鼾症儿童多导睡眠监测的临床分析

Clinical analyses of polysomnogram in snoring children

目的通过分析113例鼾症患儿的多导睡眠监测（PSG）结果，对单纯打鼾（PS）患儿以及轻、中、重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿的睡眠结构、心率情况以及脑电觉醒指数（ArI）等方面进行比较，综合分析其各自的特征。方法回顾性分析2010年1月至2012年3月因睡眠呼吸紊乱症状在首都儿科研究所附属儿童医院耳鼻喉科门诊就诊并在睡眠中心进行PSG检查的113例患儿。对患儿进行PSG，所得数据经正态性检验后分别采用F检验和非参数检验进行统计。结果（1）各组在年龄、睡眠时间、睡眠效率等方面差异均无统计学意义（均P〉0．05）。（2）睡眠结构方面，4组患儿的I期睡眠所占百分比分别为PS组2．6％±1．4％、OSAHS轻度组5．4％±3．2％、中度组4．7％±1．9％、重度组8．9％±4．O％，差异有统计学意义（F=6．542，P=0．000）；各组的Ⅳ睡眠所占百分比分别为25．3％±5．6％、32．4％±11．1％、30．6％±9．0％、21．4％±10．8％，差异有统计学意义（F=7．544，P=0．000）；各组患儿快动眼睡眠（REM）期睡眠所占百分比分别为21．1％±8．6％、13．9％±4．0％、14．5％±4．9％、12．3％±6．9％，差异有统计学意义（F=11．204，P=0．000），而Ⅱ、Ⅲ期睡眠所占百分比差异均无统计学意义（均P〉0．05）。（3）各组患儿REM期的平均心率分别为（85±11）、（904-14）、（954-10）、（101±18）次／min，差异有统计学意义（F=6．452，P=0．000），各组患儿非快动眼睡眠（NREM）期的平均心率分别为（79±10）、（84±14）、（86±7）、（93±16）次／min，差异有统计学意义（F=5．369，P=0．002）。（4）各组自发性脑电觉醒的总次数、在REM发生次数、在NREM发生次数，差异均有统计学意义（F=56．379、60．781、44．061，均P=0．000）。呼吸相关性脑电觉醒的总次数、在REM发生次数、在NREM发生次数，差异均有统计学意义（F=79．250、36．137、65．239，均P=0．000）。结论儿童OSAHS发展到中、重度对心率的影响更明显。OSAHS患儿与Ps患儿比较自发性脑电觉醒减少而呼吸相关的脑电觉醒增多，但OSAHS患儿其自发性脑电觉醒无论是在NREM期还是REM期并未随着OSAHS程度加重而继续减少，与呼吸相关的脑电觉醒是判断儿童OSAHS严重程度的客观指标。

Objective To analyze the characteristics of sleep structure, heart rate and arousal index （ArI） in children with primary snoring （PS） and mild, moderate or severe obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods A total of 113 children with sleep disorders were enrolled from January 2010 to March 2012 at Affiliated Children~ Hospital, Capital Institute of Pediatrics. All of them underwent polysomnogram （PSG） and the data were analyzed statistically by SPSS 19.0. Results （ 1 ） No statistical difference existed in age, sleeping time or sleeping efficacy between PS and all OSAHS groups （all P 〉 0.05）. （2） The proportion of stage I sleeping was 2.6% _± 1.4% in PS group, 5.4% ±3.2% in mild OSAHS group, 4. 7% ± 1.9% in moderate OSAHS group and 8.9% ± 4. 0% in severe OSAHS group （ F=6.542, P =0.000）. The proportion of stage IV sleeping was 25.3% ±5.6% in PS group, 32.4% ±11.1% in mild OSAHS group, 30.6% ±9.0% in moderate OSAHS group and 21.4% ± 10. 8% in severe OSAHS group （ F = 7. 544, P = 0. 000 ）. The proportion of stage rapid eye movement （REM） sleeping was 21.1% ±8. 6% in PS group, 13.9% ±4. 0% in mild OSAHS group,14. 5% ±4. 9% in moderate OSAHS group and 12. 3% ± 6. 9% in severe OSAHS group （F = 11. 204, P = 0. 000）. The proportion of stage I and I sleeping had no statistical difference among four groups. （3） The average heart rate in stage REM sleeping of four groups was （85 ± 11）, （90 ± 14）, （95 ± 10） and （101 ±- 18） beats per minute（F = 6. 452, P = 0. 000） and （79 ± 10）, （84 ± 14）, （86 ± 7 ） and （93 ± 16） beats per minute in stage NREM sleeping（F = 5. 369, P = 0. 002）. （4） In four groups, the difference of total count of spontaneous arousal, the spontaneous arousal count in stage REM and non-rapid eye movement （NREM） sleeping were all statistically significant （ F = 56. 379, 60. 781, 44. 061, all P = 0. 000）. And the difference of total count of respiratory arousal, the median of respiratory arousal count in stage REM and NREM sleeping were all statistically significant （ F = 79. 250, 36. 137, 65. 239, all P = 0. 000）. Conclusions Heart rate is affected more obviously in moderate-severe OSAHS children. As compared with PS counterparts, OSAHS children had a reduction of spontaneous arousal and an increase of respiratory arousal. But the occurrence of spontaneous arousal of OSAHS children does not decrease with the progress of OSAHS in either stage REM or stage NREM.