Obstructive sleep apnea is associated with use of assisted ventilation among children with bronchopulmonary dysplasia hospitalized with respiratory illness: A nationwide inpatient cohort.
Obstructive sleep apnea is associated with use of assisted ventilation among children with bronchopulmonary dysplasia hospitalized with respiratory illness: A nationwide inpatient cohort.
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阻塞性睡眠呼吸暂停与因呼吸系统疾病住院的支气管肺发育不良儿童使用辅助通气相关：全国住院患者队列。
DOI：
10.1016/j.sleep.2023.06.030
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发表时间：
2023
期刊：
影响因子：
4.8
通讯作者：
Hayden,LystraP
中科院分区：
文献类型：
--
作者：
Tsou,Po-Yang;Hayden,LystraP
目的：支气管肺发育不良（BPD）患儿在呼吸系统疾病期间发生呼吸功能不全的风险较高。我们的目的是调查阻塞性睡眠呼吸暂停（OSA）是否与急性呼吸系统疾病住院的BPD患儿发病率增加有关。研究设计从儿童住院患者数据库中获取1997年至2012年间因急性呼吸系统疾病住院的<21岁BPD儿童的出院记录。急性呼吸道疾病包括细菌性和/或病毒性肺炎、细支气管炎、急性上呼吸道感染、吸入性肺炎或哮喘加重。主要暴露是呼吸暂停。主要结局为有创机械通气（IMV），次要结局为无创机械通气（NIMV）、住院时间（LOS）和经通胀调整的住院费用（IACH）。进行多变量回归以确定OSA与bpd相关合并症的主要和次要结局之间的关系。结果在33,640例因急性呼吸系统疾病住院的BPD患儿中，607例（1.8%）合并OSA，对照组33,033例（98.2%）未合并OSA。OSA患者更容易出现吸入性肺炎、中枢性睡眠呼吸暂停、肥胖、喉狭窄、先天性气道和颅/面/颌异常。多变量回归显示，OSA与IMV （OR 1.45, 95% CI 1.09-1.94, p = 0.012）和NIMV （OR 2.61, 95% CI 1.71-3.98, p < 0.001）相关，但与LOS和IACH无关。结论在急性呼吸系统疾病住院的BPD患者中，OSA与需要无创或有创机械通气的呼吸功能不全风险增加相关。临床医生在处理这一人群时应考虑OSA以及其他与bpd相关的合并症。
Objective (s)Children with bronchopulmonary dysplasia (BPD) are at higher risk of respiratory insufficiency during respiratory illness. We aimed to investigate whether obstructive sleep apnea (OSA) is associated with increased morbidity among children with BPD hospitalized with acute respiratory illnesses.Study designHospital discharge records were obtained from the Kid's Inpatient Database for children <21 years of age with BPD hospitalized for acute respiratory illness between 1997 and 2012. Acute respiratory illnesses included bacterial and/or viral pneumonia, bronchiolitis, acute upper respiratory tract infections, aspiration pneumonia, or asthma exacerbation. The primary exposure was OSA. The primary outcome was invasive mechanical ventilation (IMV), and secondary outcomes were noninvasive mechanical ventilation (NIMV), length of hospital stay (LOS), and inflation-adjusted cost of hospitalization (IACH). Multivariable regression was conducted to ascertain the associations between OSA and primary and secondary outcomes accounting for BPD-associated comorbidities.ResultsAmong 33,640 hospitalizations of children with BPD for acute respiratory illness, there were 607 (1.8%) cases with comorbid OSA vs. 33,033 (98.2%) controls without OSA. Patients with OSA were more likely to have aspiration pneumonia, central sleep apnea, obesity, laryngeal stenosis, congenital airway, and skull/face/jaw anomalies. Multivariable regression showed that OSA was associated with IMV (OR 1.45, 95% CI 1.09–1.94, p = 0.012) and NIMV (OR 2.61, 95% CI 1.71–3.98, p < 0.001), but not LOS or IACH.ConclusionsIn BPD patients hospitalized with acute respiratory illness, having OSA is associated with increased risks for respiratory insufficiency requiring noninvasive or invasive mechanical ventilation. Clinicians should consider OSA, along with other BPD-associated comorbidities, in the management of this population.