儿童阻塞性睡眠呼吸暂停低通气综合征诊断标准的探讨  

Suggestions on the diagnostic criteria of childhood obstructive sleep apnea hypopnea syndrome

作　　者：秦旭[1] 陈爱欢[1] 孙丽红[1] 罗嘉莹[1] 黄顺开[1] 曾莉君[1] 周方略 

机构地区：[1]广州医科大学附属第一医院广州呼吸疾病研究所,510120

出　　处：《中华儿科杂志》2015年第7期528-531,共4页Chinese Journal of Pediatrics

摘　　要：目的 了解1＜阻塞性睡眠呼吸暂停低通气指数（OAHI）≤5且阻塞性呼吸暂停指数（OAI）≤1、最低血氧饱和度＜0.92的习惯性打鼾儿童的夜间血氧饱和度、睡眠结构及临床特征.方法 回顾性分析2010年6月至2013年10月期间因习惯性打鼾在广州呼吸疾病研究所就诊的267例2 ～16岁儿童的全夜多导睡眠图（PSG）,将病例分为原发性打鼾（PS）组（OAHI≤1）、临界阻塞性睡眠呼吸暂停低通气综合征（OSAHS）组（1＜OAHI≤5且OAI≤1、最低血氧饱和度＜0.92）和OSAHS组（OAHI＞5或OAI＞1,且最低血氧饱和度＜0.92）;比较三组儿童的PSG和临床特征.结果 临界OSAHS组的氧减指数为3.8±0.4,PS组为1.6±0.1（x2=34.5,P＜0.01）;最低血氧饱和度为89（87,91）,PS组为93（91,94）（x2=40.2,P＜0.01）;非快速眼动1期比率为19.0±1.2,PS组为14.2±0.1（x2=14.1,P＜0.01）;非快速眼动3期比率为24.4±1.0,PS组为29.0±1.1（P＜0.01）.临界OSAHS组的儿童睡眠问卷评分为0.41 ±0.19,PS组为0.28 ±0.14（x2=8.52,P=0.01）;腺样体厚度/鼻咽腔宽度为0.70 ±0.07,PS组为0.62 ±0.10（x2 =8.96,P=0.01）;扁桃体肥大2（1,2）度,PS组为1（1,2）度（x2=7.95,P＜0.05）.结论 I＜OAHI≤5且OAI≤1、最低血氧饱和度＜0.92的习惯性打鼾儿童存在不同程度夜间缺氧、睡眠结构紊乱和OSAHS临床特征.Objective To evaluate the sleep architecture and hypoxia and clinical features of habitual snoring children with an obstructive sleep apnea-hypopnea index （OAHI） 1 to 5.Method The polysomnographic data of 267 children aged from 2 to 16 years with habitual snoring were analyzed retrospectively,and the clinical features were analyzed in 108 of the children.The recruited children were divided into primary snoring group （PS group,OAHI ≤ 1）,obstructive sleep apnea hypopnea syndrome （OSAHS） group （1 〈 OAHI ≤5 and obstructive apnea index≤ 1）,lowest oxygen saturation （LSpO2 〈0.92） and OSAHS group （OAHI 〉 5 or dostructive apnea index 〉 1,LSpO2 〈 0.92）.Result The oxygen desaturation index of the intermediate OSAHS group （3.8 ± 0.4） was significantly higher than that of PS group （1.6 ± 0.1） （x2 =34.5,P 〈 0.01）.The LSpO2 of intermediate OSAHS group was significantly lower than that of PS group （89（87,91） vs.93（91,94）,x2 =40.2,P〈0.01）.Comparing to the PS group,the non-rapid eye movement 1 ratio （N1%） was significantly higher （19.0 ± 1.2 vs.14.2 ±0.1,x2 =14.1,P 〈0.01）,and the non-rapid eye movement 3 ratio （N3%） was significantly lower （24.4 ± 1.0 vs.29.0 ± 1.1,P 〈 0.01） in the intermediate OSAHS group.The pediatric questionnaire score intermediate OSAHS group was higher than PS （0.41 ±0.19 vs.0.28 ±0.14,x2 =8.52,P =0.01）.The adenoids-nasopharynx ratio was higher than that of PS group （0.70 ±0.07 vs.0.62 ±0.10,x2 =8.96,P =0.01）.The hypertrophy of tonsil was higher than PS group （2 （1,2） vs.1 （1,2）,x2 =7.95,P 〈 0.05）.Conclusion Hypoxia and abnormal sleep structure are present in HS children with an OAHI of 1 to 5,and they also have the clinical features of OSAHS.

关 键 词：睡眠呼吸暂停 阻塞性 诊断 儿童 

分 类 号：R766[医药卫生—耳鼻咽喉科]