儿童OSAHS危险因素和微觉醒预警机制探讨  

Mechanism of risk factors alert and systematic inflammation response in children with obstructive sleep apnea and hypopnea syndrome

作　　者：苏苗赏[1] 俞晨艺[1] 张渊博[2] 周洋洋[2] 徐莉[2] 蔡晓红[1] 

机构地区：[1]温州医科大学附属第二医院育英儿童医院儿童呼吸科,浙江温州325027 [2]温州医科大学研究生院,浙江温州325035

出　　处：《温州医学院学报》2015年第3期180-184,共5页Journal of Wenzhou Medical College

基　　金：浙江省医药卫生平台骨干人才计划项目(2013RCA037);国家重点临床专科开放课题(20130211;20130209);浙江省科技厅科研基金资助项目(2013C33174);浙江省自然科学基金资助项目(Y2110277);浙江省卫生厅科研基金资助项目(2014ZDA014)

摘　　要：目的：调查儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的危险因素,探讨脑电微觉醒与全身炎症反应的相关性。方法：对2013年1月至2014年6月我院儿童呼吸科门诊收治的285例6~11岁鼾症儿童进行睡眠问卷调查和整夜多导睡眠监测（PSG）,比较OSAHS患儿和非OSAHS患儿的临床资料,分析OSAHS的相关危险因素。随机选取30例鼾症儿童进行血炎症指标检测,分析睡眠效率（SE）、睡眠结构、微觉醒指数（AI）、氧减指数及各种睡眠呼吸紊乱指数等睡眠参数以及血常规、C反应蛋白（CRP）、白介素-1β（IL-1β）的表达水平。结果：56例（占19.6%）患儿被诊断为OSAHS。与非OSAHS组比较,OSAHS患儿与多种睡眠相关症状显著相关。Logistic回归分析显示,OSAHS主要危险因素有扁桃体腺样体肥大、习惯性打鼾（〉3次/周）、肥胖、张口呼吸、夜间遗尿、白天过度活跃和脾气暴躁。睡眠参数分析显示,OSAHS患儿睡眠总时间（TST）、SE、深睡眠（II期＋IV期睡眠）和快速眼动（REM）期睡眠时间减少,浅睡眠（I期＋I期睡眠）时间增多,AI增高;最低氧饱和度（LSa O2）、阻塞性呼吸暂停指数（OAI）、呼吸暂停低通气指数（AHI）和呼吸紊乱指数（RDI）在OSAHS和非OSAHS儿童间差异均有统计学意义。OSAHS患儿血白细胞计数、血CRP及IL-1β表达水平均明显增高。Pearson相关分析显示,OSAHS患儿AI与RDI呈正相关（r=7.56,P〈0.01）,与血IL-1β表达水平亦呈正相关（r=6.85,P〈0.01）。结论：OSAHS患儿主要危险因素有扁桃体腺样体肥大、习惯性打鼾、肥胖、张口呼吸、夜间遗尿、白天过度活跃和脾气暴躁。AI增高与呼吸紊乱有关,并且可能与全身轻度炎症反应相关。Objective： To investigate the risk factors alert mechanism in children with obstructive sleep apnea and hypopnea syndrome（OSAHS）, and to determine the correlation of arousal and systematic inflammation response. Methods： Two hundred and eighty-five cases of snoring children aged 6-11 years old were included, sleep questionnaires were completed by their parents. All the children performed the whole night polysommongraphy（PSG）, the total sleep time（TST）, sleep efficiency, sleep structure, oxygen desaturation, and various respiratory disorder index were assessed by physician. Thirty children at high risk and low risk for obstructive sleep apnea syndrome（OSAHS） were randomly selected to detect the blood routine, C reactive protein（CRP） and interleukin-1β（IL-1β） levels. Results： Fifty-six cases（19.6%） of snoring children were diagnosed OSAHS by PSG. Logistic regression analysis showed that tonsil and adenoid hypertrophy, habitual snoring, obesity, mouth breathing, enuresis, hyperactivity and irascibility were the main risk factors. PSG study showed that TST, sleep efficiency, deep sleep（stage III and IV） and REM sleep time decreased, light sleep（stage I and II）, arousal index（AI）, OAI, AHI and RDI increased in OSAHS children. IL-1β and CRP levels increased in OSAHS children. Pearson correlation analysis showed there was positive correlation between AI and RDI（r=7.56, P〈0.01）. Furthermore, AI correlated with the level of IL-1β（r=6.85, P〈0.01）. Conclusion： Tonsil and adenoid hypertrophy, habitual snoring, obesity, mouth breathing, enuresis, hyperactivity and irascibility are the main risk factors of OSAHS children. AI increases in accord with RDI and this phenomenon may correlate with systematic mild inflamation reponse.

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 多导睡眠监测 微觉醒 炎症 危险因素 儿童 

分 类 号：R725.6[医药卫生—儿科]