[Clinical significance of continuous percutaneous CO2 monitoring in severe OSA in children with NPPV].

Abstract

Objective: To explore the value and clinical significance of percutaneous CO₂ monitoring in non-invasive positive pressureventilator in the treatment of severe obstructive sleep apnea (OSA) in children. Methods: Retrospective analysis was conducted on 38 children with severe OSA, who were treated in Henan Children's Hospital from August 2023 to December 2024. All of the enrolled children were diagnosed by polysomnography(PSG), treated with non-invasive positive pressure ventilator (NPPV) according to the standard treatment plan, and continuously monitored with TcpCO₂. Arterial blood gas was analyzed before and after pressure titration and TcpCO₂ changes were compared between awake and sleep with arterial blood gas PaCO₂. The sleep parameters, parameters related to arterial blood gas, and the relationship between TcpCO₂ and alveolar hypoventilation in children were analyzed. The cut-off value of alveolar hypoventilation factors were estimated. Statistical analysis was performed using the SPSS 27.0 software. Results: (1)The difference between awake TcpCO₂ and sleep TcpCO₂ was statistically significant[(42.52±3.56)mmHg vs.(51.09±4.07)mmHg,P<0.001), and the difference between sleep TcpCO₂ and morning PaCO₂ was statistically significant[(51.09±4.07)mmHg vs. (40.83±5.34)mmHg,P<0.001]. (2) There was no significant difference in related indicators among different gender children, but the difference in BMI values between preschool and school age children was significant[(18.03±4.96)kg/m² vs.(25.21±5.25)kg/m²,t=-4.08,P<0.001]. (3) Obstructive apnea hypopnea index(OAHI), oxygen desaturation index (ODI), and TcpCO₂ were independent risk factors for alveolar hypopnea, but there was no correlation between BMI and whether alveolar hypoventilation.(4).OAHI, ODI, and TcpCO₂ were predictive of the presence of alveolar hypoventilation. When the OAHI exceeded 54.7events/h, ODI exceeded 72.1 events/h, and TcpCO₂ exceeded 56.5 mmHg, the children were more likely to have alveolar hypoventilation. Conclusion: Transcutaneous carbon dioxide, OAHI and ODI can effectively predict whether children have alveolar hypoventilation, which is helpful for clinical treatment.