不同年龄阻塞性睡眠呼吸暂停低通气综合征患儿临床表现及睡眠结构比较分析

doi:10.11852/zgetbjzz2020-2071

中国儿童保健杂志 ›› 2021, Vol. 29 ›› Issue (5): 473-478.DOI: 10.11852/zgetbjzz2020-2071

所属专题：儿童睡眠

不同年龄阻塞性睡眠呼吸暂停低通气综合征患儿临床表现及睡眠结构比较分析

徐雪云, 王宇清, 郝创利, 何燕玉, 耿雅轩, 江雨婷, 吕梦, 卢敏, 韩珺, 王景, 窦训武, 朱慧娥, 尹德佩

苏州大学附属儿童医院呼吸科/耳鼻喉科,江苏苏州 215003

收稿日期:2020-12-03 修回日期:2021-02-07 发布日期:2021-05-26
通讯作者: 王宇清,E-mail:wang_yu_qing@126.com
作者简介:徐雪云(1992-),女,湖北人,医学硕士,主要研究方向为儿童睡眠呼吸障碍。
基金资助:
国家自然科学基金(81573167);江苏省重点科技社会发展项目(BE2016676;BE2017657)

Comparative analysis of the clinical features and sleep structures of obstructive sleep apnea-hypopnea syndrome in preschool-age and school-age children

XU Xue-yun, WANG Yu-qing, HAO Chuang-li, HE Yan-yu, GENG Ya-xuan, JIANG Yu-ting, LYU Meng, LU Min, HAN Jun, WANG Jing, DOU Xun-wu, ZHU Hui-e, YIN De-pei

Department of Respiratory Medicine/Ophthalmology and Otorhinolaryngology, Children's Hospital of Soochow University, Suzhou, Jiangsu 215003, China

Received:2020-12-03 Revised:2021-02-07 Published:2021-05-26
Contact: WANG Yu-qing, E-mail:wang_yu_qing@126.com

摘要/Abstract

摘要： 目的分析学龄前期及学龄期阻塞性睡眠呼吸暂停低通气综合征(OSAHS)儿童的临床及睡眠结构特点。方法纳入2016年12月-2019年11月于苏州大学附属儿童医院呼吸科就诊,经多导睡眠监测诊断为OSAHS的123例患儿为研究对象,选择同期诊断为鼾症(PS)的313例患儿为对照组,根据年龄将两组患儿分为学龄前期组及学龄期组,收集临床资料及多导睡眠监测(PSG)结果。结果学龄前期及学龄期OSAHS患儿夜间及日间症状均较对照组显著(P<0.05)。学龄前OSAHS患儿快动眼睡眠期(REM)比例高于对照组(Z=2.467,P＜0.05);学龄期OSAHS患儿总睡眠时间(TST)及睡眠效率低于学龄前OSHAS患儿(t=2.518,Z＝1.527),NREM 2期比例升高(t＝4.080),NREM 3期比例下降(Z＝1.832),氧减指数(ODI)升高(Z=1.653,P<0.05)。呼吸暂停低通气指数(AHI)与学龄前期患儿NREM 1期睡眠比例呈正相关(r=0.217),与REM期比例呈负相关(r=-0.220),体重指数(BMI)与学龄期OSAHS患儿NREM 3期比例呈负相关(r=-0.429,P<0.05)。结论 OSAHS患儿临床表现与鼾症患儿不同,且不同年龄症状有所差异;学龄期OSAHS患儿睡眠结构改变较学龄前期患儿明显;学龄前期、学龄期OSAHS患儿睡眠结构改变分别与AHI、BMI有关。

关键词: 阻塞性睡眠呼吸暂停低通气综合征, 儿童, 临床特点, 睡眠结构

Abstract: Objective To analyze the clinical features and sleep structure characteristics of obstructive sleep apnea-hypopnea syndrome (OSAHS) in preschool-age and school-age children, in order to provide evidence for sleep assessment and interventions of children. Methods A total of 123 children diagnosed with OSAHS through polysomnography(PSG) from December 2016 to November 2019 in the Department of Respiratory of Children's Hospital of Soochow University were enrolled in this study.Meanwhile, 313 children diagnosed with primary snoring(PS) during the same period were selected into the control group.According to their ages, children were divided into preschool age group and school age group.Clinical data and PSG results were collected. Results The night and day symptoms of OSAHS preschool-age and school-age children were more significant than those in the control group (P<0.05).The proportion of rapid eye movement (REM) stage in preschool children with OSAHS was significantly higher than that in control group (Z=2.467,P＜0.05).The total sleep time (TST) and sleep efficiency of school-age children with OSAHS were lower than those of preschool children with OSHAS (t=2.518, Z=1.527, P<0.05).The proportion of non-rapid eye movement 2(NREM 2) stage in school-age OSAHS children was higher than that in the control group, while the proportion of stage NREM 3 was lower in school-age OSAHS children (t=4.080, Z=1.832, P<0.05), and oxygen desaturation index(ODI) increased(Z=1.653, P<0.05).Apnea-hypopnea index (AHI) was positively correlated with the proportion of NREM 1 stage sleep in preschool children (r=0.217), and negatively correlated with the proportion of REM stage (r=-0.220).Body mass index (BMI) was negatively related to the proportion of NREM3 stage in school-age children (r=-0.429, P<0.05). Conclusions The clinical manifestations of children with OSAHS are different from those of PS children, and vary by age.The changes of sleep structure in school-age OSAHS children are more obvious than those in pre-school children.The changes of sleep structure in preschool-age and school-age OSAHS children are related to AHI and BMI, respectively.

