睡眠呼吸障碍儿童总脑电醒觉反应指数的临床研究

Study of total arousal index in children with sleep disordered breathing

目的探讨影响睡眠呼吸障碍(sleep disordered breathing,SDB)患儿总脑电醒觉反应指数(arousal index,ArI)的因素。方法2018年3月~2019年3月因疑似阻塞性睡眠呼吸暂停低通气综合征(OSAHS)而进行多道睡眠监测的75例患儿作为研究对象,OSAHS的诊断标准采用《儿童阻塞性睡眠呼吸暂停低通气综合征诊疗指南草案(乌鲁木齐)》,呼吸暂停低通气指数(AHI)≤5次/h且阻塞性呼吸暂停指数(obstructive apnea index,OAI)≤1次/h,最低血氧饱和度(LSaO2)≥0.92的患儿纳入对照组,两组之间进行总ArI及分类ArI的比较;75例患儿再根据总ArI 11次/h为界分为两组,两组之间进行睡眠结构、总ArI、分类ArI以及AHI、OAI、阻塞性低通气指数和LSaO2的比较。结果OSAHS组和对照组之间总ArI的差异无显著性(z=-0.096,P=0.923)。"ArI>11"组较"ArI≤11"组自发性ArI和肢体运动相关性ArI显著升高(z值分别为-5.967和-4.025,P=0.000)。结论自发性ArI和肢体运动相关性ArI是造成总ArI升高的主要原因,总ArI的高低和目前反应SDB病情程度的一些参数之间关系不大。

OBJECTIVE To explore the factors influencing the total arousal index(ArI)in children with sleep disordered breathing(SDB).METHODS Between March 2018 and March 2019,75 children suspected of OSAHS underwent overnight polysomnogram monitoring in our medicine sleep center.OSAHS was diagnosed according to the general criterion(Urumqi).Seventy-five children were divided into two groups,32 children who were diagnosed as OSAHS were enrolled in OSAHS group and 43 children made up control group(AHI≤5 events/h and OAI≤1 events/h,LSaO2≥0.92).The difference of total ArI and respiratory ArI,spontaneous ArI,limb movement ArI was compared between the two groups.Besides this,75 children were divided into two groups according to total ArI(>11 events/h vs≤11 events/h).AHI,OAI,OHI,LSaO2,respiratory ArI,spontaneous ArI,limb movement ArI and sleep structure were compared between the two groups.RESULTS1.The difference of total ArI between the OSAHS group and control group was not significant(z=-0.096,P=0.923).2.The increased spontaneous ArI and limb movement ArI was significant in">11 events/h"group(z=-5.967 and-4.025,respectively,P value all=0.000).CONCLUSIONSpontaneous ArI and limb movement ArI were the factors that increase the total ArI,total ArI may be independent of SDB-related indexes(AHI,LSaO2 et al).