一种基于年龄的儿科长期无创通气依从性生理学新定义：一项探索性研究

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中文摘要

引言： 儿科长期无创通气（LT-NIV）的适应证已扩大。然而，缺乏标准化的儿科依从性定义。
目的： 提出一种新的儿科LT-NIV依从性生理学定义，并将其与两种常用的成人衍生定义进行比较。
方法： 回顾性横断面研究，纳入阿根廷Garrahan医院LT-NIV随访项目中所有符合条件的0.15-18岁儿童。临床数据来自病历，依从性数据来自设备记忆下载。所提出的定义将患者分类为“依从”，当LT-NIV使用达到年龄特异性最低推荐睡眠时长（美国睡眠医学会共识）的≥70%且在≥70%的夜晚达到时，以适合每个儿童睡眠需求的门槛替代固定阈值。将其与现行（≥70%的夜晚每晚≥4小时）和经典（≥50%的夜晚每晚≥4小时）成人衍生定义进行比较。
结果： 共纳入80例患者（中位年龄9.01岁，IQR 5.96-14.09）。最常见的诊断是神经肌肉疾病（31%）和遗传性疾病（15%）。91%为择期启动LT-NIV，75%报告睡眠呼吸障碍症状，95.2%多导睡眠图异常。依从率分别为66.25%（新定义）、83.75%（经典定义）和78.75%（现行定义），p=0.0005和p=0.0039。较差的依从性与较年轻年龄、发育迟缓、无症状、较早开始通气和较低压力设置相关。
结论： 我们的结果强调，使用成人定义会高估依从性。这是第一项探索LT-NIV儿科依从性新定义的研究。我们的研究呼吁采取行动，讨论新的国际儿科依从性阈值。

英文摘要

INTRODUCTION: The indications for pediatric long-term non-invasive ventilation (LT-NIV) have expanded. However, a standardized definition of pediatric adherence is lacking.
OBJECTIVES: To propose a novel physiological definition of adherence to pediatric LT-NIV and compare it with the two commonly used adult-derived definitions.
METHODS: Retrospective cross-sectional study including all eligible children aged 0.15-18 years enrolled in the LT-NIV follow-up program at Hospital Garrahan, Argentina. Clinical data were obtained from medical records and adherence from device memory downloads. The proposed definition classified patients as "adherent" when LT-NIV use reached ≥ 70% of the minimum age-specific recommended sleep duration (American Academy of Sleep Medicine consensus) on ≥ 70% of nights, replacing a fixed threshold with one tailored to each child´s sleep needs. This was compared to the current(≥ 4 h/night on ≥ 70% of nights) and classic (≥ 4 h/night on ≥ 50% of nights) adult-derived definitions.
RESULTS: Eighty patients were included (median age 9.01years, IQR 5.96-14.09). The most frequent diagnoses were neuromuscular (31%) and genetic disorders (15%). LT-NIV was initiated electively in 91%, 75% reported sleep-disordered breathing symptoms, polysomnography was abnormal in 95.2%. Adherence rates were 66.25% (novel definition); 83.75% (classic definition) and 78.75% (current definition), p = 0.0005 and p = 0.0039 respectively. Poorer adherence was associated with younger age, developmental delay, absence of symptoms, earlier ventilation initiation and lower pressure settings.
CONCLUSIONS: Our results highlight an overestimation of adherence when adult definitions are used. This first study explores a novel pediatric adherence definition for LT-NIV. Our research calls for action to discuss new international pediatric adherence thresholds.