Risk factors for overnight respiratory events following sedation for magnetic resonance imaging in children with sleep apnea.
OBJECTIVE
Children with sleep apnea may be at increased risk for overnight respiratory events (ORE) following anesthesia. We sought to identify ORE risk factors in sleep apnea patients sedated for magnetic resonance imaging (MRI).


METHODS
One thousand four hundred seven hospitalizations for children with sleep apnea (by ICD-9 code) occurred at our institution from 5/1/2011 to 2/1/2015. One hundred twenty-seven (9 %) encounters were solely for post-MRI observation representing 96 unique patients. The first post-MRI admission for each patient underwent chart review. ORE was defined as sustained oxygen saturation <90 % with need for increased oxygen or adjustment of respiratory support after release from recovery. Characteristics of patients with and without ORE were compared by chi-squared analysis or independent samples t test. Logistic regression identified associations with ORE.


RESULTS
Ten out of 96 (10.4 %) patients had ORE. The average time following sedation to ORE was 10.25 h. ORE patients were hospitalized longer (median 2 vs. 1 day, p < 0.001). Overall, patients were 55 % male, 60 % Hispanic, with median age of 5 years [IQR 2-10] and median body mass index (BMI) of 17.9 [IQR 15.2-24]. On logistic regression, apnea-hypopnea index (AHI; OR 1.007 [95 % CI 1.002-1.011]), anesthesia complication (OR 1.13 [95 % CI 1.01-1.28]), and home non-invasive positive pressure ventilation (NIV; OR 6.08 [95 % CI 1.57-26.17]) were associated with ORE.


CONCLUSIONS
Ninety percent of children with sleep apnea admitted for overnight observation following sedated MRI did not have an ORE. AHI, anesthesia complications, and NIV use may help target higher-risk patients and avoid unnecessary hospitalizations.
Division of Hospital Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd. #94, Los Angeles, CA, 90027, USA. mtrost@chla.usc.edu.|University of Southern California Keck School of Medicine, Los Angeles, CA, USA. mtrost@chla.usc.edu.
Margaret J
MJ
Trost
Division of Hospital Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd. #94, Los Angeles, CA, 90027, USA.|University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Melissa
M
Cowell
Division of Hospital Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd. #94, Los Angeles, CA, 90027, USA.|University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Jennifer
J
Cannon
Division of Hospital Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd. #94, Los Angeles, CA, 90027, USA.|University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Kendra
K
Mitchell
Division of Hospital Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd. #94, Los Angeles, CA, 90027, USA.|University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Kevin
K
Waloff
University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Humberto
H
Avila
Division of Hospital Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd. #94, Los Angeles, CA, 90027, USA.
Sanjay
S
Chand
Division of Hospital Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd. #94, Los Angeles, CA, 90027, USA.|University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Christopher J
CJ
Russell
D000402:Airway Obstruction / Q000150:complications / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015508:Nasal Obstruction / Q000150:complications / Q000000981:diagnostic imaging; D014066:Palatine Tonsil / Q000000981:diagnostic imaging; D010343:Patient Admission; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000000981:diagnostic imaging*
Anesthesia; Sedation; Sleep apnea; Ventilation
Pediatrics. 2006 Dec;118(6):2587-602
17142550
Int J Pediatr Otorhinolaryngol. 2015 Feb;79(2):240-5
25575425
J Biomed Inform. 2009 Apr;42(2):377-81
18929686
Am J Respir Crit Care Med. 2001 Jul 1;164(1):16-30
11435234
Paediatr Anaesth. 2016 Jul;26(7):742-51
27212000
Anesthesiology. 2012 Sep;117(3):657-68
22797282
Curr Opin Anaesthesiol. 2009 Aug;22(4):509-13
19512915
Pediatr Radiol. 2014 Aug;44(8):1020-5
24859263
Pediatr Emerg Care. 2014 Jun;30(6):381-7
24849275
Anesth Analg. 2009 Mar;108(3):795-804
19224786
Otolaryngol Head Neck Surg. 2011 Jul;145(1 Suppl):S1-15
21676944
Arch Dis Child. 2011 Nov;96(11):998-1002
21109507
J Otolaryngol Head Neck Surg. 2009 Feb;38(1):49-58
19344613