以临床表现筛查阻塞性睡眠呼吸暂停综合征在儿科中的应用

Clinical application of the screening for children with obstructive sleep apnea according to the clinical manifestations

目的探讨以临床病史、体格检查及颈部侧位X线影像学检查筛查儿童阻塞性睡眠呼吸暂停综合征(obstructivesleepapneasyndrome,OSAS)的可行性。方法在门诊收集有打鼾症状的儿童病例,进行问卷调查、体格检查以及颈部侧位X线检查,以多导睡眠监测仪(PSG)的监测结果作为诊断标准,将患儿分成OSAS和非OSAS组,在两组患儿之间进行临床资料的比较。结果51例鼾症儿童中确诊为OSAS32例。两组患儿的年龄、性别比以及体块指数差异无显著性,而临床表现之间差异有显著性(P<0.001)。如果患儿有8条以上的临床症状、体格检查或影像学的异常,则其患有OSAS的可能性增加,敏感性74%,特异性63%。结论以病史、体格检查及颈部侧位X线检查的结果对患儿进行临床评估,以初步筛查OSAS是可行的。但还需要增加样本量,并改进临床资料的收集工作,以提高筛查的敏感性和特异性。

Objective To evaluate the feasibility of screening for obstructive sleep apnea(OSAS)in children according to clinical manifestations such as questionnaire,physical examination and lateral neck imaging of X-ray.Methods Outpatients with snoring received qestionnaire,physical examination and lat-eral neck imaging of X-ray.All patients were divided into OSAS or non-OSAS group based on the results detected with polysomnography(PSG).Clinical manifestations were compared between those two groups.Results51children with snoring were enrolled in this study with32diagnosed as OSAS.There was no significant difference between OSAS and non-OSAS groups in age and gender.But significant difference was existed between these two groups in clinical manifestations as they were expressed in scores(P<0.001).If a patient with more than8items of abnormality in medical history,physical examination and lateral neck imaging,these patients were more likely with OSAS.The sensitivity rate was74%and the specificity was63%.Conclusions It is feasible to screen for OSAS according to medical history,physical examination and lateral neck imaging of X- ray.So it is helpful to make early diagnosis and treatment for children with snoring.