快速眼动睡眠相关阻塞性睡眠呼吸暂停儿童的临床特点及预后分析  

Clinical and prognostic characteristics of REM sleep related obstructive sleep apnea in children

作　　者：吴云肖[1] 冯国双[2] 许志飞[3] 倪鑫[4] Wu Yunxiao;Feng Guoshuang;Xu Zhifei;Ni Xin(Beijing Key Laboratory of Pediatric Diseases of Otolaryngology,Head and Neck Surgery,Beijing Pediatric Research Institute,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Big Data Center,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Respiratory Medicine 1,MOE Key Laboratory of Major Diseases in Children,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Otolaryngology,Head and Neck Surgery,MOE Key Laboratory of Major Diseases in Children,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、北京市儿科研究所儿童耳鼻咽喉头颈外科疾病北京市重点实验室,北京100045 [2]国家儿童医学中心、首都医科大学附属北京儿童医院大数据中心,北京100045 [3]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、儿科重大疾病研究教育部重点实验室,北京100045 [4]国家儿童医学中心、首都医科大学附属北京儿童医院耳鼻咽喉头颈外科、儿科重大疾病研究教育部重点实验室,北京100045

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第8期765-772,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金(82070092);北京市自然科学基金(7212033);国家呼吸系统疾病临床医学研究中心呼吸专项(HXZX-20210401)。

摘　　要：目的:分析快速眼动睡眠相关阻塞性睡眠呼吸暂停(REM-OSA)儿童的临床特点及预后情况。方法:回顾性分析2017年12月至2021年4月就诊于首都医科大学附属北京儿童医院,经多导睡眠监测(PSG)诊断为中重度OSA,进行腺样体扁桃体切除术,且在术后6个月完成复诊的2~14岁儿童62例的临床资料。其中男45例(72.6%),女17例(27.4%),年龄2.0~12.3(5.9±2.4)岁。所有儿童在基线时均完成临床资料收集、PSG、OSA-18生活质量问卷和儿童睡眠问卷-睡眠呼吸障碍分量表,术后6个月复查PSG和OSA-18生活质量问卷。根据基线PSG中快速眼动睡眠期阻塞性呼吸暂停低通气指数(OAHI)与非快速眼动睡眠期OAHI比值是否≥2,将患儿分为REM-OSA组(33例)和非REM-OSA组(29例)。对比2组患儿基线PSG参数及量表得分、术后6个月治愈率及OSA-18生活质量问卷结果,使用SPSS 23.0进行统计学分析。结果:2组患儿在年龄、性别、体质量指数(BMI)、颈围/身高比、是否超重或肥胖、病史时间、扁桃体和腺样体大小上差异无统计学意义(P值均>0.05)。REM-OSA组的氧减指数、SpO_(2)<90%占总睡眠时间的比例高于非REM-OSA组(Z值分别为-2.723、-3.414,P值分别为0.006、0.001),而最低SpO_(2)低于非REM-OSA组(Z=-3.957,P<0.001)。REM-OSA组阻塞型呼吸暂停占总呼吸事件的比例(与解剖因素相关)高于非REM-OSA组(t=2.840,P=0.006),而中枢型呼吸暂停占总呼吸事件的比例和觉醒指数(均与功能因素相关)低于非REM-OSA组(t=-2.597、P=0.012,Z=-2.956、P=0.003),其余PSG指标两组间差异无统计学意义(P值均>0.05)。在不同基线OAHI情况下,2组患儿术后6个月OSA治愈率的变化趋势有交互效应(χ^(2)=4.282,P=0.039)。结论:解剖因素和功能因素在REM-OSA与非REM-OSA患儿病因中所占的权重不同,2组患儿术后OSA治愈率在不同基线OAHI的情况下变化趋势相反。Objective To analyze the clinical and prognostic characteristics of rapid eye movement sleep related obstructive sleep apnea(REM-OSA)in children.Methods A retrospective analysis was performed on the clinical data of 62 children aged from 2 to 14 years who were admitted to Beijing Children′s Hospital,Capital Medical University from December 2017 to April 2021,diagnosed with moderate to severe OSA by polysomnography monitoring(PSG),underwent adenoid tonsillectomy,and completed follow-up 6 months after surgery.There were 45 males(72.6%)and 17 females(27.4%).The age range was 2.0-12.3 years.All children completed the clinical data collection,PSG,OSA-18 quality of life questionnaire and Children′s Sleep questionnaire-sleep related breathing disorder subscale at baseline.PSG and OSA-18 quality of life questionnaire were reexamined at 6 months after surgery.Children were divided into REM-OSA group(33 cases)and non-REM-OSA group(29 cases)according to whether the obstructive apnea-hypopnea index(OAHI)during rapid eye movement sleep and OAHI during non-rapid eye movement sleep ratio was≥2.Baseline PSG parameters and scale scores,6-month postoperative cure rate and OSA-18 quality of life questionnaire scores of the 2 groups were compared,and statistical analysis was performed using SPSS 23.0 software.Results There were no significant differences in age,sex,body mass index,neck circumference/height ratio,overweight or obesity,history of disease,tonsil and adenoid size between the two groups(all P>0.05).Compared with non-REM-OSA group,REM-OSA group had higher oxygen desaturation index and proportion of SpO_(2)<90%of total sleep time(Z=-2.723,P=0.006;Z=-3.414;P=0.001 respectively),and lower SpO_(2) nadir(Z=-3.957,P<0.001).The proportion of obstructive apnea in total respiratory events(related to anatomical factors)in REM-OSA group was higher than that in non-REM-OSA group(t=2.840,P=0.006).However,the proportion of central apnea in total respiratory events and arousal index(related to functional factors)in REM-OSA group w

关 键 词：阻塞性睡眠呼吸暂停 儿童 REM相关OSA 腺样体扁桃体切除术 

分 类 号：R766[医药卫生—耳鼻咽喉科]