儿童睡眠呼吸障碍程度的判断  

Diagnostic and severity classification criteria of PSG in children with sleep disordered breathing

作　　者：许志飞[1] 张亚梅[2] 赵靖[2] 安嘉清[2] 

机构地区：[1]首都医科大学附属北京儿童医院内科,北京100045 [2]首都医科大学附属北京儿童医院耳鼻咽喉科,北京100045

出　　处：《中国耳鼻咽喉头颈外科》2007年第9期547-550,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：首都医学发展科研基金资助项目(2003-2036)

摘　　要：目的为儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的诊断和严重程度分级寻找实验室监测指标的依据,探讨睡眠呼吸障碍影响儿童认知能力的发病机制。方法对睡眠呼吸障碍的儿童进行问卷调查和多导睡眠监测法(polysomnography,PSG)监测。睡眠呼吸分析包括夜间睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)、阻塞性呼吸暂停指数(obstructive apnea index,OAI)、氧减指数(oxygen desaturation index,ODI)和最低血氧饱和度(arterial oxygen saturation,SaO2)等多项指标。结果124例有打鼾症状的儿童纳入研究。在所有鼾症儿童中,AHI>5次/h或OAI>1者共105例,占所有鼾症儿童的87%。按认知能力正常和减低将患儿分成两组,发现AHI、OAI、ODI、最低SaO2及觉醒指数在两组患儿之间差异具有显著性意义,P值分别为0.001、0.019、0.018、<0.001和0.033。SaO2减低的严重程度是独立于各种因素之外的,导致患儿认知能力差的重要因素(P=0.005)。结论应把AHI>5和OAI>1同时纳入儿童OSAHS诊断标准中。夜间严重的SaO2下降可能是导致儿童认知能力减低的重要原因。SaO2减低是判断睡眠呼吸障碍严重程度的重要指标。　OBJECTIVE ①To investigate the appropriate PSG （polysomnography） criteria in children with OSAHS （obstructive sleep apnea/hypopnea syndrome）. ②To explore the pathogenesis of cognitive defects in children with sleep disordered breathing. METHODS Children with snoring were recruited. Questionnaires were filled out and PSG was performed for all the children. Apnea/hypopnea index （AHI）, obstructive apnea index （OAI）, oxygen desaturation index （ODI）, arousal index and minimum oxygen saturation were analyzed. RESULTS A total of 124 children with snoring were recruited. There were 105 children who has either AHI 〉5 or OAI 〉1, occupying 87% of the total subjects. Patients were divided into two groups depending on whether they had cognitive defects or not. There were no differences between the two groups regarding the age, gender and BMI （body mass index）. AHI, OAI, ODI, the minimum oxygen saturation and arousal index were significantly different between the two group with P value of 0.001, 0.019, 0.018, 〈0.001 and 0.033 respectively. Logistic regression test showed that, after controlled for age, gender, AHI, ODI and other PSG parameters, the minimum oxygen saturation was the independent factor that correlated with cognitive disability （P=0.005）. CONCLUSION Paediatric patients with either AHI〉5 or OAI〉1 should be considered as having OSAHS. Nocturnal hypoxemia is the major cause of cognitive defects in OSAHS children. While classifying the severity of childhood OSAHS, the minimum oxygen saturation should be paid more attention to as well as AHI.

关 键 词：睡眠呼吸暂停 阻塞性 诊断 儿童 多道睡眠描计术 认知 

分 类 号：R766[医药卫生—耳鼻咽喉科]