重度阻塞性睡眠呼吸暂停儿童睡眠脑电慢波活动的特征及其在腺样体与扁桃体切除后的变化特点  

Characteristics of slow wave activity of sleep electroencephalogram and the changes of slow wave activity after adenotonsillectomy in children with severe obstructive sleep apnea

作　　者：吴云肖 王长明 许力 唐瑜芬 吴盼婷 张远 许志飞[4] Wu Yunxiao;Wang Changming;Xu Li;Tang Yufen;Wu Panting;Zhang Yuan;Xu Zhifei(Beijing Key Laboratory of Pediatric Diseases of Otolaryngology,Head and Neck Surgery,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;College of Electronic and Information Engineering,Southwest University,Chongqing,400715,China;Department 1 of Respiratory Medicine,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院儿童耳鼻咽喉头颈外科疾病北京市重点实验室,北京100045 [2]首都医科大学宣武医院神经外科,北京100053 [3]西南大学电子信息工程学院,重庆400715 [4]国家儿童医学中心首都医科大学附属北京儿童医院呼吸一科,北京100045

出　　处：《中华医学杂志》2022年第8期544-549,共6页National Medical Journal of China

基　　金：国家自然科学基金(82070092);北京市自然科学基金(7212033);北京市医院管理中心儿科学科协同发展中心专项经费(XTYB201807)。

摘　　要：目的:探讨重度阻塞性睡眠呼吸暂停(OSA)患儿睡眠脑电慢波活动(SWA)特征和腺样体与扁桃体切除后SWA的变化特点。方法:以2018年5月至2019年12月就诊于北京儿童医院睡眠中心且完成腺样体和扁桃体切除的24例重度OSA患儿,及按年龄、性别成组匹配且排除OSA的儿童26名(对照组)作为研究对象,完成整夜多导睡眠图(PSG)监测,计算睡眠脑电SWA强度。比较重度OSA组手术前和对照组,以及重度OSA组手术前后PSG指标和SWA强度的差异,并分析SWA强度与PSG指标的相关性。结果:重度OSA组手术前年龄为(6.1±1.7)岁,其中男性20例(83.3%),手术与随访的时间间隔M(Q1,Q3)为6.3(5.8,7.1)个月。对照组年龄为(6.2±1.1)岁,其中男性20名(76.9%)。重度OSA组手术后[M(Q1,Q3)]非快眼动睡眠1期(N1期)占总睡眠时间比例、阻塞性呼吸暂停低通气指数、氧减指数(ODI)和血氧饱和度(SpO 2)<90%的时间占总睡眠时间比例的分别为6.8%(5.6%,8.9%)、1.2(0.4,2.4)次/h、2.1(0.7,4.3)次/h和0(0,0),均低于手术前[分别为9.1%(7.5%,16.8%)、21.6(14.1,39.5)次/h、23.1(10.2,36.0)次/h和0.8%(0,3.9%)],非快眼动睡眠3期占总睡眠时间比例、快眼动睡眠占总睡眠时间比例和最低SpO 2分别为(24.3±5.7)%、(19.1±3.7)%和91%(86%,94%),均高于手术前[分别为(19.0±5.3)%、(15.4±3.9)%和83%(70%,88%)](均P<0.05)。对N1期SWA强度的重复测量方差分析显示:OSA与睡眠时间进程间无交互作用(F=0.02,P=0.997),OSA的主效应具有统计学意义(F=5.12,P=0.040),重度OSA组N1期SWA强度高于对照组[SWA强度重度OSA组手术前-对照组(95%CI):0.379(0.020,0.739)],睡眠时间进程的主效应无统计学意义(F=1.66,P=0.191);腺样体和扁桃体切除术与睡眠时间进程间无交互作用(F=0.88,P=0.461),手术的主效应具有统计学意义(F=8.95,P=0.010),OSA患儿手术后N1期SWA强度低于手术前[SWA强度手术后-手术前(95%CI):-0.572(-0.982,-0.162)],睡眠时间进程的主效应具有统计学意义Objective To investigate the characteristics of slow wave activity(SWA)during sleep and the changes of SWA after adenotonsillectomy in children with severe obstructive sleep apnea(OSA).Methods A total of 24 children with severe OSA,who completed adenotonsillectomy in Sleep Center of Beijing Children′s Hospital and 26 control children category matched for age and sex and excluded from OSA were included as subjects from May 2018 to December 2019.The subjects underwent overnight PSG,as well as SWA analysis of sleep electroencephalogram.The differences of PSG indexes and SWA intensity between children with severe OSA and control children,before and after operation in severe OSA children were compared and the correlations between SWA intensity and PSG indexes were analyzed.Results The age of the children with severe OSA before surgery was(6.1±1.7)years,including 20 males(83.3%),and the interval M(Q1,Q3)between surgery and follow-up was 6.3(5.8,7.1)months.The age of the control children was(6.2±1.1)years,including 20 males(76.9%).In severe OSA group,the M(Q1,Q3)of non-rem sleep stage 1 to total sleep time,obstructive apnea hypopnea index,oxygen desaturation index(ODI)and proportion of oxygen saturation(SpO2)<90%during night sleep to total sleep time were 6.8%(5.6%,8.9%),1.2(0.4,2.4)events/h,2.1(0.7,4.3)events/h and 0(0,0)after surgery,respectively,which were lower than those before surgery[9.1%(7.5%,16.8%),21.6(14.1,39.5)events/h,23.1(10.2,36.0)events/h and 0.8%(0,3.9%),respectively],while non-rem sleep stage 3 to total sleep time%,rem sleep stage to total sleep time%and lowest SpO2 were(24.3±5.7)%,(19.1±3.7)%and 91%(86%,94%)after surgery,which were higher than those before operation[(19.0±5.3)%,(15.4±3.9)%and 83%(70%,88%)respectively](all P values<0.05).The repeated measure ANOVA of SWA intensity in phase N1 showed no interaction between OSA and sleep time course(F=0.02,P=0.997),the main effect of OSA was statistically significant(F=5.12,P=0.040),SWA intensity in children with severe OSA at stage N1 was higher

关 键 词：睡眠呼吸暂停 阻塞性 儿童 脑电波 病例对照研究 

分 类 号：R766[医药卫生—耳鼻咽喉科]