便携式睡眠监测诊断儿童阻塞性睡眠呼吸暂停综合征的临床价值  

Clinical value of portable sleep testing in children with obstructive sleep apnea syndrome

作　　者：苏苗赏[1] 俞晨艺[1] 张渊博[1] 周洋洋[1] 梅红芳[1] 林晶[1] 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,325027

出　　处：《中华儿科杂志》2015年第11期845-849,共5页Chinese Journal of Pediatrics

基　　金：浙江省医药卫生平台重点和骨干人才科技计划项目（2014ZDA014、2013RCA037）;国家卫计委国家重点临床专科开放课题（20130201、20130211）;温州市科技局科技合作项目（H20130001）

摘　　要：目的探讨应用Watch—PAT便携式睡眠监测仪（简称PAT）在诊断儿童阻塞性睡眠呼吸暂停综合征（OSAS）中的临床价值。方法采用自身平行对照临床试验设计，双盲法随机选择2013年1月至2014年12月门诊收治的50例鼾症儿童，其中3—5岁组20例，6-11岁组30例，均同时用PAT和整夜多导睡眠监测仪（PSG）监测睡眠。比较分析两种睡眠监测方法对OSAS和非OSAS儿童睡眠各参数的吻合性，以及诊断OSAS的敏感度和特异度。以PSG为参考标准，ROC曲线分析PAT诊断OSAS的敏感度和特异度。结果6～11岁组PAT监测法检出14例OSAS，与PSG监测法一致。而3～5岁组PAT仅检出6例OSAS，PSG检出11例（X^2=4．80，P〈0．05）。对6—11岁组的睡眠参数分析结果显示，与非OSAS患儿比较，PAT法显示OSAS患儿Ⅲ＋Ⅳ期睡眠时间[（30．5±2．4）％比（38．2±2．3）％，X^2=4．31，P〈0．05]、快动眼睡眠期睡眠时间[（8．9±2．5）％比（18．3±2．1）％，）（。=4．31，P〈0．05]、睡眠总时间[（458±78）min比（522±56）min，t=4．85，P〈0．05]和睡眠效率[（83．5±3．1）％比（93．5±3．5）％，t=3．75，P〈0．05]明显减少Ⅰ＋Ⅱ期睡眠时间[（61．5±4．4）％比（44．1±3．5）％，X^2=6．07，P〈0．05]和微觉醒指数[（29．5±8．2）／h比（10．6±5．6）／h，t=3．70，P〈0．05]增多，最低氧饱和度[（82．1±6．8）％比（96．8±3．2）％，t=2．56，P〈0．05]、呼吸暂停低通气指数（AHI）[（7．6±5．3）／h比（2．1±2．0）／h，t=2．40，P〈0．05]、呼吸紊乱指数（RDI）[（18．2±5．1）／h比（6．5±3．9）／h，t=3．85，P〈0．05]均显示差异有统计学意义。PAT监测显示OSAS患儿总睡眠时间[（458±78）min比（430±76）min，t=2．90，P〈0．05]和睡眠效率[（83．5±3．1）％比（81．9±4．3）％，t=2．45，P〈0．05]均高于PSG监测。ROC曲线分析显示，当取值AHI5．0时Objective To determine the clinical value of portable sleep testing by Watch-PAT （PAT） in children with obstructive sleep apnea syndrome （OSAS）. Method Fifty cases of snoring children aged 3 - 11 years were randomly selected to undergo the polysomnography （PSG） and PAT simultaneously at the same night. The consistency of sleep parameters in OSAS and non - OSAS children were compared with PSG as reference standard, and ROC curve analysis was performed to assess the sensitivity and specificity in the diagnosis of OSAS with PAT portable sleep monitor. Result Fourteen cases were diagnosed as OSAS in 6 - 11 years group by PAT and PSG. But in 3 -5 years group, only six children were diagnosed as OSAS,there was significant difference between PAT and PSG （ P 〈 0. 05 ）. Among those 6 - 11 years old children, compared with non-OSAS, PAT study showed that Ⅲ ＋ Ⅳ stage sleep （（30.5 ±2.4）% vs. （38.2 ± 2.3）%, X^2 =4.31, P〈0. 05）, REM sleep duration（（8.9±2.5）% vs. （18.3 ±2.1）%, X^2 =4.31, P 〈 0. 05 ） , TST（ （458 ± 78） rain vs. （522 ± 56） rain, t = 4. 85, P 〈 0. 05 ） and sleep efficiency （ （83.5 ± 3.1）% vs. （93.5±3.5）%, t=3.75, P〈0.05）decreased, Ⅰ ＋ Ⅱ stage sleep （（61.5 ±4.4）% vs. （44.1 ±3.5）%, X^2 =6.07, P〈0.05）, arousal index （（29.5±8.2）/hrs. （10.6±5.6）/h, t=3.70, P〈0.05）, AHI （（7.6±5.3）/hrs. （2.1 ±2.0）/h, t=2.40, P〈0.05）, RDI（（18.2±5.1）/h vs. （6. 5 ± 3.9）/h, t = 3.85, P 〈 0. 05 ） increased in OSAS children. Furthermore, the total sleep time （TST） （（458 ± 78） rain vs. （430 ± 76） min, t =2. 90, P〈0. 05） and sleep efficiency （（83.5 ±3.1） % vs. （81.9 ±4.3） %, t =2.45, P 〈0.05） were higher by PAT than scored by PSG. ROC cmwe analysis showed the best threshold selection of AHI 5. 0, the sensitivity was 0. 952, the specificity was 0. 858. AHI 7. 0, the sensitivity was 0. 968, the specificity was 0. 985. AHI 10, the sensitivity was 0. 985 and t

关 键 词：睡眠呼吸暂停 鼾症 儿童 睡眠监测 

分 类 号：R766[医药卫生—耳鼻咽喉科]