脉搏血氧饱和度监测在预测中重度儿童阻塞性睡眠呼吸暂停中的应用价值

Value of pulse oxygen saturation monitoring in predicting the moderate-to-severe obstructive sleep apnea in children

目的探讨脉搏血氧饱和度(SpO_(2))监测在预测儿童中重度阻塞性睡眠呼吸暂停(OSA)中的价值。方法回顾性研究。选取2017年6月至2020年11月以夜间睡眠打鼾至苏州大学附属儿童医院就诊的341例儿童,均接受同步多导睡眠监测(PSG)和SpO_(2)监测。SpO_(2)参数:SpO_(2)减低指数(ODI),包括下降幅度≥3%、≥4%的ODI3、ODI4;平均SpO_(2)(MSpO_(2));最低SpO_(2)(LSpO_(2));血氧饱和度低于95%、92%、90%累积时间(T95、T92、T90)。根据阻塞性呼吸暂停低通气指数(OAHI)将患儿分为打鼾及轻度OSA组(OAHI≤5次/h)与中重度OSA组(OAHI>5次/h),采用χ^(2)检验及Mann-Whitney U检验比较2组间SpO_(2)参数的差异,采用Spearman相关分析对全部患儿SpO_(2)参数与OAHI进行相关性分析,将SpO_(2)参数纳入Logistic回归分析。采用受试者工作特征曲线(ROC)分析SpO_(2)参数对中重度OSA的预测价值。结果341例患儿中男206例,女135例;年龄6.0(4.0,7.5)岁;体重指数(BMI)16.2(15.1,18.0)kg/m^(2);OAHI 0.6(0.1,3.0)次/h。打鼾及轻度OSA组283例(83.0%),中重度OSA组58例(17.0%)。打鼾及轻度OSA组及中重度OSA组ODI3分别为0.7(0.3,1.4)次/h、7.7(4.4,12.8)次/h,ODI4分别为0.4(0.1,0.8)次/h、5.3(2.7,9.1)次/h,T95分别为1.4(0.3,5.3)min、13.7(7.0,33.5)min,T92分别为0.1(0,0.5)min、1.8(0.9,6.0)min,T90分别为0(0,0.1)min、0.6(0.2,2.2)min,LSpO_(2)分别为91.0(89.0,93.0)%、86.5(82.0,88.0)%,MSpO 2分别为97.0(97.0,98.0)%、96.0(96.0,97.0)%。打鼾及轻度OSA组中ODI3、ODI4、T95、T92、T90均低于中重度OSA组,LSpO 2、MSpO_(2)均高于中重度OSA组(均P<0.001)。各项SpO_(2)参数均与OAHI相关(均P<0.001),其中ODI3与OAHI相关系数为0.660。ODI3是中重度OSA的独立预测因子(OR=3.117,95%CI:1.635~5.945,P=0.001),其预测中重度OSA的ROC曲线下面积为0.957,临界值为3.45次/h,且诊断中重度OSA的特异度为95.4%,MSpO_(2)是中重度OSA的独立预测因子(OR=2.917,95%CI:1.589~5.354,P=0.001)。结论ODI3可以用来预测中重度儿童OSA。

ObjectiveTo investigate the value of pulse oxygen saturation(SpO_(2))monitoring in predicting children with moderate-to-severe obstructive sleep apnea(OSA).MethodsIt was a retrospective study involving 341 children with snoring during nighttime sleep who had visited the Children′s Hospital of Soochow University from June 2017 to November 2020 and monitored for polysomnography(PSG)and SpO_(2).The SpO_(2) parameters mainly included oxygen desaturation index(ODI),oxygen desaturation index≥3%(ODI3),oxygen desaturation index≥4%(ODI4),mean pulse blood oxygen saturation(MSpO_(2)),lowest pulse blood oxygen saturation(LSpO_(2)),cumulative time spent with blood oxygen saturation below 95%,92% and 90%(T95,T92 and T90).According to obstructive sleep apnea hypopnea index(OAHI),patients were divided into the snoring and mild OSA group(OAHI≤5 times/h)and moderate-to-severe OSA group(OAHI>5 times/h).Differences in SpO_(2) parameters were compared between groups using the Chi-square test and Mann-Whitney U test.Spearman correlation analysis was used to analyze the correlation between SpO_(2) parameters and OAHI in all children.The SpO_(2) parameters were included in the Logistic regression model.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of SpO_(2) parameters on moderate-to-severe OSA.ResultsA total of 341 patients were recruited,including 206 male and 135 female patients with the mean age,body mass index(BMI)and OAHI of 6.0(4.0,7.5)years,16.2(15.1,18.0)kg/m 2 and 0.6(0.1,3.0)times/h,respectively.There were 283(83.0%)and 58(17.0%)patients in the snoring and mild OSA group and moderate-to-severe OSA group.The ODI3[0.7(0.3,1.4)times/h vs.7.7(4.4,12.8)times/h],ODI4[0.4(0.1,0.8)times/h vs.5.3(2.7,9.1)times/h],T95[1.4(0.3,5.3)min vs.13.7(7.0,33.5)min],T92[0.1(0,0.5)min vs.1.8(0.9,6.0)min]and T90[0(0,0.1)min vs.0.6(0.2,2.2)min]were significantly lower in the snoring and mild OSA group than those of moderate-to-severe group,while LSpO_(2)[91.0(89.0,93.0)%vs.86.5(82.0,88.0)%]and MSpO_(2)[97.0(97.0,98.0)%vs.96.0(96.0,97.0)%]were significantly higher(all P<0.001).All SpO 2 parameters were significantly correlated with OAHI(all P<0.001),and the correlation coefficient between ODI3 and OAHI was 0.660.ODI3 was an independent predictor of moderate-to-severe OSA(OR=3.117,95%CI:1.635-5.945,P=0.001).The area under the ROC curve of ODI3 in predicting the moderate-to-severe OSA was 0.957,and the cut-off value of 3.45 times/h and specificity of 95.4%.MSpO_(2) was an independent predictor of moderate-to-severe OSA(OR=2.917,95%CI:1.589-5.354,P=0.001).ConclusionsODI3 can be used to predict the moderate-to-severe OSA in children.