阻塞性睡眠呼吸暂停低通气综合征患儿临床特征分析

Analysis of Clinical Features in Children with Obstructive Sleep Apnea-hypopnea Syndrome

目的探讨不同程度儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床特征。方法选择经多导睡眠监测(PSG)确诊的157例OSAHS患儿,据PSG结果,分为轻、中、重度3组,对其临床症状、PSG结果、上气道影像结构进行分析。结果轻度94例,中度38例,重度25例。夜间打鼾、张口呼吸、喉头哽咽、睡眠不安三组发生率无显著性差异(P>0.05),呼吸暂停发生率以重度组最高(P<0.05)。REM期、Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期睡眠时间百分比三组无显著性差异(P>0.05);呼吸暂停总次数三组有显著性差异,重度组最多(P<0.01);最长呼吸暂停时间轻度组与中度组无显著性差异,重度组比其他两组明显延长(P<0.05);低通气次数三组比较有显著性差异(P<0.05),重度组最多;最长低通气时间三组有显著性差异(P<0.05),重度组最长;鼾声事件次数中度组与重度组比较无显著性差异(P>0.05),两者与轻度组相比明显增加(P<0.01)。呼吸紊乱指数AHI、氧减指数OD I三组比较有显著性差异(P<0.01),重度组最高;三组俯卧位、右侧位睡眠时间百分比有显著性差异(P<0.05),重度组多采取俯卧位及右侧卧位睡眠。三组腺样体、扁桃体肥大程度和发生率无显著性差异(P>0.05),腺样体咽腔比值A/N有显著性差异,重度组最大(P<0.01)。结论不同程度OSAHS患儿临床表现、睡眠呼吸事件、睡眠体位有不同特点,腺样体、扁桃体肥大程度不能判断病情严重程度,气道绝对狭窄是OSAHS病情轻重的关键,PSG结合影像能更好地评估OSAHS病情的严重程度。

Objective To explore clinical features of different degrees obstructive sleep apnea-hypopnea syndrome（OSAHS） in children.Methods 157 cases diagnosed OSAHS by polysomnography（PSG） were divided into three groups which were mild,moderate and severe group.The clinical symptoms,PSG reports and the structure of the upper airway image of them were analyzed.Results There were 94 cases in mild group,38 cases in moderate group and 25 cases in severe group.There was no significant difference in the incidence of night-time snoring,mouth breathing,throat choking,sleep disturbed among the three groups（P0.05）.The severe group had the highest incidence of apnea（P0.05）.There was no significant difference in the proportion of sleep time of REM period,I phase,II phase,III phase and IV phase between the three groups.（P0.05）.The difference in total number of apnea among the three groups was significant（P0.05）.The severe group had the highest total number of apnea（P0.01）.There was no significant difference in longest apnea time between the mild group and the moderate group（P0.05）.The longest apnea time of severe group was prolonged significantly compared with the other two groups（P0.05）.There was significantly different in hypopnea among three groups（P0.05）,and the severe group had the highest total number of hypopnea.There was significantly different in the longest hypopnea among three groups（P0.05）,and the severe group had the highest the longest hypopnea.There was no significant difference in snoring frequency between moderate group and severe group（P0.05）,and snoring in both groups was significantly increased compared with mild group（P0.01）.There was significantly different in AHI and ODI among the three groups（P0.01）,and the severe group had the highest AHI and ODI.There was a significant difference in prone position and the right of supine sleep time（P0.05）.The severe group took a more prone and right position of sleep.There was no significant difference in the incidence of adenoids hypertrophy and tonsil hypertrophy（P0.05）,but there was significant in the pharyngeal adenoids ratio A/N among the three groups,and the severe group had the largest ratio of A/N（P0.01）.Conclusion There were different characteristics in clinical performance,sleep apnea events,sleep position of OSAHS children of varying degrees.The degree of adenoids hypertrophy and tonsils hypertrophy could not determine the severity of the disease.The degree of airway stenosis caused by adenoidal hypertrophy was the key to OSAHS severity.Polysomnography combined with imaging could evaluation the severity of OSAHS more accurately.