阻塞性睡眠呼吸暂停低通气综合征儿童手术前后注意力缺陷和多动症状  

Comparison of the sleep architecture and symptom of inattention-hyperactivity in children with obstructive sleep apnea hypopnea syndrome before and after surgery

作　　者：黄振云[1] 刘大波[1] 李志斌[2] 钟建文[1] 俞洁[1] 谭宗瑜[1] 孙昌志[1] 周丽枫[1] 陈倩[1] 

机构地区：[1]广州市儿童医院耳鼻咽喉科,510120 [2]广州市儿童医院神经科,510120

出　　处：《中华耳鼻咽喉头颈外科杂志》2008年第3期169-173,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广州市医药卫生科技一般引导项目（2006-YB-076）;广东省医学科研基金课题立项资助（A2007517）

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）儿童是否更易出现注意力缺陷和多动症状，并观察手术治疗前后睡眠呼吸紊乱及注意力缺陷和多动症状有无好转。方法2004年6月至2007年5月经多道睡眠监测（polysomnography，PSG）确诊的OSAHS儿童80例为患儿组，其中有手术前后完整PSG监测资料的16例儿童进行睡眠结构和呼吸紊乱相关指标的分析。选择因声带小结就诊经PSG监测睡眠呼吸正常儿童30例为对照组。由神经科医生对所有儿童进行注意缺陷和多动症状分数（inattention-hyperactivity score，IHS）的评估，以IHS〉1．25判定为明显注意力缺陷和多动症状。患儿组均行腺样体切除或扁桃体＋腺样体切除的手术治疗，术后6个月再次接受PSG监测及神经科医师的IHS评估，比较对照组与OSAHS患儿有关数据的差异。结果①患儿组术前和对照组的IHS的中位数分别为0．89和0．17，秩和检验差异有统计学意义（Z=-4．276，P〈0．05）；手术前后患儿组的IHS的中位数分别为0．89和0．44，配对t检验差异有统计学意义（t=6．219，P〈0．05）。②患儿组术前、术后和对照组分别有25例、9例和3例儿童的IHS〉1．25，卡方检验示患儿组术前与对照组、术前与术后比较出现症状患儿的比率差异有统计学意义（χ^2值分别为5．192和9．56，P值均〈0．05）。③患儿组中有完整资料的16例手术后呼吸紊乱指标及睡眠结构有明显改变，睡眠Ⅰ期减少，睡眠Ⅱ期、慢波睡眠及快动眼睡眠的比例显著增加（配对t检验t值分别为12．2、-5．4、-6．3和-8．1，P值均〈0．001）呼吸暂停低通气指数从13．9次／h下降到1．5次／h，最低血氧饱和度从0．855上升到0．940（t值分别为5．3和-3．7，P值均〈0．01）；术后和对照组相比，快速动眼睡眠的比例及最低血氧饱和度仍未达到对Objective To observe the symptoms of inattention, hyperactivity among obstructive sleep apnea hypopnea syndrome（OSAHS） children, also to investigate the effects of surgery （tonsillectomy and adenoidectomy or adenoidectomy alone）on the changes of sleep architecture and inattention-hyperactivity score（IHS）. Methods Between June 2004 and may 2007, eighty children diagnosed as OSAHS with overnight polysomnography （PSG） were included in this study, only sixteen children had complete pre-op and post-op PSG data. Thirty children with vocal cord nodules were selected as control group. DSM-Ⅳ- derived IHS was evaluated by neurologist. All OSAHS children accepted surgery （tonsillectomy and adenoideetomy or adenoidectomy alone） and IHS evaluation. The pre-op and post-op sleep architecture and IHS were compared with that of control group. Results ①The median IHS 80 OSAHS chidren was higher than that it in control group （0. 89 vs 0. 17 ） and the difference was significant （ Z = - 4. 276, P 〈 0. 05 ）. After surgery, it showed a significant reduction in IHS（0. 44 vs 0. 89, t =6. 219, P 〈0. 05）.② Twenty-five OSAHS children had pre-op IHS greater than 1.25 and nine had post-op IHS greater than 1.25, while only three children in control group had IHS greater than 1.25. The difference was statistically significant（ χ^2 = 5. 192,9. 56 respectively, P 〈0. 05）. ③ For sixteen OSAHS children who had both pre-op and post-op PSG data, a decrease in the percentage of phase 1 sleep and an increase in the percentage of phase 2 sleep, slow wave sleep（SWS） and rapid eye movement（REM） sleep were observed in six months after surgery and the difference was significant（ t = 12.2, - 5.4, - 6. 3, - 8.1 respectively, P 〈 0. 001 ）. After surgery, apneahypopnea index（AHI） decreased from 13. 9 times/h to 1.5 times/h while lowest saturation of blood oxygen （ LSaO2 ） increased from 0. 855 to 0. 940 （ t = 5. 3, - 3. 7 respectively, P 〈 0. 01 ）. REM sleep percentage and LSaO2 was

关 键 词：睡眠呼吸暂停 阻塞性 儿童 轻微脑损伤综合征 

分 类 号：R686[医药卫生—骨科学]