血清维生素D3水平检测在儿童阻塞性睡眠呼吸暂停的应用价值

Value of serum vitamin D3 level detection in children with obstructive sleep apnea

目的评价血清维生素D3水平与儿童阻塞性睡眠呼吸暂停(OSA)的关系及其临床诊断价值。方法选择2018年1月1日至2021年12月31日在上海市儿童医院呼吸科就诊,年龄2~14岁,症状为习惯性打鼾患儿227例(男135例、女92例)为研究对象进行回顾性分析,同时选择同期体检的236例健康儿童作为健康对照组。对所有患儿行夜间多导睡眠监测,记录患儿的性别、年龄、颈围、身高、体重、身体质量指数(BMI)、呼吸暂停最长时间、低通气最长时间、平均血氧、最低血氧、睡眠效率、微觉醒指数、鼾声指数、快速动眼期比例、阻塞性睡眠呼吸暂停低通气指数(OAHI)等,同时本研究选择对维生素D状态最具指标性的血清25羟化维生素D3[25-VitD3,化学分子式:25(OH)VitD3]含量水平作为依据,检测血清中25-VitD3水平。根据OAHI将研究对象分为OSA组(80例)及非OSA组(147例),比较两组25-VitD3水平的差异,同时对OSA组患儿血清维生素D水平与睡眠监测指标进行相关性分析。结果OSA组与非OSA组在OAHI、呼吸暂停低通气指数(AHI)、阻塞性呼吸暂停指数、最低血氧饱和度、平均血氧、呼吸暂停最长时间、低通气最长时间、微觉醒指数的差异存在统计学意义(P<0.05);血脂方面,两组总胆固醇的差异存在统计学意义(P<0.05),OSA组的血清胆固醇高于非OSA组。OSA组和非OSA组患儿的血清25-VitD3水平显著低于健康对照组,而OSA组的血清25-VitD3水平则显著低于非OSA组,差异具有统计学意义(P<0.05);患儿血清25-VitD3水平与一般指标、血脂及睡眠监测相关指标的多元回归模型具有显著的统计学意义(P<0.05),睡眠效率和年龄对25-VitD3水平的影响具有统计学意义(P<0.05);OSA患儿血清25-VitD3水平与最低血氧饱和度存在正相关(P<0.05),而与AHI和OAHI呈负相关(P<0.05)。结论OSA组的血清25-VitD3水平显著低于非OSA组与健康对照组,血清25-VitD3水平检测对儿童阻塞性睡眠呼吸暂停有一定的临床诊断价值。

To evaluate the relationship between serum vitamin D3 level and obstructive sleep apnea in children and its clinical diagnosis value.Methods T otally 227 children with snoring,aged from 2 to 14 years old,were enrolled for retrospective analysis,who were treated in the Respiratory Department of Shanghai Children's Hospital from January 1,2018 to December 31,2021.A total of 236 healthy children were included as healthy control group at the same time.Polysomnography(PSG)was performed in all the children.The gender,age,neck circumference,height,weight,body mass index(BMI),longest time of apnea(LTA),longest time of hypoventilation(LTH),lowest oxygen saturation(LSaO2),average oxygen saturation(ASaO2),sleep efficiency(SE),snoring index(SI),arousal index(ARI),REM phase ratio,obstructive apnea hypopnea index(OAHI)and other items were recorded.At the same time,serum 25-VitD3 level was detected.According to OAHI,the patients were divided into OSA group(80 cases)and non OSA group(147 cases).The differences in 25-VitD3 between the two groups were compared.Meanwhile,the correlation between serum 25-VitD3 level and PSG indexes in OSA group was analyzed.Results There were significant differences in OAHI,AHI,OAI,LSaO2,ASaO2,LTA,LTH and ARI between OSA group and non-OSA group(P<0.05).In terms of blood lipid,the difference in TC between the two groups was statistically significant(P<0.05).The serum cholesterol of-OSA group was higher than that of non-OSA group.The serum25-VitD3 level in OSA group and non OSA group was significantly lower than that in healthy control group,while that in OSA group was significantly lower than that in non-OSA group(P<0.05).There was significant statistical significance between serum 25-VitD3 level of SDB and other indicators(general indicators,TC,TG and PSG indicators)in the multiple regression model(P<0.05).SE and age had statistically significant effects on 25-VitD3 level(P<0.05).Serum 25-VitD3 level was positively correlated with LSaO2(P<0.05)and negatively correlated with AHI and OAHI(P<0.05)in children with OSA.Conclusion The serum 25-VitD3 level in OSA group is significantly lower than that in non OSA group and healthy control group.The detection of serum 25-VitD3 level has certain clinical diagnosis value for children with obstructive sleep apnea.