Key words: obstructive sleep apnea hypopnea syndrome, children, clinical features, sleep structure

中图分类号:

R766

徐雪云, 王宇清, 郝创利, 何燕玉, 耿雅轩, 江雨婷, 吕梦, 卢敏, 韩珺, 王景, 窦训武, 朱慧娥, 尹德佩. 不同年龄阻塞性睡眠呼吸暂停低通气综合征患儿临床表现及睡眠结构比较分析[J]. 中国儿童保健杂志, 2021, 29(5): 473-478.

XU Xue-yun, WANG Yu-qing, HAO Chuang-li, HE Yan-yu, GENG Ya-xuan, JIANG Yu-ting, LYU Meng, LU Min, HAN Jun, WANG Jing, DOU Xun-wu, ZHU Hui-e, YIN De-pei. Comparative analysis of the clinical features and sleep structures of obstructive sleep apnea-hypopnea syndrome in preschool-age and school-age children[J]. Chinese Journal of Child Health Care, 2021, 29(5): 473-478.

参考文献

[1] ElMallah M, Bailey E, Trivedi M, et al.Pediatric obstructive sleep apnea in high-risk populations: clinical implications[J].Pediatr Ann,2017,46(9):e336-e339.
[2] Scullin MH, Ornelas C, Montgomery-Downs HE.Risk for sleep-disordered breathing and home and classroom behavior in Hispanic preschoolers[J].Behav Sleep Med,2011,9(3):194-207.
[3] Kang KT, Chiu SN,Weng WC, et al.Comparisons of office and 24-hour ambulatory blood pressure monitoring in children with obstructive sleep apnea[J].J Pediatr,2017, 182(40):177-183.
[4] Savini S, Ciorba A, Bianchini C, et al.Assessment of obstructive sleep apnoea (OSA) in children: an update[J].Acta Otorhinolaryngol Ital,2019,39(5):289-297.
[5] Ng AK, Guan C.Impact of obstructive sleep apnea on sleep-wake stage ratio[J].Annu Int Conf IEEE Eng Med Biol Soc,2012:4660-4463.
[6] 美国睡眠医学会.睡眠障碍国际分类[M].高和,译.3版.北京:人民卫生出版社,2017.
[7] 儿童阻塞性睡眠呼吸暂停低通气综合征诊疗指南草案(乌鲁木齐)[J].中华耳鼻咽喉头颈外科杂志, 2007, 42(2):83-84.
[8] 倪鑫.中国儿童阻塞性睡眠呼吸暂停诊断与治疗指南(2020)[J].中国循证医学杂志, 2020,20(8):883-900.
[9] Su MS, Li AM, So HK, et al.Nocturnal enuresis in children: prevalence, correlates, and relationship with obstructive sleep apnea[J].J Pediatr,2011, 159:238-420.
[10] Alexopoulos EI, Malakasioti G, Varlami V, et al.Nocturnal enuresis is associated with moderate-to-severe obstructive sleep apnea in children with snoring[J].Pediatr Res,2014,76:555-559.
[11] Kovacevic L, Wolfe-Christensen C, Lu H, et al.Why does adenotonsillectomy not correct enuresis in all children with sleep disordered breathing?[J]. J Urol,2014,191:1592-6.
[12] Jeyakumar A, Rahman SI, Armbrecht ES, et al.The association between sleep-disordered breathing and enuresis in children[J].Laryngoscope,2012, 122:1873-1877.
[13] Scholle S, Zwacka G.Arousals and obstructive sleep apnea syndrome in children[J].Clin Neurophysiol,2001,112(6):984-991.
[14] Tauman R, O'Brien LM, Holbrook CR, et al.Sleep pressure score: a new index of sleep disruption in snoring children[J].Sleep,2004,27(2):274-278.
[15] 孙元锋,雷飞,杜丽娜.学龄前与学龄期阻塞性睡眠呼吸暂停低通气综合征患儿睡眠结构特点比较[J].中华医学杂志,2016,96(8):601-604.
[16] Durdik P, Sujanska A, Suroviakova S, et al.Sleep architecture in children with common phenotype of obstructive sleep apnea[J].J Clin Sleep Med,2018,14(1):9-14.
[17] 王鹏,李星晶,沈芳.不同睡眠分期相关OSAHS的睡眠结构紊乱程度分析[J].中国中西医结合耳鼻咽喉科杂志,2018, 26(1):62-65.
[18] Loadsman JA, Wilcox I.Is obstructive sleep apnea a rapid eye movement-predominant phenomenon?[J].Br J Anaesth,2000,85(3):354-358.
[19] Brockmann PE, Alonso-Álvarez ML,Gozal D.Diagnosing sleep apnea-hypopnea syndrome in children: past, present, and future[J].Arch Bronconeumol,2018,54(6):303-305.

