睡眠压力指数诊断轻度阻塞性睡眠呼吸暂停综合征儿童认知功能损害价值研究

Sleep pressure score in the evaluation of cognitive function impairment in children with mild obstructive sleep apnea syndrome

目的分析轻度阻塞性睡眠呼吸暂停综合征（OSAS）对儿童认知功能的影响，评价睡眠压力指数（SPS）在轻度OSAS儿童认知功能受损中的诊断价值。方法2013年1月至2014年12月，对在上海儿童医学中心就诊的鼾症儿童行多导睡眠监测（PSG），并从中选取年龄5—7岁的体重正常患儿61例，根据呼吸暂停低通气指数（Anl）分为轻度OSAS组33例和中重度OSAS组28例，分析其睡眠结构参数、睡眠觉醒参数和完成认知功能测试。以同期社区招募的31名无打鼾健康儿童作为健康对照组，进行相同检查。以ROC曲线分析SPS对轻度OSAS儿童认知功能受损的诊断作用。结果轻度、中重度OSAS组及健康对照组这3组间在年龄、性别、体重指数（BMI）Z评分和父母受教育程度方面差异无统计学意义（P〉0．05）。3组在AHI、阻塞性呼吸暂停指数（OAI）、最低氧饱和度及呼吸相关脑电觉醒反应指数（RAI）、自发脑电觉醒反应指数（SAI）、睡眠压力指数（SPS）等方面，差异有统计学意义（P〈0．05），组间两两比较显示AHI、OAI、最低氧饱和度、RAI和SPS在轻度OSAS组、中重度OSAS组高于健康对照组（P〈0．05）。3组间短时记忆的记忆保持量和正确回忆百分数差异无统计学意义（P〉0．05），综合注意力商数的差异有统计学意义（P〈0．05），其中中重度OSAS组最差，轻度OSAS组次之。ROC曲线分析显示，用SPS诊断注意力损害的ROC曲线下面积为0．88（95％可信区间0.82～0．94，P〈0．001），最佳分界值为0.11（敏感性为71．4％，特异性为74.0）。结论轻度OSAS可能造成儿童注意力的损害；SPS可能是有效的判断轻度OSAS儿童是否伴有注意力损害的指标。

Objective To investigate the effect of mild obstructive sleep apnea syndrome （OSAS） on the neurocogni- tive function of the children and evaluate the potential value of sleep pressure score （SPS） in the diagnosis of the neuro- cognitive deficits in these children. Methods Consecutive OSAS children（aged 5 - 7 years） were recruited from Shang- hai Children＇ s Medical Center as the case group, and non-snoring healthy children as the control group. Both of the 2 groups underwent the overnight polysomnograpby （PSG） and a comprehensive neuropsychologieal battery including atten- tion and memory test. The case group was divided into 2 subgroups according to the apnea hypopnea index （AHI） ： mild OSAS （AHI 1 -5 times per hour） and moderate to severe OSAS （AHI≥5 times per hour）. The sleep architectures and sleep arousal parameters were analyzed and the neuroeognitive tests were performed in the three groups. Analyze the SPS as a diagnosis tool of neurocognitive impairment in mild OSAS in children by ROC curve. Results There were 30 casesrecruited into the control group. Mild OSAS group includ- ed 33 cases and moderate to severe group 28 cases. In the 3 groups, there was no difference with regard to the age, gender, BMI z score or parents＇ education level （P 〉 0.05）. There was significant difference in AHI, ob- structive apnea index （OAI）, nadir SpO2 and respiratory arousal index （RAI）, spontaneous arousal index （SAI）,sleep pressure score （SPS） in the 3 groups. The AHI, OAI, nadir SpO2, RAI and SPS of mild and moderate to severe OSAS group were significantly higher than those in control group. There was no significant difference in retention and the percentage of recall of the immediate memory （P 〉 0.05）. There was significant difference in cognition-attention index in the 3 groups even in the mild OSAS group, and the moderate to severe OSAS group was the worst. In the ROC analy- sis, the area under the curve was 0.88 [95 % confidence interval （CI） = 0.82 to 0.94] for SPS. The cutoff point of 0.11 for SPS was optimal for diagnosing cognitive-attention deficit in mild OSAS group （sensitivity 71.4%, specificity 74%）. Conclusion Mild OSAS may be associated with the deficit of attention and SPS could be an effective index to evaluate it in mild OSAS children.