阻塞性睡眠呼吸暂停综合征患儿的血管内皮细胞功能研究

Endothelial dysfunction in children with obstructive sleep apnea syndrome

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)患儿血管内皮细胞功能状态及影响血管内皮细胞功能的相关因素。方法横断面研究。纳入自2015年6月1日至2016年3月1日在北京儿童医院耳鼻咽喉头颈外科就诊,年龄3~11岁的习惯性打鼾患儿355例(男245例、女110例)为研究对象。对研究对象行整夜多导睡眠监测,同时完成血管内皮细胞功能检测。根据阻塞性睡眠呼吸暂停低通气指数(OAHI)将研究对象分为原发鼾症组(107例)及OSAS组(248例),通过t检验或秩和检验比较两组儿童在睡眠检查结果等的差异,采用单因素和多因素相关分析探索影响血管内皮细胞功能的相关因素。结果355例患儿纳入研究,其中OSAS组和原发鼾症组在年龄、性别、体质指数Z值上差异无统计学意义(P均>0.05)。OSAS组OAHI、氧减指数和呼吸相关觉醒指数明显高于原发鼾症组[5.2(2.2,13.2)比0.4(0.1,0.7),4.1(2.0,13.1)比0.5(0.1,1.0),2.5(1.0,4.8)比0.4(0.1,0.9),Z=-14.957、-11.790、-10.378,P均<0.01],最低血氧饱和度及反应性充血指数(RHI)明显低于原发鼾症组[0.89(0.85,0.92)比0.94(0.91,0.95),1.2±0.2比1.1±0.1,Z=-9.337,t=5.354,P均<0.01]。单因素线性回归分析显示,RHI与年龄(参数估计值=0.017,P<0.01)、性别(参数估计值=0.065,P<0.01)、OAHI(参数估计值=-0.023,P<0.01)、氧减指数(参数估计值=-0.019,P<0.01)、呼吸相关觉醒指数(参数估计值=-0.031,P<0.01)及最低血氧饱和度(参数估计值=0.067,P=0.045)呈线性相关,与体质指数Z值呈二次项关系。多因素线性回归分析显示,年龄(参数估计值=0.015,P<0.01)、体质指数Z值(参数估计值=0.040,P<0.01)、体质指数Z值二次项形式(参数估计值=-0.010,P<0.01)、呼吸相关觉醒指数(参数估计值=-0.020,P<0.01)和RHI独立相关。结论OSAS组血管内皮细胞功能明显低于原发鼾症组,夜间阻塞性呼吸事件相关的频繁觉醒可能是导致OSAS患儿血管内皮细胞功能障碍的危险因素。

Objective To evaluate the endothelial function in obstructive sleep apnea syndrome(OSAS)children and to identify related factors of endothelial dysfunction.Methods This was a cross-sectional study.Children with habitual snoring(snoring≥3 nights per week)admitted to the ward of otolaryngology,head and neck surgery,Beijing Children′s Hospital were recruited to this study between 1st June 2015 and 1st March 2016.All children aged 3 to 11 years and of them 245 were boys and 110 were girls.All subjects underwent an overnight polysomnography(PSG),as well as endothelial function testing.All subjects were grouped into primary snoring(PS)and OSAS group according to the obstructive apnea hypopnea index(OAHI).T test or Wilcoxon test were used to compare the differences in PSG results between the two groups,and univariate and multivariate correlation analyses were used to explore the relevant factors affecting the endothelial function.Results A total of 355 subjects were enrolled and 248 had OSAS,and 107 had PS.There were no significant differences in age,gender and body mass index(BMI)Z-score between the two groups(all P>0.05).OSAS group had higher OAHI,oxgen desaturation index and respiratory related arousal index(5.2(2.2,13.2)vs.0.4(0.1,0.7),4.1(2.0,13.1)vs.0.5(0.1,1.0),2.5(1.0,4.8)vs.0.4(0.1,0.9),Z=-14.957,-11.790,-10.378,all P<0.01),and lower minimum oxygen saturation and reactive hyperemia index(RHI)than those of PS(0.89(0.85,0.92)vs.0.94(0.91,0.95),1.2±0.2 vs.1.1±0.1,Z=-9.337,t=5.354,P<0.01).Univariate regression analysis showed that RHI was linearly correlated with age(parameter estimate=0.017,P<0.01),gender(parameter estimate=0.065,P<0.01),OAHI(parameter estimate=-0.023,P<0.01),oxygen desaturation index(parameter estimate=-0.019,P<0.01),respiratory related arousal index(parameter estimate=-0.031,P<0.01),and oxygen saturation nadir(parameter estimate=0.067,P=0.045).The relationship between BMI Z-score and RHI was quadratic.Multivariate regression analysis showed that age(parameter estimate=0.015,P<0.01),BMI Z-score(parameter estimate=0.040,P<0.01),BMI Z-score quadratic form(parameter estimate=-0.010,P<0.01),respiratory related arousal index(parameter estimate=-0.020,P<0.01)were independently correlated with RHI.Conclusions Children with OSAS have significant endothelial dysfunction compared with PS.Frequent arousals due to obstructive respiratory events during sleep may be a candidate risk factor for endothelial dysfunction in children with OSAS.