儿童阻塞性睡眠呼吸暂停低通气综合征危险因素的病例对照研究

Risk factors associated with obstructive sleep apnea-hypopnea syndrome in children: a retrospective case-control study

目的研究儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的潜在危险因素及其因素之间的协同作用。方法因打鼾、呼吸音粗、张口呼吸等就诊福建省福州儿童医院耳鼻咽喉科行多导睡眠(PSG)监测的患儿纳入研究对象。经过PSG监测确诊为OSAHS的321例临床病例资料完整的患儿为病例组(OSAHS组)。采用年龄和性别匹配的方法,纳入经过PSG监测排除OSAHS的321例临床资料完整的儿童作为对照组。收集这两组患儿口咽部检查和电子鼻咽喉镜等检查结果的临床病例资料进行回顾性分析。结果多因素回归分析显示,伴有鼻窦炎的患儿OSAHS发生率较无鼻窦炎时高3.229 78倍(P<0.001);与Ⅰ度扁桃体比较,Ⅱ度扁桃体发生儿童OSAHS的OR为1.596 58(P=0.032 2),Ⅲ度和Ⅳ度扁桃体发生儿童OSAHS的OR分别为2.306 52(P=0.000 8)和4.430 85(P<0.001)。与Ⅰ度腺样体比较,Ⅱ度腺样体发生儿童OSAHS的OR为1.804 33(P=0.005 1),Ⅲ度和Ⅳ度腺样体发生儿童OSAHS的OR分别为2.883 38(P<0.001)和3.220 91(P=0.000 2)。分层分析显示,伴有鼻窦炎的患者中随着腺样体肥大程度的递增,OSAHS的发病危险增加的趋势高于不伴有鼻窦炎的患者(P=0.004 1)。结论儿童阻塞性睡眠呼吸暂停低通气综合征是多因素共同作用的结果,其中腺样体肥大、扁桃体肥大、鼻窦炎是儿童OSAHS的独立危险因素。鼻窦炎可以与肥大的腺样体产生协同作用,共同增加OSAHS的发病风险。

Objective The aim of this study was to investigate the potential risk factors for pediatric obstructive sleep apnea-hypopnea syndrome（ OSAHS） and their possible synergistic effects. Methods Three hundred and twenty-one children with OSAHS diagnosed by polysomnography and a control group comprising 321 children matched for age and sex but without obstruction of the upper respiratory tract were enrolled between January 2016 and January 2017. The data from cases and controls were analyzed retrospectively.Results Multivariate logistic regression analysis showed that adenoid hypertrophy,tonsil hypertrophy,and chronic sinusitis were independent risk factors for pediatric OSAHS（ P0.05）. The incidence of pediatric OSAHS was 3.229 78 times higher when chronic sinusitis was present than when it was not（ P0.001）. When compared with grade Ⅰ tonsils,the ORs for grade Ⅱ,grade Ⅲ,and grade Ⅳ tonsils were 1.596 58（ P= 0.032 2）,2.306 52（ P= 0.000 8）,and 4.430 85（ P0.001）,respectively. When compared with grade Ⅰ adenoids,the ORs for grade Ⅱ,grade Ⅲ,and grade Ⅳ adenoids were 1.804 33（ P= 0.005 1）,2.883 38（ P0.001）,and 3.220 91（ P = 0.000 2）,respectively. Stratification analysis showed that the degree of adenoid hypertrophy was greater in patients with chronic sinusitis and was associated with a gradual increase in risk of OSAHS（ P= 0.004 1）. Conclusion The causes of obstructive sleep apnea syndrome in children are multifactorial. Adenoid hypertrophy,tonsil hypertrophy,and chronic sinusitis may be potential risk factors for pediatric OSAHS. Chronic sinusitis could act synergistically with hypertrophic adenoids toincrease the risk of OSAHS.