睡眠呼吸障碍儿童注意缺陷、多动-冲动的特征分析

Characteristics of Attention Deficit and Hyperactivity Disorder in Children with Sleep-disordered Breathing

背景睡眠呼吸障碍(SDB)儿童注意缺陷、多动-冲动的发生率较高,对其学习能力、远期智力发展危害严重,但是目前缺乏关于SDB儿童注意缺陷、多动-冲动发生情况的全面分析。目的分析SDB儿童注意缺陷、多动-冲动的特征,为制订SDB儿童的临床决策提供依据。方法选取2020年5月至2021年6月在首都医科大学附属北京儿童医院睡眠中心就诊、4~10岁、有打鼾或张口呼吸的儿童为研究对象,均完成整夜多导睡眠监测及注意缺陷、多动-冲动诊断量表父母版。根据阻塞性睡眠呼吸暂停低通气指数(OAHI)分为原发鼾症组(OAHI≤1次/h),轻度阻塞性睡眠呼吸暂停(OSA)组(1次/h<OAHI≤5次/h)及中重度OSA组(OAHI>5次/h)。比较不同严重程度儿童多导睡眠监测参数[总睡眠时间、睡眠效率、非快速眼动睡眠1期占总睡眠时间的比例(N1%)、非快速眼动睡眠2期占总睡眠时间的比例(N2%)、非快速眼动睡眠3期占总睡眠时间的比例(N3%)及快眼动睡眠占总睡眠时间的比例(R%)、OAHI、觉醒指数(ArI)、氧减指数(ODI)、平均血氧饱和度(SpO_(2))以及最低SpO_(2)],注意缺陷、多动-冲动以及注意缺陷、多动-冲动诊断量表阳性发生率;比较不同性别、不同年龄SDB儿童注意缺陷、多动-冲动及注意缺陷、多动-冲动诊断量表阳性发生率。结果原发鼾症组76例,轻度OSA组86例,中重度OSA组77例。中重度OSA组N1%、OAHI、ArI、ODI均高于原发鼾症组及轻度OSA组,平均SpO_(2)和最低SpO_(2)均低于原发鼾症组、轻度OSA组(P<0.05);中重度OSA组R%低于原发鼾症组(P<0.05);轻度OSA组OAHI、ArI、ODI均高于原发鼾症组,最低SpO_(2)低于原发鼾症组(P<0.05)。中重度OSA组注意缺陷及注意缺陷、多动-冲动诊断量表阳性发生率高于原发鼾症组(P'<0.0167)。男性儿童注意缺陷、多动-冲动发生率及注意缺陷、多动-冲动诊断量表阳性发生率均高于女性儿童(P<0.05)。学龄期儿童注意缺陷及注意缺陷、多动-冲动诊断量表阳性发生率均高于学龄前儿童(P<0.05)。结论SDB儿童注意缺陷、多动-冲动发生率高于普通人群,其中男孩注意缺陷、多动-冲动发生率均高于女孩,学龄期儿童注意缺陷发生率高于学龄前儿童。

Background Children with sleep-disordered breathing(SDB)are more prone to attention deficit,and hyperactivity disorder,which seriously impairs their learning ability and long-term intellectual development.However,there is a lack of comprehensive analysis of attention deficit,and hyperactivity disorder in SDB children.Objective To investigate the characteristics of attention deficit,and hyperactivity disorder in children with SDB,so as to provide a basis for making clinical decisions for such patients.Methods Children aged 4-10 years with snoring or mouth breathing,who were admitted to the Sleep Center,Beijing Children's Hospital,Capital Medical University from May 2020 to June 2021 were selected.Physiologic parameters during sleep were measured by polysomnography.Attention deficit and hyperactivity disorder symptoms were assessed by parent-rated attention deficit and hyperactivity disorder Symptoms Scale(PASS).The severity of obstructive sleep apnea(OSA)was classified by obstructive apnea-hypopnea index(OAHI):OAHI≤1 event/hour,1<OAHI≤5 events/hour and OAHI>5 events/hour were defined as primary snoring,mild OSA,and moderate to severe OSA,respectively.Polysomnographic parameters[total sleep time,sleep efficiency,non-rapid eye movement(NREM)sleep stage 1(N1%),stage 2(N2%),and stage 3(N3%)and REM sleep percentage of total sleep time(R%),OAHI,arousal index(ArI),oxygen desaturation index(ODI),average oxygen saturation(SpO_(2))and SpO_(2) nadir]were compared by the severity of OSA.The prevalence of attention deficit,hyperactivity disorder,and attention deficit and hyperactivity disorder diagnosed by the PASS were compared by the severity of OSA,sex and age.Results Seventy-six cases of primary snoring,86 cases of mild OSA and 77 cases of moderate to severe OSA were included.Moderate to severe OSA children had greater N1%,OAHI,ArI,and ODI,and lower average SpO_(2) and SpO_(2) nadir than other two groups(P<0.05).The R%of moderate to severe OSA group was lower than that of primary snoring group(P<0.05).OAHI,ArI and ODI were higher and SpO_(2) nadir was lower in children with mild OSA than those with primary snoring(P<0.05).The prevalence of attention deficit,and attention deficit and hyperactivity disorder diagnosed by the PASS in moderate to severe OSA group was statistically higher than that in primary snoring group(P'<0.0167).Male children had higher prevalence of attention deficit,hyperactivity disorder,and attention deficit and hyperactivity disorder diagnosed by the PASS than female children(P<0.05).Compared with preschoolers,school-age children have higher prevalence of attention deficit and attention deficit and hyperactivity disorder diagnosed by the PASS(P<0.05).Conclusion The prevalence of attention deficit and hyperactivity disorder in children with SDB was higher than that in the general population.Male children had higher prevalence of attention deficit and hyperactivity disorder than female children.And the prevalence of attention deficit in school-age children was higher than that in preschoolers.