肥胖儿童睡眠呼吸障碍与肥胖相关性调查研究

Sleep-disordered breathing in obese children

目的了解肥胖儿童中阻塞性睡眠呼吸暂停/低通气综合征(OSAHS)和睡眠低通气的发病情况,并探讨肥胖与儿童OSAHS的相关性。方法对2006年4月至2007年12月在北京儿童医院就诊,年龄大于7岁的肥胖儿童行问卷调查、体格检查、血常规及动脉血气分析,拍摄鼻咽侧位X线平片并进行整夜多导睡眠监测(PSG)。以体重正常的儿童作为对照组。结果 203例肥胖患儿及171例体重正常的对照儿童纳入研究。肥胖但腺样体、扁桃体不大的患儿中,OSAHS占50.8%(31/61),肥胖同时伴有腺样体、扁桃体大(ATH)的患儿中,OSAHS占81.5%(116/142)。肥胖和对照组间睡眠效率、呼吸暂停/低通气指数(AHI)、最低血氧饱和度差异有统计学意义(P值分别为0.018、<0.01、<0.01)。肥胖、扁桃体大、腺样体大是OSAHS发病的危险因素(肥胖:OR=20.4,P<0.01;扁桃体大:OR=2.1,P=0.03;腺样体大:OR=4.7,P<0.01)。肥胖的程度和AHI呈正相关(r=0.383,P<0.01),而与最低血氧饱和度呈负相关(r=-0.312,P<0.01)。结论肥胖是导致儿童OSAHS发病的危险因素,肥胖程度和睡眠呼吸障碍的严重程度相关。

Objective To determine the prevalence of sleep disordered breathing in obese children,and to study the relationship between obesity and obstructive sleep apnea/hypopnea syndrome （OSAHS）.Methods Children with obesity were included into the study consecutively.Normal weight controls were recruited as well.Questionnaires and physical examination were carried out,standard lateral neck roentgengraphy,full blood count and polysomnography （PSG）,including end tidal CO2 （ETCO2） were performed.Results Totally 203 obese children and 171 normal weight controls were recruited.A significantly higher AHI,lower sleep efficiency and MinSaO2 were found in obese patients than their normal weight controls （P 0.01,P = 0.018 and P 0.01 respectively）.Among children who were obese and didn’t have adenotonsillar hypertrophy,50.8% （31/61） subjects had abnormal polysomnograms.Among children who were obese and had ATH,81.5% （116/142） were diagnosed as having OSAHS.Obesity,tonsillar hypertrophy,and adenoid hypertrophy were independent risk factors for OSAHS （obesity：OR = 20.4,P 0.01;adenotonsillar hypertrophy：OR = 2.1,P = 0.03;adenoid hypertrophy：OR = 4.7,P 0.01）.There was a positive correlation between the degree of obesity and the apnea/hypopnea index（r = 0.383,P 0.01）,and an inverse correlation between the degree of obesity and the MinSaO2（r = -0.312,P 0.01）.Conclusion Obese children have a higher risk for OSAHS,and the severity of obesity was positively related to the severity of OSAHS.