社会脆弱性对儿童阻塞性睡眠呼吸暂停的影响

文献信息

中文摘要

目的： 评估社会脆弱性指数（SVI）与儿童阻塞性睡眠呼吸暂停（OSA）结局之间的关联，包括合并症、诊断时机和手术干预。
方法： 对本机构TriNetX Research Enterprise Data Warehouse进行回顾性审查，评估2014年至2024年诊断为OSA的0-18岁患者。患者被分为四个SVI四分位组：低、低-中、中-高和高。提取的变量包括多导睡眠监测（PSG）、持续气道正压通气（CPAP）、扁桃体切除术和腺样体切除术（T&A）手术、继发并发症，以及从诊断到操作或并发症之间经过的时间。
结果： 研究纳入5753例患者，平均年龄7.69岁，43.9%处于高SVI四分位组。黑人或非裔美国患者占这一高度脆弱队列的75.9%。总体而言，8.7%的队列接受了PSG，在检测或至PSG时间方面无显著差异。合并哮喘在各脆弱性层级间呈显著逐步增加，在高SVI组达到峰值9.4%（p = 0.001）。高SVI患者接受T&A的比例显著高于低SVI（p = 0.008）和低-中SVI（p = 0.002）四分位组。至手术的平均时间为166.5天，在各SVI组间无显著差异。
结论： 生活在高度脆弱社区的儿童承受着不成比例的合并哮喘负担，并显著更高比例地接受OSA手术治疗。这提示社会脆弱患者可能表现为更严重的疾病而需要手术。将SVI等指标纳入临床路径可以更好地指导以患者为中心的照护和公平的资源分配。

英文摘要

OBJECTIVES: To evaluate the association between the Social Vulnerability Index (SVI) and pediatric obstructive sleep apnea (OSA) outcomes, including comorbidities, diagnostic timing, and surgical intervention.
METHODS: A retrospective review of our institution's TriNetX Research Enterprise Data Warehouse assessed patients aged 0-18 years diagnosed with OSA from 2014 to 2024. Patients were grouped into four SVI quartiles: Low, Low-Medium, Medium-High, and High. Extracted variables included polysomnography (PSG), Continuous Positive Airway Pressure (CPAP), tonsillectomy and adenoidectomy (T&A) surgeries, secondary complications, and the time elapsed between diagnosis and procedures or complications.
RESULTS: The study included 5753 patients with an average age of 7.69 years, and 43.9% were in the High SVI quartile. Black or African American patients comprised 75.9% of this highly vulnerable cohort. Overall, 8.7% of the cohort underwent PSG, with no significant differences in testing or time to PSG. There was a significant stepwise increase in comorbid asthma across vulnerability tiers, peaking at 9.4% in the High SVI group (p = 0.001). High SVI patients underwent T&A at significantly higher rates compared to those in the Low (p = 0.008) and Low-Medium (p = 0.002) quartiles. The mean time to surgery was 166.5 days, which did not significantly differ between SVI groups.
CONCLUSION: Children in highly vulnerable neighborhoods experienced a disproportionate burden of comorbid asthma and underwent surgical management for OSA at significantly higher rates. This suggests that socially vulnerable patients may present with more severe disease requiring surgery. Incorporating metrics like SVI into clinical pathways can better guide patient-centered care and equitable resource allocation.