儿童阻塞性睡眠呼吸暂停综合征多道睡眠监测诊断界值的探讨

摘要

目的 探讨更为适宜儿童的阻塞性睡眠呼吸暂停综合征(obstructive sleep apneasyndrome,OSAS)多道睡眠监测(polysomnography,PSG)诊断标准.方法 收集2014年10月至2015年9月间因打鼾到首都医科大学附属北京儿童医院睡眠中心进行PSG的儿童,以健康儿童作为对照组.所有观察对象完成PSG.根据PSG结果将观察对象分为介于符合国际睡眠疾病分类(ICSD)标准[阻塞性睡眠呼吸暂停低通气指数(obstructive apnea/hypopnea index,OAHI)≥1]和美国胸科学会(ATS)标准(AHI＞5或OAI＞1)之间、ICSD诊断原发鼾症(OAHI＜1)、ATS诊断OSAS、健康对照组共4组.比较4组间睡眠障碍量表、PSG参数的差异.结果 共1115例儿童纳入研究,4组分别纳入143、345、529、98例儿童.介于ICSD和ATS标准之间的儿童较健康儿童睡眠障碍量表总评分显著高(P＜0.01),夜间打鼾相关症状、日间行为异常相关症状、夜间睡眠伴随症状和相关疾病三个维度的评分亦明显高(P ＜0.01,＜0.01,＜0.05);介于ICSD和ATS标准之间的儿童阻塞性呼吸暂停平均持续时间、最长时间以及低通气平均持续时间、最长时间均明显长于ICSD原发鼾症组(P值均＜0.01),且其最低血氧饱和度低于原发鼾症组(P＜0.05).结论 介于ICSD和ATS诊断标准之间的打鼾儿童夜间症状明显、日间行为表现受到影响、PSG参数与OSAS相似,应将OAHI≥1作为儿童OSAS的PSG诊断界值.%Objective To determine the appropriate criteria of obstructive sleep apnea syndrome (OSAS) in children.Method Children with snoring and healthy children were recruited from October 2014 to September 2015.Subjects were divided into four groups based on polysomnography (PSG).Group 1:children with obstructive apnea hypopnea index (OAHI) ≥ 1 (the OSAS criteria of the International Classification of Sleep Disorders,ICSD) but their AHI≤5 or OAI ≤1 (under the OSAS criteria of AHI ＞ 5 or OAI ＞ 1 by the American Thoracic Society,ATS);Group 2:children with OAHI ＜ 1 (the primary snoring criteria of the ICSD);Group 3:children with AHI ＞5 or OAI ＞ 1;and Group 4:normal children as controls.Sleep disorder scales and polysomnography parameters were compared among the four groups.Results A total of 1 115 children were included.There were 143,345,529 and 98 children in each group.After adjust for age,gender and body mass index(BMI),children in group 1 had higher total sleep disorder scale score (P＜0.01),as well as sub-scores for severe snoring (P ＜ 0.01),daytime behavior problem (P ＜0.01) and sleep related nighttime abnormality (P ＜0.05) compared with normal controls,and they had longer mean and longest duration of obstructive apnea and hypopnea and lower minimum oxygen saturation compared with children with obstructive AHI ＜ 1 (all P ＜ 0.05 or ＜ 0.01).Conclusion OA-H＞ 1 should be defined as the criteria of OSAS in children.