儿童支气管哮喘睡眠呼吸障碍特点分析

Characteristics of Sleep-Disordered Breathing in Children with Bronchial Asthma

目的:总结哮喘患儿睡眠呼吸障碍特点,比较哮喘患儿和非哮喘患儿的特征。方法:回顾性分析深圳市儿童医院2017年1月至2021年1月收治的30例行多导睡眠监测(PSG)的4~11岁哮喘患儿临床资料,并选取同期主诉睡眠习惯异常的39例身体质量指数(BMI)、性别及年龄相匹配的PSG示睡眠结构正常的非哮喘患儿为对照组,对所有患儿进行儿童阻塞性睡眠呼吸暂停低通气综合征(OSA)特异性生活质量调查(OSA-18)及哮喘控制水平(C-ACT)评估。结果:哮喘组与非哮喘组患儿性别、年龄及BMI比较差异无统计学意义(P>0.05)。30例哮喘患儿中,18例(60.0%)诊断为OSA(哮喘OSA组),其中打鼾15例(83.3%),监护人报告的呼吸暂停9例(50.0%)、白天嗜睡11例(61.1%)、注意力不集中11例(61.1%),均高于哮喘非OSA组(P均<0.05)。哮喘OSA组OSA-18量表、C-ACT评分均较高(P均<0.05)。哮喘组患儿OSA-18量表中打鼾25例(83.3%),夜间咳嗽气喘11例(36.7%),均高于非哮喘组(P均<0.05)。与非哮喘组比较,哮喘组深睡眠减少、浅睡眠及快速眼动(REM)期睡眠增加、呼吸紊乱指数(AHI)和氧减指数(ODI)更高、平均期血氧饱和度(SpO)更低(P均<0.05)。结论:与非哮喘患儿比较,哮喘患儿存在睡眠障碍的比例较高,以浅睡眠和REM期睡眠增加、深睡眠减少为特点,哮喘合并OSA患儿临床常出现打鼾、呼吸暂停、白天嗜睡及注意力不集中等表现,更易出现哮喘控制较差的情况。

Objective:To summarize the characteristics of sleep-disordered breathing in children with bronchial asthma,and compare the characteristics of asthmatic children and non-asthmatic children.Methods:Clinical data of 30 asthmatic children aged from 4 to 11 years who underwent polysomnography(PSG)monitoring from Jan.2017 to Jan.2021 in Shenzhen Children’s Hospital were retrospectively analyzed.And 39 non-asthmatic children with body mass index(BMI),gender and age matched PSG and normal sleep structure who complained of abnormal sleep habits during the same period were selected as the control group.All children were evaluated by the obstructive sleep apnea hypopnea syndrome(OSA)-specific quality of life survey(OSA-18)and childhood asthma control test(C-ACT).Results:There were no significant differences in gender,age and BMI between the asthmatic group and non-asthmatic group(P>0.05).Among the 30 children with asthma,18 cases(60.0%)were diagnosed with OSA(OSA group),including 15 cases(83.3%)of snoring,9 cases(50.0%)of apnea,11 cases(61.1%)of daytime sleepiness,and 11 cases(61.1%)of inattention reported by the guardians,higher than those in the non-OSA group(P<0.05).Compared with the non-OSA group,OSA-18 scale and C-ACT score were higher in the OSA group(P<0.05).There were 25 cases(83.3%)of snoring and 11 cases(36.7%)of night cough and asthma in OSA-18 scale in the asthmatic group,higher than those in non-asthmatic group(P<0.05).Compared with the non-asthmatic group,asthmatic group had decreased deep sleep,increased light sleep and rapid eye movement(REM)sleep,higher apnea hypopnea index(AHI)and desaturation index(ODI),and lower oxygen saturation(SpO)(P<0.05).Conclusion:Compared with non-asthmatic children,the proportion of asthmatic children with sleep disorder is higher,which is characterized by increased light sleep and REM sleep and decreased deep sleep.Children with asthma complicated with OSA often have snoring,apnea,daytime sleepiness and inattention,and are more likely to have poor asthma control.