儿童上气道阻力综合征与阻塞性睡眠呼吸暂停低通气综合征的临床分析  

Clinical analysis of upper airway resistance syndrome and obstructive sleep apnea-hypopnea syndrome in children

作　　者：钟建文[1] 刘大波[1] 黄振云[1] 谭宗瑜[1] 仇书要[1] 俞洁[1] 

机构地区：[1]广州市儿童医院耳鼻咽喉科,510120

出　　处：《中华耳鼻咽喉头颈外科杂志》2009年第6期464-468,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的分析上气道阻力综合征（upper airway resistance syndrome，UARS）与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的临床表现的异同，探讨两者临床特点和睡眠呼吸特征。方法采用双盲法收集资料，所有患儿多道睡眠监测由1名睡眠技师和1名耳鼻咽喉科医师分析监测结果确诊为UARS和OSAHS，再由另外的耳鼻咽喉科医师详细记录两者的临床表现和体格检查。结果睡眠监测结果，253例OSAHS患儿的呼吸暂停低通气指数和最低血氧饱和度中位数[25分位数；75分位数]分别为3．60[2．00；7．55]次／h和0．90[0．85；0．91]，而102例UARS的同类指标分别为0．90[0．50；1．10]次／h和0．95[0．92；0．96]，秩和检验差异均有统计学意义（P值均〈0．001）。两组学龄前期患儿比例均较学龄期患儿高。两组患儿均以睡眠打鼾为主诉，均以睡眠打鼾、睡眠不安、注意力缺陷和多动、张口呼吸为主要症状，以上症状的发生率：UARS分别为94．1％、72．5％、62．7％、37．3％，OSAHS分别为92．9％、78．7％、57．7％、45．5％，卡方检验差异均无统计学意义（P值均〉0．05）。两组患儿均多伴扁桃体和腺样体肥大，但差异没有统计学意义（X^2=0．27，P=0．87），而OSAHS患儿较UARS患儿更容易观察到睡眠出现呼吸暂停情况，差异有统计学意义（X^2=34．07，P〈0．001）。结论UARS和OSAHS的临床表现相近，根据患儿的临床表现难以判断两者的差别，OSAHS患儿更易被观察到睡眠出现呼吸暂停的情况，两者的确诊要依据睡眠监测。Objective To analyze the similarities and differences of the clinical manifestations between the children with upper airway resistance syndrome （UARS） and obstructive sleep apnea-hypopnea syndrome （OSAHS）, and to explore the clinical features and characteristics of sleep respiratory parameters. Methods Using the double-blind method, all children were diagnosed as UARS or OSAHS through the polysomnography test and the results of all children were analyzed by a sleep technician and an otolaryngologist. Another ENT doctor recorded their clinical and physical examination in detail. Results Polysomnography showed that the apnea-hypopnea index（AHI） and the lowest oxygen in 253 children with OSAHS were 3.60 [ 2. 00 ;7.55 ] times/h and 0. 90 [ 0. 85 ;0. 91 ], and were 0.90 [ 0. 50 ; 1.10 ] times/h and 0. 95 [ 0. 92;0.96 ] in 102 children with UARS, the difference of the two groups by rank test was statistically significant. The proportion of UARS and OSAHS was more common during preschool period than during school-age period. The chief complaint in two groups was sleep snoring, and the main symptoms were sleep restless, attention deficit/hyperactivity and breath with mouth open. The incidence rate of above symptoms were as follows, 94. 1% ,72. 5% ,62. 7% and 37.3% in children with UARS, 92. 9% ,78.7% ,57. 7% and 45.5% in children with OSAHS. The difference was not significant by chi-square test （ P 〉 0.05 ）. Tonsil and adenoid hypertrophy were also observed in the two groups, the difference was not significant （ X^2 = 0. 27, P = 0. 87）. However, the children with OSAHS were more apt to have the sleep apnea than with UARS, the difference was statistically significant （ X^2 = 34. 07, P 〈 0. 001 ）. Conclusions The clinical manifestations of two groups are similar, the difference between UARS and OSAHS can not be determined by the patient＇s clinical performance. Sleep apnea can be more easily observed in children with OSAHS than that in UARS, the final diagnosis is based on polysomnography.

关 键 词：睡眠呼吸暂停 阻塞性 睡眠呼吸暂停综合征 儿童 气道阻力 

分 类 号：R686[医药卫生—骨科学]