体位性心动过速综合征患儿睡眠调查及干预研究

doi:10.11852/zgetbjzz2020-0296

中国儿童保健杂志 ›› 2020, Vol. 28 ›› Issue (4): 374-378.DOI: 10.11852/zgetbjzz2020-0296

体位性心动过速综合征患儿睡眠调查及干预研究

顾英^1*, 王嘉琪^2*, 荚婉茹², 武敏², 焦富勇³, 沈杰⁴, 蔺婧²

1 西安交通大学第一附属医院儿科,陕西西安 710061;
2 西安交通大学医学部公共卫生学院儿少卫生与妇幼保健系,陕西西安 710061;
3 陕西省人民医院儿科,陕西西安 710068;
4 浙江大学医学院附属儿童医院心血管内科、国家儿童健康与疾病临床医学研究中心,浙江杭州310051

收稿日期:2020-02-28 发布日期:2020-04-10 出版日期:2020-04-10
通讯作者: 沈杰,E-mail:shenjie112@zju.edu.cn; 蔺婧,E-mail:linjing0127@xjtu.edu.cn
作者简介:顾英(1985-),女,陕西人,硕士学位,主要研究方向为营养与疾病; 王嘉琪(1991-),女,陕西人,硕士研究生在读,主要研究方向为儿童生长发育营养流行病学。
基金资助:
国家自然科学基金青年基金(81803263);浙江省卫生健康委员会科研项目(2020KY612)

Survey and intervention study of sleep in children with postural tachycardia syndrome

GU Ying^1*, WANG Jia-qi^2*, JIA Wan-ru², WU Min², JIAO Fu-yong³, SHEN Jie⁴, LIN Jing²

1 Department of Pediatrics, the first Affiliated Hospital of Xi′an Jiaotong University, Xi′an, Shaanxi 710061, China;
2 Department of Maternal and Child Health, School of Public Health,Xi′an Jiaotong University, Xi′an, Shaanxi 710061, China;
3 Department of Pediatrics, Shaanxi Provincial Peoples′ Hospital, Xi′an, Shaanxi 710068, China;
4 Department of Cardiology, Children′s Hospital, Zhejiang University School of Medicine,National Clinical Research Center for Child Health, Hangzhou,Zhejiang 310051, China

Received:2020-02-28 Online:2020-04-10 Published:2020-04-10
Contact: SHEN Jie, E-mail: shenjie112@zju.edu.cn; LIN Jing, E-mail: linjing0127@xjtu.edu.cn

摘要/Abstract

摘要： 目的调查体位性心动过速综合征(POTS)患儿的睡眠情况,分析睡眠干预在改善POTS患儿临床症状中的效果。方法选择2018年5月-2019年5月确诊为POTS的40例患儿为病例组,儿保科体检的20例健康儿童为对照组。以直立试验或直立倾斜试验(HUTT)的结果作为POTS诊断依据。利用匹兹堡睡眠质量指数量表(PSQI)进行睡眠现况调查。POTS组患儿接受为期3个月的睡眠促进疗法,直立不耐受症状评分下降＞2分表示睡眠干预治疗有效,≤2分表示治疗干预无效。结果 POTS组和对照组平卧位心率(t=-2.117)、直立位最大心率(t=3.88)、卧立位心率差值(t=-7.86)比较,差异有统计学意义(P＜0.05)。与对照组相比,POTS组中有77.5%的患儿PSQI总分＞5分,POTS患儿与健康儿童相比,PSQI评分(t=8.31,P＜0.001)以及除睡眠药物以外的其他6项因子得分差异均有统计学意义(P＜0.001)。POTS组患儿睡眠促进疗法干预前后血压变化差异无统计学意义,干预后平卧位心率(t=-2.707)、直立位最大心率(t=2.656)、卧立位心率差值(t=4.771)较干预前降低,临床症状评分显著低于干预前(Z=-5.083),差异有统计学意义(P＜0.05)。与干预前相比,症状评分下降＞2分的患儿占60%,年龄＞10岁的POTS患儿,行睡眠疗法治疗有效的敏感度为91.7%,特异度为43.7%。结论多数POTS患儿存在睡眠质量差的问题,采用睡眠干预疗法可促进儿童POTS临床症状的改善。

