中重度阻塞性睡眠呼吸暂停低通气综合征患儿二氧化碳的监测与分析

Carbon dioxide monitoring in children with moderate and severe obstructive sleep apnea hypopnea syndrome

目的探讨中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿睡眠期CO_(2)波动趋势特点,分析其变化与多导睡眠监测(PSG)指标的相关性。方法选取经PSG同时联合经皮二氧化碳分压(TcpCO_(2))监测确诊的中重度OSAHS患儿21例(OSAHS组),同期选取健康体检儿童25例作为对照组。比较两组儿童的一般情况、呼吸事件及睡眠期TcpCO_(2)趋势的特点,并将TcpCO_(2)平均值及最高值与各变量进行相关性分析。结果OSAHS组患儿与对照组的体重指数(BMI)分别为(27.9±6.8)、(16.8±2.9)kg/m^(2);呼吸暂停低通气指数(AHI)分别为(21.6±17.2)、(1.3±1.0)次/h;阻塞型呼吸暂停指数(OAI)中位数分别为1.1、0.0次/h;阻塞型呼吸暂停低通气指数(OAHI)中位数分别为19.2、0.2次/h;氧减指数(ODI)分别为(19.5±16.9)、(1.1±1.0)次/h;TcpCO_(2)平均值分别(46.8±3.8)、(44.7±2.5)mmHg;TcpCO_(2)最高值分别为(54.8±5.3)、(48.9±3.3)mmHg;非快速眼动(NREM)TcpCO_(2)分别为(47.0±3.8)、(45.1±2.4)mmHg;快速眼动(REM)TcpCO_(2)分别为(48.0±5.2)、(44.4±2.8)mmHg;OSAHS组患儿与对照组中BMI、AHI、OAI、OAHI、ODI、TcpCO_(2)平均值及最高值、NREM TcpCO_(2)、REM TcpCO_(2)均高于对照组。OSAHS组患儿与对照组的平均SaO_(2)分别为(96.5±1.2)%、(97.6±0.9)%;最低SaO_(2)分别为(82.6±8.7)%、(92.2±2.9)%。OSAHS组患儿平均SaO_(2)、最低SaO_(2)均低于对照组。两组间BMI、AHI、OAI、OAHI、ODI、平均SaO_(2)、最低SaO_(2)、TcpCO_(2)平均值及最高值、NREM TcpCO_(2)、REM TcpCO_(2)比较,差异具有统计学意义(P均<0.05)。两组间TcpCO_(2)平均值和最高值均与BMI、OAHI、ODI无相关性。结论TcpCO_(2)监测可以反映整夜CO_(2)动态变化,OSAHS患儿睡眠期CO_(2)有升高趋势,且REM睡眠CO_(2)水平较NREM睡眠亦有升高。CO_(2)水平不能根据PSG指数判断,需要进行客观检查进行评估。

Objective To explore the fluctuation trend of carbon dioxide(CO_(2))during sleep in children with moderate and severe obstructive sleep apnea hypopnea syndrome(OSAHS),and to analyze the correlation between CO_(2)and polysomnographic(PSG)indexes.Methods Twenty-one children with moderate and severe OSAHS confirmed by PSG and transcutaneous partial pressure of carbon dioxide monitoring(TcpCO_(2))(OSAHS group)and 25 healthy children(control group)were selected.The general situation,respiratory events and TcpCO_(2)trend during sleep were compared between the two groups.The correlations between variables of TcpCO_(2)and PSG were analyzed.Results There were no significant differences in gender and age between the OSAHS group and the control group.The body mass index(BMI)[(27.9±6.8)kg/m^(2)vs(16.8±2.9)kg/m^(2)],apnea hyponea index(AHI)[(21.6±17.2)times/h vs(1.3±1.0)times/h],obstructive apnea index(OAI)(1.1times/h vs 0.0 time/h),obstructive apnea hyponea index(OAHI)(19.2 times/h vs 0.2 times/h),oxygen desaturation index(ODI)[(19.5±16.9)times/h vs(1.1±1.0)times/h],the average and highest values of TcpCO_(2)[(46.8±3.8)mmHg vs(44.7±2.5)mmHg、(54.8±5.3)mmHg vs(48.9±3.3)mmHg],TcpCO_(2)in non-rapid eye movement(NREM)[(47.0±3.8)mmHg vs(45.1±2.4)mmHg]and TcpCO_(2)in rapid eye movement(REM)[(48.0±5.2)mmHg vs(44.4±2.8)mmHg]stage of OSAHS children were higher than those of the control group.The averages of oxygen saturation(SaO_(2))[(96.5±1.2)%vs(97.6±0.9)%]and lowest SaO_(2)[(82.6±8.7)%vs(92.2±2.9)%]in OSAHS children were lower than those in the control group.The differences in BMI,AHI,OAI,OAHI,ODI,average and lowest SaO_(2),average and highest TcpCO_(2),NREM TcpCO_(2)and REM TcpCO_(2)between the two groups were all statistically significant(all P<0.05).There were no correlations among the average and highest TcpCO_(2)and the BMI,OAI,ODI.Conclusions TcpCO_(2)monitoring can reflect the dynamic changes of CO_(2)in the whole night.CO_(2)in OSAHS children has a rising trend during sleep,and the level of CO_(2)in REM sleep is also higher than that in NREM sleep.CO_(2)level can not be judged according to the PSG indexes,but needs to be evaluated by objective inspection.