5, 95 % CI 1.2-13.6, p = 0.03]. Additionally, spending more than 10 % of total sleep time with SpO2 < 90 % was associated with the need for revision surgery [OR 7.6, 95 % CI 1.1-12.4, p = 0.04]. The 5-year respiratory illness-related mortality rate was 8 % (n = 4), with higher mortality observed in children age ≤2 years (p = 0.003) and those with craniofacial anomalies or symptomatic laryngomalacia (p = 0.004).
CONCLUSION: Early identification of high-risk patients, vigilant care, and multidisciplinary follow-up are essential for optimizing outcomes in extreme OSA.
METHODS: Retrospective reviewed patients aged ≤18 years with extreme OSA who underwent level 1 polysomnography (PSG) from 2010 to 2024. Logistic regression was performed to identify factor associated with surgical management, residual OSA, and revision surgery. Kaplan-Meier analysis was used to estimate 5-year mortality.
RESULTS: Fifty patients were reviewed, with a median (IQR) age: 4.9 (1.9, 12.8) years and 32 (64 %) were male. Median (IQR) OAHI was 123.2 (112, 143.1) events/hour, with median (IQR) nadir SpO2 of 65.5 % (52.3, 74.3). The residual OSA was noted 77.8 % on follow-up PSG after initial surgery. A BMI Z-score < -2 was significantly associated with surgical management [OR 19.8, 95 % CI 1.9-21.7, p = 0.013]. A nadir SpO2 ≤ 60 % was associated with residual OSA [OR 12.5, 95 % CI 1.2-13.6, p = 0.03]. Additionally, spending more than 10 % of total sleep time with SpO2 < 90 % was associated with the need for revision surgery [OR 7.6, 95 % CI 1.1-12.4, p = 0.04]. The 5-year respiratory illness-related mortality rate was 8 % (n = 4), with higher mortality observed in children age ≤2 years (p = 0.003) and those with craniofacial anomalies or symptomatic laryngomalacia (p = 0.004).
CONCLUSION: Early identification of high-risk patients, vigilant care, and multidisciplinary follow-up are essential for optimizing outcomes in extreme OSA.