体重正常的阻塞性睡眠呼吸暂停低通气综合征患儿体脂含量与睡眠参数相关性研究

摘要

Objective To investigate the effect of obstructive sleep apnea hypopnea syndrome( OSAHS ) on the body fat volume of the normal-weight children,to provide the basis for early screening and actively intervention to the obese children. Methods Consecutive OSAHS children( ages 3-7 years ) were recruited from Shanghai Children 's Medical Center as the case group,and non-OSAHS children and non-snoring healthy children as the control group. Both of the 2 groups underwent the overnight polysomnography( PSG)and assay to test the composition of the body. The case group was divided into 2 subgroups according to the apnea hypopnea index( AHI):mild OSAHS subgroup( AHI 5-10 times per hour )and moderate-severe OSAHS subgroup( AHI≥10 times per hour). The relation was analyzed between the sleep architectures,sleep arousal parameters and the body composition of the body of the three subgroups of the case group and the control group. The relation between sleep architecture,arousal parameters and the body composition of the body was studied by multiple linear regression analysis. Results There were 58 cases recruited into the case group. Mild OSAHS subgroup include 28 cases with mild OSAHS and 30 cases with moderate-severe OSAHS,and 63 cases for the control group. Age,gender and BMI Z-score were not significantly different among 4 subgroups(P>0. 05). ① There was significant difference in AHI,obstructive apnea index(OAI),nadir SpO2 and respiratory arousal index( RAI),spontaneous arousal index( SAI),sleep pressure score( SPS)in the 4 subgroups. The AHI, OAI,nadir SpO2 ,RAI and SPS of mild and moderate-severe OSAHS subgroup were siginificantly higher than those in primary snoring subgroup and healthy children subgroup. ②There was no statistically difference in fat free mass,protein,skeletal muscle, resting metabolic rate,visceral fat area,arm circumference and waist hip ratio among the 4 subgroups. Body fat volume and the percentage of body fat were different among the 4 subgroups,with the highest levels in the moderate-severe group. ③The multiple linear regression analysis indicated that a positive correlation between the body fat volume and the SPS(r=0. 641),however it was not correlated with AHI,OAI or nadir SpO2 . Conclusion OSAHS maybe associated with the increased body fat volume in the normal-weight children,and it appears to correlate with the sleep fragmentation,but not with the intermittent hypopnea. Introducing SPS interpretation in PSG scoring of normal body weight OSAHS children is helpful in order to make early intervention to prevent the concurrency of obesity.%目的：分析体重正常的阻塞性睡眠呼吸暂停低通气综合征（ OSAHS）患儿体脂肪含量的影响因素，为OSAHS患儿肥胖的早期筛查及干预提供依据。方法从2012年1月至2013年12月在上海儿童医学中心门诊就诊的鼾症患儿和社区招募的健康儿童且行PSG监测者中选取：体重正常、行人体成分检测、年龄3~7岁儿童。分为病例组（ OSAHS轻度亚组、中重度亚组）和对照组（原发性鼾症亚组、健康儿童亚组），分析睡眠参数与人体成分的差异，以多元线性回归分析人体成分与睡眠结构和觉醒参数的相关性。结果病例组纳入58例，其中OSAHS中重度亚组30例，OSAHS轻度亚组28例；对照组63例，其中原发性鼾症亚组33例，健康儿童亚组30例。4个亚组间年龄、性别和BMI Z评分差异无统计学意义（P＞0.05）。①4个亚组在呼吸暂停低通气指数（AHI）、阻塞性呼吸暂停指数（OAI）、最低氧饱和度及呼吸相关脑电觉醒反应指数（RAI）、自发脑电觉醒反应指数（SAI）、睡眠压力指数（SPS）差异总体上有统计学意义（P＜0.05），亚组间两两比较显示，AHI、OAI、最低氧饱和度、RAI和SPS OSAHS轻度、OSAHS中重度亚组高于原发性鼾症亚组和健康儿童亚组（ P＜0.05）。②4个亚组间去脂体重、蛋白质、骨骼肌、静息代谢率、内脏脂肪面积、上臂围和腰臀比差异总体上无统计学意义，体脂肪含量和体脂肪百分比差异有统计学意义，其中OSAHS中重度亚组最高。③多元线性回归分析显示，体脂肪含量与SPS呈正相关（ r=0.641），与AHI、OAI、最低氧饱和度无显著相关性。结论 OSAHS可能与正常体重儿童的体脂肪含量增加相关，引起体脂肪含量增加的主要相关因素可能是睡眠片段化而非间歇性缺氧。