儿童腺样体扁桃体切除术治疗阻塞性睡眠呼吸障碍后的心电图变化：一项前瞻性初步研究

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中文摘要

背景/目的： 腺样体扁桃体肥大（ATH）是儿童阻塞性睡眠呼吸障碍（OSDB）的主要驱动因素，可能导致心脏重构。本研究评估了腺样体扁桃体切除术（AT）对心电图（ECG）参数的影响，并将这些变化与睡眠指标进行相关性分析。方法：本前瞻性研究评估了年龄>3岁、有症状的ATH患儿在AT术前和术后三个月的心电图参数（P波和QRS形态）。其中一部分患儿在两个时间点均通过心肺耦合（CPC）进行睡眠分析。术前和术后数据采用配对t检验和线性混合模型（LMM）进行比较。心电图与睡眠变化之间的关联也通过各自变化量（Δ）的Pearson和Spearman相关性进行分析。结果：观察到最大RR间期显著缩短（p = 0.027）。平均P波持续时间显著缩短（84.40 ± 6.51 ms至81.20 ± 3.32 ms；p = 0.043），平均振幅增加（0.076 ± 0.008 mV至0.080 ± 0.004 mV；p < 0.001）。平均、最小和最大QRS振幅均显著增加（p ≤ 0.018）。探索性LMM证实，在调整年龄和性别后，这些变化仍然显著。此外，事后分析显示，Δ QRS最大振幅与Δ AHI 4%最大值（r = -0.727，p = 0.045）、Δ ODI 3%最大值（r = -0.765，p = 0.045）、Δ ODI 4%平均值（r = -0.819；p = 0.033）以及Δ最大缺氧负荷（r = -0.730，p = 0.045）呈负相关，且经错误发现率（FDR）校正后仍显著。结论：AT可能改变心电图参数。QRS振幅的增加与夜间呼吸事件的减少具有良好的相关性。这些发现可能代表与术后呼吸改善相关的初步心电图变化。需要更大规模的对照研究来确定这些心电图参数是否可作为术后心肺恢复的标志物。

英文摘要

Background/Objectives: Adenotonsillar hypertrophy (ATH) is the primary driver of pediatric obstructive sleep-disordered breathing (OSDB), potentially leading to cardiac remodeling. This study evaluated the impact of adenotonsillectomy (AT) on electrocardiographic (ECG) parameters and correlated these changes with sleep metrics. Methods: This prospective study evaluated ECG parameters (P-wave and QRS morphology) in children (>3 years) with symptomatic ATH before and three months after AT. A subset underwent sleep analysis via Cardiopulmonary Coupling (CPC) at both time points. Pre- and postoperative data were compared using paired t-tests and Linear Mixed Models (LMMs). The link between ECG and sleep modifications was also analyzed using Pearson and Spearman correlations of their respective variations (Δ). Results: Significant reductions were observed in the maximum RR interval (p = 0.027). Mean P-wave duration significantly shortened (84.40 ± 6.51 ms to 81.20 ± 3.32 ms; p = 0.043) and mean amplitude increased (0.076 ± 0.008 mV to 0.080 ± 0.004 mV; p < 0.001). Mean, minimum, and maximum QRS amplitudes increased significantly (p ≤ 0.018). Exploratory LMM confirmed that these modifications remained significant after adjusting for age and sex. Furthermore, post hoc analyses revealed that Δ QRS maximum amplitude exhibited negative correlations that survived false discovery rate (FDR) adjustment with Δ AHI 4% max (r = -0.727, p = 0.045), Δ ODI 3% max (r = -0.765, p = 0.045), Δ ODI 4% mean (r = -0.819; p = 0.033), and Δ maximal hypoxic burden (r = -0.730; p = 0.045). Conclusions: AT may alter ECG parameters. QRS amplitude increments correlated well with a decrease in nocturnal respiratory events. These findings may represent preliminary ECG changes associated with postoperative respiratory improvement. Larger controlled studies are needed to determine whether these ECG parameters can serve as markers of post-operative cardiopulmonary recovery.