临床疑似阻塞性睡眠呼吸暂停低通气综合征儿童的多道睡眠图分析

Analyses of polysomnogram in children suspected of obstructive sleep apnea hypopnea syndrome

目的通过对临床怀疑为阻塞性睡眠呼吸暂停低通气综合征(obatructive sleep apneahppopnea syndrome,OSAHS)儿童的多道睡眠图分析,探讨阻塞性呼吸暂停指数(obstructive apneaindex,OAI)、呼吸暂停低通气指数(apnea-hypopnea index,AHI)、脑电醒觉反应指数的特点。方法对61例临床怀疑为 OSAHS 的儿童行多道睡眠监测,按照广州市儿童医院耳鼻咽喉科实验室标准[简称科室标准,将口鼻气流停止、胸腹呼吸运动存在的持续任何时间长度的阻塞性呼吸暂停事件均定义为阻塞性呼吸暂停,睡眠过程中呼吸气流强度(幅度)较基础水平降低50%以上并伴有动脉血氧饱和度较基础水平下降≥0.04定义为低通气]分析其 OAI、AHI、脑电醒觉反应指数。再以乌鲁木齐草案的标准[对阻塞性呼吸暂停的时间长度定义为大于或等于2个呼吸周期,低通气为口鼻气流信号峰值降低50%,并伴有0.03以上的血氧饱和度下降和(或)觉醒]重新分析这组结果。结果①67.2%(41例)的疑似 OSAHS 儿童发生了共206次阻塞性呼吸暂停事件,88.5%(54例)的儿童发生了共2249次阻塞性低通气事件,呼吸事件主要发生在快动眼睡眠期(rapid eye movement sleep,REMsleep);②采用科室标准61例疑似 OSAHS 儿童中有68.9%(42例)的儿童 OAI<1次/h,有34.4%(21例)的儿童 AHI<5次/h;采用乌鲁木齐草案标准61例儿童中有75.4%(46例)的疑似 OSAHS 儿童 OAI<1次/h,有24.6%(15例)的儿童 AHI<5次/h;③与呼吸有关的脑电醒觉反应指数与自发性脑电醒觉反应指数之间的差异有统计学意义(z=-5.787,P=0.000),自发性脑电醒觉反应指数大于与呼吸有关的脑电醒觉反应指数。结论在儿童 OSAHS 诊断标准的制订中应考虑到低通气事件的重要性,呼吸事件判断依据的确定应建立在大规模调查的基础上,应慎重考虑脑电醒觉反应在诊断中的地位。

Objective To analyze polysomnogram characteristics of children with suspected obstructive sleep apnea hypopnea syndrome （ OSAHS ） and to explore the role of obstructive apnea index （OAI）, apnea hypopnea index（AHI） and arousal index for pediatric OSAHS diagnosis. Methods Sixty one suspected pediatric OSAHS cases had overnight polysomnography for at least 8 h in a quiet, dark room. Sleep studies were interpreted according to diagnostic criteria of Guangzhou Children＇s Hospital （ Obstructive apnea was defined as cessation of nose and mouth airflow, while the respiratory effort continues for any duration. Hypopnea was defined as reduction of oronasal flow 〉 50% accompanied by a desaturation of 0. 04 or greater. ）and Urumqi diagnostic criteria（ Obstructive apnea was defined as cessation of airflow at the nose and the mouth, while the respiratory effort continues for at least two breaths. Hypopnea was defined as reduction of oronasal flow 〉 50% accompanied by a desaturation of more than 0.03 ,or/and by an arousal. ） respectively. The OAI, AHI and arousal index were recorded and analyzed according to the two different diagnostic criteria respectively. Results ①Forty - one children （ 67.2% ） had 206 obstructive apneas. Fifty -four children （88. 5% ） had 2249 obstructive hypopneas. Apnea - hypopnea events mainly occurred during rapid eye movement sleep. ②OAI and AHI were analyzed by diagnostic criteria of Guangzhou Children＇s Hospital and Urumqi diagnostic criteria respectively. OAI 〈 1 was observed in 68.9% and 75.4% children respectively and AHI 〈 5 occurred in 34.4% and 24. 6% children respectively. ③Statistically significant difference found between spontaneous arousal index and respiratory - related arousal index （z = - 5.787, P = 0. 000）. Conclusions As the criteria of pediatric OSAHS, arbitrary OAI number should be determined on the basis of large sample investigation, the signitqcance of spontaneous arousal index still needs further investigation.