Predicting obstructive sleep apnoea and perioperative respiratory adverse events in children: role of upper airway collapsibility measurements

• Published in: British journal of anaesthesia : BJA Vol. 131; no. 6; pp. 1043 - 1052
• Main Authors: Ohn, Mon, Sommerfield, David, Nguyen, Julie, Evans, Daisy, Khan, R. Nazim, Hauser, Neil, Herbert, Hayley, Bumbak, Paul, Wilson, Andrew C., Eastwood, Peter R., Maddison, Kathleen J., Walsh, Jennifer H., von Ungern-Sternberg, Britta S.
• Format: Journal Article
• Language: English
• Published: 01.12.2023
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1016/j.bja.2023.09.021

BACKGROUNDObstructive sleep apnoea (OSA) and perioperative respiratory adverse events are significant risks for anaesthesia in children undergoing adenotonsillectomy. Upper airway collapse is a crucial feature of OSA that contributes to respiratory adverse events. A measure of upper airway collapsibility to identify undiagnosed OSA can help guide perioperative management. We investigated the utility of pharyngeal closing pressure (PCLOSE) for predicting OSA and respiratory adverse events.METHODSChildren scheduled for elective adenotonsillectomy underwent in-laboratory polysomnography 2-12 weeks before surgery. PCLOSE measurements were obtained while the child was anaesthetised and breathing spontaneously just before surgery. Logistic regression was used to assess the predictive performance of PCLOSE for detecting OSA and perioperative respiratory adverse events after adjusting for potential covariates.RESULTSIn 52 children (age, mean [standard deviation] 5.7 [1.8] yr; 20 [38%] females), airway collapse during PCLOSE was observed in 42 (81%). Of these, 19 of 42 (45%) patients did not have OSA, 15 (36%) had mild OSA, and eight (19%) had moderate-to-severe OSA. All 10 children with no evidence of airway collapse during the PCLOSE measurements did not have OSA. PCLOSE predicted moderate-to-severe OSA (odds ratio [OR] 1.71; 95% confidence interval [CI]: 1.2-2.8; P=0.011). All children with moderate-to-severe OSA could be identified at a PCLOSE threshold of -4.0 cm H2O (100% sensitivity), and most with no or mild OSA were ruled out (64.7% specificity; receiver operating characteristic/area under the curve=0.857). However, there was no significant association between respiratory adverse events and PCLOSE (OR 1.0; 95% CI: 0.8-1.1; P=0.641).CONCLUSIONSMeasurement of PCLOSE after induction of anaesthesia can reliably identify moderate or severe OSA but not perioperative respiratory adverse events in children before adenotonsillectomy.CLINICAL TRIAL REGISTRATIONANZCTR ACTRN 12617001503314.