Airway obstruction in Robin sequence: Evaluating longitudinal evolution
Notice bibliographique
Résumé
Airway obstruction of various degrees is one of the most important problems in infantswith Robin sequence. Various tools are used to evaluate airway obstruction in these infantsand monitor treatment, but polysomnography is the gold standard. Routine use ofpolysomnography is however limited by cost and availability. The general purpose of thestudy was to document the evolution of airway obstruction in the first 18 months of life in acohort of infants afflicted with Robin sequence. More specifically, we wanted to determinewhether night-time pulse oximetry, an inexpensive and widely available technology, could beused as a surrogate for polysomnography in identifying obstructive apnea in infants withRobin sequence.METHODSThis is a retrospective cohort study for all patients admitted in the neonatal periodwith a final diagnosis of Robin sequence at the Montreal Children’s Hospital from 2003 to2018. All data was thoroughly review from medical records for infants qualifying as Robinsequence: association of micro-retrognathia, glossoptosis and airway obstruction. We alsoreviewed all polysomnography and oximetry test and extracted the following standard data:Apnea hypopnea index (AHI) and mixed obstructive AHI (MOAHI) from polysomnography andDesaturation index (drops by ≥3%/hour, DI ≥3%; drops by ≥4%/hour, DI ≥4%; and time spent<90%) from the oximetry done at the time of polysomnography. A MOAHI ≤5 events/hourwas used to separate infants with no/mild obstruction from those with moderate/severeobstruction (MOAHI >5 events/hour).Analysis of data for the correlations was obtained through linear regression modelswith prediction equations; agreement was judged using the intraclass correlation coefficientand Bland-Altman plots. Next, generalized linear models and receiver-operator characteristiccurves were used to determine the diagnostic accuracy of the desaturation index and to selecta cut-off value. Statistical significance was set at a p value of <0.05.RESULTSThe cohort of patients was comprised of sixty infants (34 males, 56.7%). With thestepwise approach to management, treatment consisted of: no intervention, n = 10; pronepositioning, n = 26; nasopharyngeal airway, n = 4; low flow oxygen: n = 1; and surgery: tongue5lip-adhesion (TLA), n = 9; mandibular distraction osteogenesis (MDO), n = 9; andtracheostomy, n = 1.We reviewed 57 polysomnographies in 29 infants; many infants with very mildobstruction in the neonatal period and normal evolution did not require a polysomnography.However, of the 97 tests that could have been done according to the institution protocol, only59% were done. The tests done were useful to identify moderate to severe obstruction in38.6% of cases.When we compared oximetry to polysomnography, there was a strong correlationbetween DI ≥3% and MOAHI data (correlation coefficient: 0.721, p<0.001). All infants with aDI ≥3% <10 events/hour had no or mild obstructive apnea (MOAHI <5 events/hour, 100%negative predictive value). In patients with MOAHI >5 events/hour, all had a DI ≥3% >7events/hour (100% sensitivity). Finally, in infants who had serial oximetry in the first 6 monthsof life to follow evolution, significant obstruction at age 10-12 months (moderate or severeobstructive index) was associated with an elevated value of the DI ≥3% at age 5 to 6 months(>10 events/hour).CONCLUSIONIn our cohort of infants with Robin sequence, a cohort having the characteristics ofother larger cohorts, oximetry can identify the infants with no or mild obstructive apneathereby decreasing the demand for polysomnography. Oximetry could be also a solution toserial evaluation of infants in the first several months of life to avoid adverse outcome andorganize rapid intervention
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
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Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».