不同年龄阻塞性睡眠呼吸暂停低通气综合征患儿临床表现及睡眠结构比较分析

Comparative analysis of the clinical features and sleep structures of obstructive sleep apnea-hypopnea syndrome in preschool-age and school-age children

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]	向伟. 儿童青少年脂质异常血症早期预防与成人期心血管健康[J]. 中国儿童保健杂志, 2023, 31(7): 697-702.
[2]	吴婷, 李斐. 生命早期不利因素与慢性疾病的发生与预防[J]. 中国儿童保健杂志, 2023, 31(7): 703-706.
[3]	刘浩东, 李成, 赵敏, 席波. 儿童期腹型肥胖及其腹型肥胖前期与高尿酸血症的关联研究[J]. 中国儿童保健杂志, 2023, 31(7): 707-712.
[4]	刘敏, 张倩, 杨亭, 陈洁, 陈立, 代英, 贾飞勇, 武丽杰, 郝燕, 李玲, 张婕, 柯晓燕, 衣明纪, 洪琦, 陈津津, 方拴锋, 王益超, 王琦, 金春华, 李廷玉. 全国多中心学龄前儿童血清叶酸现况调查[J]. 中国儿童保健杂志, 2023, 31(7): 713-717.
[5]	霍言言, 刘钟泠, 马玲, 吴丹, 汪秀莲, 仇晓艳, 窦家莹, 任玉倩, 李亦诚, 洪霞, 陈津津. 真实世界2岁以下儿童不同体型匀称度现况及风险因素[J]. 中国儿童保健杂志, 2023, 31(7): 718-723.
[6]	刘慧娟, 宋志霄, 高南南, 张莉, 孙瑾, 乔秀芸, 柯佳媚, 李燕. 2～6岁儿童词汇和语法发展现状及相关因素分析[J]. 中国儿童保健杂志, 2023, 31(7): 724-730.
[7]	李荣, 李年, 吴丹丹, 黄荣, 陈银花. 盐酸哌甲酯缓释片对注意缺陷多动障碍儿童生长的影响[J]. 中国儿童保健杂志, 2023, 31(7): 731-735.
[8]	张超. 早期介入丹佛模式在不同病情程度孤独症谱系障碍儿童康复中的应用研究[J]. 中国儿童保健杂志, 2023, 31(7): 736-740.
[9]	杨钰儒, 王红, 许树红, 曹艳梅, 孟仙, 葛冬梅. 0～14岁儿童骨骼发育与维生素K的关联研究[J]. 中国儿童保健杂志, 2023, 31(7): 746-750.
[10]	叶芝旭, 余福勋. 肠道微生物与儿童呼吸道病毒感染的研究进展[J]. 中国儿童保健杂志, 2023, 31(7): 766-769.
[11]	曹慧, 严双琴, 关宏岩. 亲子互动对儿童早期发展结局的影响[J]. 中国儿童保健杂志, 2023, 31(7): 770-774.
[12]	张容, 吴襄仪, 朱一民, 朱文丽, 《儿童肥胖预防与控制指南》修订委员会. 就餐地点与儿童肥胖的定性循证研究[J]. 中国儿童保健杂志, 2023, 31(7): 775-780.
[13]	李玮玮, 张丹丹, 刘晓鸣, 陈娇, 夏露. 探讨基于互联网技术的长程管理模式在难治性癫痫患儿中的应用研究[J]. 中国儿童保健杂志, 2023, 31(7): 781-784.
[14]	朱丽君, 李彪章, 周嘉雯, 吴柏欣, 李卫东. 1990—2019年中国5岁以下儿童低体重疾病负担分析[J]. 中国儿童保健杂志, 2023, 31(7): 790-793.
[15]	曹亚船, 豆吉娟, 马亚萍, 任金冬, 陈新颜. 肥胖儿童脂质代谢与左心室肥厚及左心室重构的相关性[J]. 中国儿童保健杂志, 2023, 31(7): 809-812.