特异性生活质量调查量表及儿童睡眠问卷在学龄前儿童OSA中的应用研究

Application of OSA-18 and PSQ in preschool children with OSA

目的评估特异性生活质量调查(disease specific quality of life for children with obstructive sleep apnea 18 items survey,OSA-18)量表及简体中文版儿童睡眠问卷(pediatric sleep questionnair,PSQ)在学龄前打鼾儿童中筛查阻塞性睡眠呼吸暂停(OSA)中的临床实用价值。方法横断面研究选取141例患者,有打鼾伴张口呼吸问题并在南京市妇幼保健院进行了鼻咽部侧位片和整夜便携式睡眠监测(portable monitoring,PM),根据腺样体大小(A/N比值)及阻塞性呼吸暂停低通气指数(OAHI)、最低血氧饱和度(lowest oxygen saturation,LSaO_(2))将患者进行分组。由患儿家长填写OSA-18量表及PSQ。比较不同分组患儿的OSA-18量表及PSQ各个维度评分及总分,分析PM和A/N比值与OSA-18及PSQ评分的相关性,并通过受试者工作特征(ROC)曲线确定最佳临界点。结果OSA组及低氧血症组OSA-18总分及各维度评分均高于非OSA组及非低氧血症组,OSA组及低氧血症组PSQ除嗜睡及其他维度,其余各维度评分及总分均高于非OSA组及低氧血症组;腺样体病理性肥大组OSA-18除身体症状及日间功能维度,其余各维度评分及总分均高于腺样体非病理性肥大组,PSQ总分及呼吸评分高于腺样体非病理性肥大组,以上差异均有统计学意义(P<0.05)。A/N比值与OSA-18除日间功能外其他各维度及总分呈显著正相关,与PSQ总分、呼吸评分呈显著正相关(P<0.05);OAHI与OSA-18总分及各维度呈显著正相关,与PSQ除其他外各维度及总分呈显著正相关(P<0.05);LSaO_(2)与OSA-18总分及各维度评分呈显著负相关,与PSQ总分、呼吸、行为维度呈显著负相关(P<0.05)。PSQ总分评价是否是OSA及是否存在低氧血症的最佳临界点均为6.5分,OSA-18总分评价是否是OSA及是否存在低氧血症的最佳临界点均为46.5分。结论OSA-18量表及PSQ可作为筛查学龄前儿童OSA、评估缺氧程度及推测腺样体肥大程度的可靠辅助检查。

OBJECTIVE To assess the disease specific quality of life for children with obstructive sleep apnea 18 items survey(OSA-18)scale and the Simplified Chinese version of the Pediatric Sleep Questionnaire(PSQ)in screening for obstructive sleep apnea(OSA)disorders in preschool snoring children.METHODS In this cross-sectional study,141 patients with snoring and open-mouth breathing problems who underwent lateral nasopharyngeal radiographs and overnight portable monitoring(PM)at Nanjing Maternity and Child Health Care Hospital were selected and grouped according to adenoid size(A/N ratio)and obstructive apnea hypopnea Index(OAHI),lowest oxygen saturation(LSaO_(2)).The OSA-18 scale and PSQ were completed by the parents of the children.The correlation between PM and A/N ratio and OSA-18 and PSQ scores was analysed and the optimal threshold was determined by the ROC curve.RESULTS The OSA-18 total score and all dimensions were higher in the OSA and hypoxaemic groups than in the non-OSA and non-hypoxaemic groups;the PSQ scores and total scores were higher in the OSA and hypoxaemic groups than in the non-OSA and hypoxaemic groups,except for somnolence and other dimensions;the OSA-18 scores and total scores were higher in the adenoid pathological hypertrophy group than in the non-adenoid pathological hypertrophy group,except for physical symptoms and daytime function dimensions.The differences were statistically significan(P<0.05).The best threshold for assessing the presence of OSA and hypoxemia was 6.5 for the PSQ total score and 6.5for the respiratory and behavioural dimensions.The best cut-off points for OSA and hypoxaemia were 46.5 for the OSA-18 total score.CONCLUSION The OSA-18 scale and PSQ can be used as reliable adjunctive tests to screen preschool children for OSA,assess the degree of hypoxia and predict the degree of adenoid hypertrophy.