学龄前和学龄期阻塞性睡眠呼吸暂停低通气综合征患儿呼吸事件特点及影响因素分析

Characteristics of respiratory events and related factors in preschool-and school-aged children with obstructive sleep apnea hypopnea syndrome

摘要:

目的 探讨学龄前和学龄期阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿睡眠呼吸事件特点及相关影响因素。方法 统计2018年1月1日—2018年12月31日因打鼾、张口呼吸在首都医科大学附属北京儿童医院就诊，年龄3~14岁，并在睡眠中心行多导睡眠监测（PSG）确诊为OSAHS儿童。按年龄分为学龄前（3~5岁）和学龄期（6~14岁）两组。分析比较两组间体质指数（BMI）、呼吸暂停低通气指数（AHI）、阻塞型呼吸暂停指数（OAI）、阻塞型呼吸暂停低通气指数（OAHI）、中枢型呼吸暂停指数（CAI）、氧减指数（ODI）、平均血氧饱和度、最低血氧饱和度。结果 654例患儿确诊为OSAHS，其中学龄前组374例，学龄期组280例。学龄期组的CAI、平均血氧饱和度低于学龄前，CAI中位数分别为1.2、1.4次/h，平均血氧饱和度分别为97%、98%。学龄期组的BMI、AHI、OAHI、ODI均高于学龄前组，BMI中位数分别为18.6、15.1kg/m²，AHI分别为11.7、9.6次/h，OAHI分别为9.6、8.0次/h，ODI分别为8.2、6.0次/h。两组间BMI、AHI、OAHI、CAI、ODI、平均血氧饱和度比较，差异具有统计学意义（P均<0.05）。两组间性别、OAI、最低血氧饱和度比较，差异无统计学意义（P均>0.05）。各类型呼吸事件比例比较，学龄期组的中枢型呼吸暂停（CA）、混合型呼吸暂停（MA）占比均低于学龄前，CA占比中位数分别为8.4%、12.7%，MA占比分别为1.5%、2.3%。两组间CA、MA所占呼吸事件比例比较，差异有统计学意义（P均<0.05）。阻塞型呼吸暂停（OA）、低通气（H）所占呼吸事件比例比较，差异无统计学意义（P均>0.05）。完成专科查体的550例OSAHS患儿行多元线性回归分析，AHI与BMI独立相关（r=1.318，P<0.01），与年龄、性别、腺样体及扁桃体分度不相关。结论 在OSAHS患儿中，学龄期儿童呼吸事件发生频率高于学龄前期，最多见的呼吸事件是低通气。年龄越小合并发生中枢型呼吸暂停比例越高。腺样体和（或）扁桃体肥大的OSAHS患儿中，肥胖是影响AHI严重程度的重要因素。

Abstract:

Objective To explore the characteristics and related factors of respiratory events in preschool- and school-aged children with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods The study was conducted in Beijing Children's Hospital, Capital Medical University from January 1st to December 31st 2018. Children aged 3~14 yrs old with history of snoring and mouth breathing who underwent polysomnography (PSG) in sleep center and diagnosed as OSAHS were recruited. The clinical and PSG data were collected and analysed. All children were divided into preschool-aged (3~5 yrs) and school-aged group (6~14 yrs). The parameters including body mass index (BMI), apnea hypopnea index (AHI), obstructive apnea index (OAI), obstructive apnea hypopnea index (OAHI), central apnea index (CAI), oxygen desaturation index (ODI), average and minimum blood oxygen saturation were compared between the two groups. Results A total of 654 children were diagnosed as OSAHS including 374 in preschool-aged group and 280 in school-aged group respectively. Both CAI and average blood oxygen saturation in the school-aged group were lower than those in the preschool-aged group. The medians of CAI and average blood oxygen were 1.2 events/h and 1.4 events/h, 97% and 98% in the school-aged and preschool-aged group respectively. The parameters of BMI, AHI, OAHI and ODI in the school-aged group were higher than those in the preschool-aged group. The medians of BMI, AHI, OAHI and ODI were 18.6 kg/m² and 15.1 kg/m², 11.7 events/h and 9.6 events/h, 9.6 events/h and 8.0 events/h, 8.2 events/h and 6.0 events/h in the school-aged and preschool-aged groups respectively. The differences in BMI, AHI, OAHI, CAI, ODI, and mean oxygen saturation between the two groups were all statistically significant (all P<0.05). There were no statistical significances in gender, OAI or minimum blood oxygen saturation between the two groups (all P>0.05). In terms of the comparison for proportions of various respiratory events types, the fractions of CA and MA in the school-aged group were lower than those in the preschool-aged group. The medians of CA and MA fraction were 8.4% and 12.7%, 1.5% and 2.3% in the school-aged and in preschool-aged groups respectively. The differences were statistically significant in fractions of CA and MA (both P<0.05),but insignificant in fractions of OA and H (both P>0.05) between the two groups. Multiple linear regression analyses performed in 550 children with OSAHS who completed the specialized physical examination revealed that BMI was independently related to AHI (r=1.318, P<0.01), and there were no correlations between AHI and age, gender or the degree of adenoid and tonsil. Conclusions In children with OSAHS, obesity is an important factor affecting AHI parameter. There are no correlations between AHI and age, gender or adenotonsil hypertrophy. The frequency of respiratory events in school-aged children is greater than that in preschool-aged children. The most common type of respiratory event is hypopnea. The fraction of central apnea decreases with the increase of age.