P2A152: Obstructive Sleep Apnea and Short Term Post-surgical Outcomes in Pediatric Cardiac Critical Care

Background: Obstructive sleep apnea (OSA) has been associated with negative cardiovascular effects and negative outcomes following cardiovascular surgery in the adult population. The study's main objective was to evaluate if there is a similar association in children aged 1-18 years old.

Methods: In a single center retrospective matched cohort study, data was collected on 1-18 years old patients exposed to OSA. These patients were matched 1:1 by age, sex, and severity with patients not exposed to OSA, but who were admitted to the cardiac intensive care unit (CICU) following cardiac surgery between Jan 2012 and Dec 2021. Primary outcome was a composite variable: “bad outcome,” consisting of prolonged CICU stay, prolonged duration of mechanical ventilation, need for extracorporeal membrane oxygenation, presence of arrhythmia, and death. McNemar’s test and Wilcoxon signed rank tests were used for comparison between the two groups with a significance threshold set at p ≤0.05.

Results: The study comprised of 80 patients exposed to OSA and 80 unexposed patients before cardiac surgery. Table 1 describes the demographics of the overall cohort. The median age and weight at surgery were 5.3 years (IQR: 2.6-11.2) and 18.1 kg (IQR: 12.4-39.2), respectively. There were 92 (57.5%) males and 29 (18.6%) had single ventricle physiology. In the OSA group, the apnea- hypopnea index (AHI) was 4.3 (2.8-7.1), the REM AHI was 8.6 (IQR:3.2-13.3), 6.8% used CPAP at home, and their lowest saturation was 80% (IQR:80-90%). Table 2 summarizes the differences between the two groups. Chromosomal anomalies were significantly higher in the OSA group compared to non-OSA group (26.3% vs. 62.5%, p< 0.01). However, there was no significant difference in “bad outcomes” between the two groups (41.3% vs. 42.5%; p=0.873). Additionally, no other significant differences were found in the multiple perioperative variables collected between the two groups.

Conclusion: We report no significant difference in short-term post-surgical outcomes between children with and without OSA who underwent cardiac surgery. This is in contrast to what has been reported in the adult population previously. The study further stresses the significant differences between children and adults, not just restricted to size and weight. Future prospective studies should continue to describe the relationship between OSA and outcomes after cardiac surgery in children.