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

Obstructive 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 (P CLOSE) for predicting OSA and respiratory adverse events. Children scheduled for elective adenotonsillectomy underwent in-laboratory polysomnography 2–12 weeks before surgery. P CLOSE measurements were obtained while the child was anaesthetised and breathing spontaneously just before surgery. Logistic regression was used to assess the predictive performance of P CLOSE for detecting OSA and perioperative respiratory adverse events after adjusting for potential covariates. In 52 children (age, mean [standard deviation] 5.7 [1.8] yr; 20 [38%] females), airway collapse during P CLOSE 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 P CLOSE measurements did not have OSA. P CLOSE 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 P CLOSE threshold of –4.0 cm H 2 O (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 P CLOSE (OR 1.0; 95% CI: 0.8–1.1; P =0.641). Measurement of P CLOSE after induction of anaesthesia can reliably identify moderate or severe OSA but not perioperative respiratory adverse events in children before adenotonsillectomy. ANZCTR ACTRN 12617001503314. [ABSTRACT FROM AUTHOR]