关键词: 体位性心动过速综合征, 睡眠干预, 儿童青少年

Abstract: Objective To explore the effects of sleep improvement intervention on the clinical symptoms of children with postural tachycardia syndrome (POTS) by investigating the sleep status.Methods Totally 40 children diagnosed with POTS from May 2018 to May 2019 were selected as the POTS group, and meanwhile 20 healthy children for physical examination in child healthcare department were selected as the control group.The diagnosis of POTS were based on the results of head-up tilt test (HUTT).The Pittsburgh Sleep Quality Index (PSQI) was used to investigate sleep status.POTS group received sleep improvement intervention for 3 months.A decrease of orthostatic intolerance score> 2 indicated that the sleep intervention was effective, and ≤2 indicated ineffective.Results Significant differences were found in supine heart rate (t=-2.117), upright maximum heart rate (t=3.88) and upright heart rate difference (t=-7.86) between POTS group and control group(P＜0.05).Compared with the control group, 77.5% of children in POTS group had a total PSQI score of > 5.Except from sleep drugs, significant differences were found in PSQI score (t=8.31,P＜0.001) and six factors of PSQI (P＜0.001) .There was no statistical difference on blood pressure before and after sleep improvement intervention in POTS group.While supine heart rate (t=-2.707), upright maximum heart rate (t=2.656), upright heart rate difference (t=4.771) and clinical symptoms score(Z=-5.083) dramatically decreased after intervention (P＜0.05).Furthermore, 60% of POTS children had a decrease of symptom score > 2.The ROC curve showed that the sleep improvement intervention for POTS would be predicted to be effective when the patients more than 10 years old, yielded a sensitivity of 91.7% and specificity of 43.7%. Conclusions Most children with POTS suffered from poor sleep quality, and sleep intervention therapy can effectively improve the clinical symptoms of POTS children.

Key words: postural tachycardia syndrome, sleep intervention, children and adolescents

中图分类号:

R179

顾英, 王嘉琪, 荚婉茹, 武敏, 焦富勇, 沈杰, 蔺婧. 体位性心动过速综合征患儿睡眠调查及干预研究[J]. 中国儿童保健杂志, 2020, 28(4): 374-378.

GU Ying, WANG Jia-qi, JIA Wan-ru, WU Min, JIAO Fu-yong, SHEN Jie, LIN Jing. Survey and intervention study of sleep in children with postural tachycardia syndrome[J]. journal1, 2020, 28(4): 374-378.

