睡眠时体位对儿童阻塞性睡眠呼吸暂停低通气综合征的影响

Influence of sleep posture to children with obstructive sleep apnea hypopnea syndrome

目的评估阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿与正常儿童在睡眠时体位上的差异及体位对儿童睡眠呼吸紊乱的影响。方法比较358例经多导睡眠检测(PSG)诊断为OSAHS的儿童(OSAHS组)与161例在年龄、性别上相匹配的儿童(对照组)的PSG结果,并进一步比较睡眠时不同体位对睡眠呼吸暂停低通气指数(AHI)和暂停指数(AI)的影响。结果睡眠时OS-AHS组儿童采用仰卧位、侧卧位和俯卧位的时间占总的睡眠时间的百分比分别为45·4%±36·3%、39·5%±34·5%和15·1%±32·6%,而对照组则分别为32·8%±24·5%、54·7%±23·9%和12·5%±17·2%。OSAHS组仰卧位睡眠时间比对照组儿童明显增加(P<0·01),侧卧位的时间明显减少(P<0·01),但俯卧位的睡眠时间没有差异(P>0·05)。OSAHS组在3种不同体位睡眠时平均AHI为14·5/h,平均阻塞性AI为3·80/h。仰卧位时的AHI和AI较侧卧位和俯卧位时明显增加(P<0·01),而对照组的AHI和AI在3种睡眠体位中无明显差异。结论睡眠时,OSAHS儿童更多采用仰卧位,提示这种体位可能是促使OSAHS儿童发生上气道阻塞的原因。

Objective To find out the differences of sleep posture between normal children and those with obstructive sleep apnea hypopnea syndrome（OSAHS）,and assess the effects of sleep posture on the children with OSAHS.Methods The results of polysomnography（PSG） of 385 children diagnosed as OSAHS by polysomnography were compared with that of 161 children who matched the former in age and gender（Controls）.The effects of different sleep posture on obstructive apnea,hypopnea index（AHI） and apnea index（AI） were analyzed.Results For the children with OSAHS when sleeping,the percentages of sleep time in different posture were 45.4%＋36.3% in supine posture,39.5%＋34.5% in side posture and 15.1%＋32.6% in prone posture,respectively;while in control group,the correspond percentages were 32.8%＋24.5%,54.7%＋23.9% and 12.5%＋17.2%,respectively.Comparing the two groups,significant differences existed on the sleep time in both supine and side posture（P〈0.01）,but no significant difference existed in prone posture（P〉0.05）.Children with OSAHS spent more time in supine posture and less time in side posture than those children in control group（P〈0.01）,but no difference between them on the sleep time in prone posture（P〉0.05）.For the children with OSAHS,the average AHI and obstructive AI in three sleep-related postures were 14.5 and 3.80,respectively.The values of both AHI and AI in supine posture were significantly greater than that in side or prone posture（P〈0.01）,while no significant difference existed on the AHI and AI values when comparing the three sleep-related postures in control group.Conclusion Children with OSAHS spend more sleeping time with supine posture and less time with side posture,implying that supine posture may be easier to cause the upper airway obstructive event.