睡眠研究在预测医学复杂儿童术后结局中的作用

文献信息

中文摘要

背景： 在医学复杂儿童（CMC）中，呼吸系统受累是导致发病的主要原因之一。早期识别夜间低通气或睡眠呼吸障碍（SDB）可能有助于及时干预并减少围手术期呼吸系统并发症。本研究旨在评估睡眠研究在指导接受脊柱融合术矫正脊柱侧凸的CMC患者临床决策和围手术期呼吸管理中的作用。
方法： 我们回顾性分析了2012年11月20日至2024年6月11日期间接受脊柱侧凸手术的357例患者（196例女性）的临床数据。所有患者均在IRCCS Burlo Garofolo肺科接受了标准化的术前呼吸评估。
结果： 患者被分为七个诊断组，包括神经系统、神经肌肉、脑瘫、畸形及其他复杂疾病。手术时中位年龄为12岁（范围2-22岁）。119例患者进行了睡眠研究，并发现了提示睡眠呼吸障碍或夜间低通气的异常，包括呼吸暂停低通气指数升高、氧饱和度下降或经皮二氧化碳水平异常。术前，20例患者接受无创通气（nIV），其启动基于睡眠研究结果或肺功能损害，另有2例患者接受持续气道正压通气（CPAP）支持。儿科重症监护病房（PICU）中位住院时间为4.0天（IQR 3.0-5.5天；范围1-23天），各诊断类别之间无统计学显著差异（p = 0.12）。术后常需要呼吸支持，包括有创机械通气、NIV或CPAP，但有创通气持续时间为15.5小时（范围1-36小时）。仅1例患者需要气管切开，且无围手术期死亡发生。
结论： 在接受脊柱融合术的CMC中，术前睡眠研究显著影响临床决策过程，并通过识别隐匿性呼吸脆弱性和指导个体化通气策略来支持围手术期呼吸评估。尽管与结构化管理的路径相关，睡眠指导干预对术后临床结局的前瞻性影响仍有待通过对照研究加以确认。

英文摘要

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.