参考文献

[1] Goodman BP.Evaluation of postural tachycardia syndrome (POTS)[J].Auton Neurosci, 2018, 215:12-19.
[2] Chen Li, Li XY, Todd O, et al.A clinical manifestation-based prediction of hemodynamic patterns of orthostatic intolerance in children: a multi-centre study[J].Cardiol Young, 2013, 18:1-5.
[3] Lin J, Han Z, Li X, et al.Risk factors for postural tachycardia syndrome in children and adolescents[J].PLoS One, 2014, 9(12):e113625.
[4] 杨锦艳,王成,田宏,等.儿童一过性意识丧失基础疾病谱分析[J].国际儿科学杂志, 2014, 41(2):195-197.
[5] 张琪然,张小遥,黄柳,等.儿童睡眠及睡眠障碍研究的回顾与展望[J].中国临床护理,2018,10(6):461-466.
[6] Lin J, Wang Y, Todd O, et al.Tilt angles and positive response of head-up tilt test in children with orthostatic intolerance[J].Cardiol Young, 2015, 25(1): 76-80.
[7] 胡金玮,阎小娟,王远飞,等.《儿童晕厥诊断指南(2016年修订版)》解读[J].中国实用儿科杂志,2016,31(5):321-325.
[8] Goodin BR, Smith MT, Quinn NB, et al.Poor sleep quality and exaggerated salivary cortisol reactivity to the cold pressor task predict greater acute pain severity in a non-clinical sample[J].Biol Psychol, 2012, 91(1): 36-41.
[9] Winker R, Barth A, Dorner W, et al.Diagnostic management of orthostatic intolerance in the workplace[J].Int Arch Occup Environ Health, 2003, 76(2): 143-150.
[10] Zhang F, Li X, Todd O, et al.Midregional pro-adrenomedullin as a predictor for therapeutic response to midodrine hydrochloride in children with postural orthostatic tachycardia syndrome[J].J Am Coll Cardiol, 2012, 60(4): 315-320.
[11] Ha-Yeun CHUNG.Acute onset and severe manifestation of postural orthostatic tachycardia syndrome-Two cases[J].Clin Neurophysiol, 2020, 131(1): 158-159.
[12] StewartJM, Pianosi P, Shaban MA, et al.Postural hyperventilation as a cause of postural tachycardia syndrome: increased systemic vascular resistance and decreased cardiac output when upright in all postural tachycardia syndrome variants[J].J Am Heart Assoc, 2018, 7(13):1-13.
[13] Kanjwal Y, Kosinski D, Grubb BP.The postural orthostatic tachycardia syndrome: definitions, diagnosis, and management[J].Pacing Clin Electrophysiol, 2010, 26(8):1747-1757.
[14] 解新星, 侯应龙.窦性心动过速[J].中国心脏起搏与心电生理杂志, 2013,27(1):71-73.
[15] Mustafa HI, Raj SR, André D, et al.Altered systemic hemodynamic and baroreflex response to angiotensin II in postural tachycardia syndrome[J].Circ Arrhythm Electrophysiol, 2012,5(1):173-180.
[16] Baschieri F, Cortelli P.Circadian rhythms of cardiovascular autonomic function: Physiology and clinical implications in neurodegenerative diseases[J].Auton Neurosci, 2019, 217:91-101.
[17] Rosa Neto NS, Bento JCDB.Depression, sleep disturbances, pain, disability and quality of LIFE in Brazilian Fabry disease patients[J].Mol Genet Metab Rep, 2020, 22:1-7.
[18] Korenic SA, Klingaman EA, Wichwire EM, et al.Sleep quality is related to brain glutamate and symptom severity in schizophrenia[J].J Psychiatr Res, 2020, 120:14-20.
[19] 陈天麒,董彬,张文静,等.儿童青少年睡眠时间与速度和耐力成绩的相关性研究[J].北京大学学报:医学版,2018,50(3):429-435.
[20] 陈秋,章景丽,陈瑞美,等.扬州市学龄前儿童睡眠状况调查研究[J].中国妇幼保健,2018,33(21):4961-4965.
[21] Bagai K, Wakwe CI, Malow B, et al.Estimation of sleep disturbances using wrist actigraphy in patients with postural tachycardia syndrome[J].Auton Neurosci, 2013, 177:260-265.
[22] 杨佳琳,宋红涛,张理义,等.睡眠剥夺对青年人神经内分泌激素的影响[J].中华保健医学杂志,2014,16(6):439-441.
[23] 丛超宇.蓝斑去甲肾上腺素能神经元损毁对警觉信息素唤醒作用的影响[D].兰州:兰州大学,2019:32-34.
[24] 郭蕾,包爱民.双向障碍中糖皮质激素对下丘脑-垂体-肾上腺轴活性的负反馈调节[J].重庆医科大学学报,2019,44(4):493-500.
[25] Zipursky RT, Press MC, Srikanthan P, et al.Relation of stress hormones (urinary catecholamines/cortisol) to coronary artery calcium in men versus women (from the Multi-Ethnic Study of Atherosclerosis [MESA])[J].Am J Cardiol, 2017, 119(12):1963-1971.
[26] Zhang Q, Chen X, Li J, et al.Clinical features of hyperadrenergic postural tachycardia syndrome in children[J].Pediatr Int, 2014,56(6):813-816.
[27] 满盈盈.儿童青少年睡眠不足及与其他生活方式关系的研究[D].天津:天津医科大学,2016,25-32.
[28] Bagai K, Song Y, Ling JF, et al.Sleep disturbances and diminished quality of life in postural tachycardia syndrome[J].Clin Sleep Med, 2011, 7:204-210.
[29] Lei LY, Chew DS, Sheldon RS, et al.Evaluating and managing postural tachycardia syndrome[J].Cleve Clin J Med, 2019, 86(5):333-344.

