Risk factors for overnight respiratory events following sedation for magnetic resonance imaging in children with sleep apnea

Purpose 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. Conclusion 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.