体位性心动过速综合征患儿睡眠调查及干预研究

Survey and intervention study of sleep in children with postural tachycardia syndrome

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

[1]	吴巧玲, 徐健, 赵正言, 彭咏梅, 龚春丹. 超敏C反应蛋白与儿童青少年代谢综合征的相关性[J]. 中国儿童保健杂志, 2023, 31(4): 427-432.
[2]	陶佳慧, 陈琳琳, 马钰, 丁琴琴, 王秋晶, 丁文清. 儿童青少年肌肉质量与心血管疾病危险因素的关系[J]. 中国儿童保健杂志, 2022, 30(7): 706-710.
[3]	刘宇, 杨新军. 异常出生体重与儿童青少年神经行为发育的研究进展[J]. 中国儿童保健杂志, 2022, 30(7): 759-763.
[4]	舒瑶, 张英波. 动作技能干预对智力障碍儿童青少年基本动作技能影响的系统综述[J]. 中国儿童保健杂志, 2022, 30(7): 770-774.
[5]	唐敏华, 赵根明, 姜永根, 朱虹, 李咏梅, 陈妮儿, 何玉萍, 姚春霞. 上海市松江区2 036名儿童青少年视力健康现状及其影响因素分析[J]. 中国儿童保健杂志, 2022, 30(3): 319-324.
[6]	周金玉, 白玲, 董洋洋, 蔡蓉蓉, 贾磊娜, 丁文清. 银川城区儿童青少年骨矿物质含量与肥胖相关关系的研究[J]. 中国儿童保健杂志, 2022, 30(1): 15-19.
[7]	余丽蓉, 杜香平, 吴限, 袁意, 杨玉, 余珍. 先天性肾上腺皮质增生症儿童及青少年的生存质量及其影响因素[J]. 中国儿童保健杂志, 2021, 29(8): 843-847.
[8]	王椿淇, 刘磊, 刘洋, 许志勇, 王一诺, 庄绪秀, 闻德亮. 血清单胺氧化酶与儿童青少年肥胖之间的关系研究[J]. 中国儿童保健杂志, 2021, 29(2): 151-155.
[9]	李娟, 王海军, 陈巍. 运动改善大脑奖赏功能防治儿童青少年肥胖的研究进展[J]. 中国儿童保健杂志, 2021, 29(2): 165-168.
[10]	朱谦让, 戴月, 张坚, 张静娴, 谢玮. 儿童青少年膳食及血清锌状况与心血管疾病代谢危险因素的关系[J]. 中国儿童保健杂志, 2021, 29(12): 1304-1308.
[11]	张耀东, 王一然, 黄晓培, 卫海燕. 河南省6~17岁儿童青少年超重肥胖流行情况及影响因素分析[J]. 中国儿童保健杂志, 2021, 29(11): 1181-1185.
[12]	陈曼曼, 霍家康, 马莹, 马涛, 李艳辉, 高迪, 陈力, 董彦会, 马军. 中国七省市儿童青少年不同肥胖类型对血压偏高的影响研究[J]. 中国儿童保健杂志, 2021, 29(10): 1053-1057.
[13]	马莹, 苏彬彬, 霍家康, 陈曼曼, 李艳辉, 高迪, 董彦会, 马军. 全国7省父母视屏时间和限制行为对6~17岁儿童青少年视屏时间的联合影响研究[J]. 中国儿童保健杂志, 2021, 29(10): 1063-1067.
[14]	吴越, 曲巍立, 庄璇, 汤继文, 王玉玺, 魏丽丽. 屏幕时间与儿童青少年健康的研究进展[J]. 中国儿童保健杂志, 2020, 28(9): 1005-1008.
[15]	刘军廷, 侯冬青, 朱忠信, 高爱钰, 郁兆仓, 林宁翔, 黄贵民, 米杰. 学龄儿童握力水平与体成分的相关性研究[J]. 中国儿童保健杂志, 2020, 28(6): 613-617.