儿童中枢性睡眠呼吸暂停56例临床分析

Clinical analysis of 56 children with central sleep apnea

目的探讨儿童中枢型呼吸暂停(CA)(按呼吸事件类型分类)的临床特点及疾病构成,以提高临床对儿童睡眠呼吸疾病的认识。方法横断面研究。统计2019年3月至2022年3月在首都医科大学附属儿童医院睡眠监测中心完成整夜多导睡眠监测(PSG)的患儿共计5708例,按照中枢型呼吸暂停指数(CAI)≥5次/h且CA和/或中枢型低通气数量>呼吸暂停低通气数量50%的标准,共有56例患儿(1.0%)符合此标准,回顾性分析56例以CA为主要表现的PSG及临床资料,总结分析疾病构成和呼吸特点。采用多元线性回归分析中枢型呼吸事件的相关因素。结果中枢性睡眠呼吸暂停(CSA)同时符合阻塞性睡眠呼吸暂停(OSA)有37例患儿,其中男16例、女21例。CAI与阻塞型呼吸暂停低通气指数呈正相关(r=0.673,P<0.001),与体重指数、年龄无相关性。在56例CSA患儿中,CAI>20次/h有4例患儿,其中Chiari畸形1例,脑干肿瘤2例,遗传代谢病1例。结论CA相对于阻塞型呼吸暂停发生率更低。CSA患儿多合并OSA,阻塞的严重程度是影响CAI的主要因素。若CAI>20次/h,应高度重视,需全面评估病史,完善相关影像学等检查,排除内外科基础疾病导致的CSA。

Objective To explore the clinical characteristics and disease composition of pediatric patients with central apnea(CA)(classification by respiratory event type)and enhance the understanding of pediatric sleep-disordered breathing diseases.Methods A cross section study was conducted.From March 2019 to March 2022,a total of 5708 children underwent overnight polysomnography(PSG)at the Sleep Monitoring Center of Beijing Children′s Hospital,Capital Medical University.Among them,56 patients(1.0%)had the central apnea index(CAI)≥5 times/h and the number of CA and/or central hypopneas>50%of the number of apneas and hypopneas.A retrospective analysis was conducted on the PSG and clinical data of the 56 pediatric patients with CA as the main manifestation.The disease composition and respiratory characteristics were summarized and analyzed.The factors related to central respiratory events were analyzed by multiple linear regression analysis.Results Among the 56 children,37 had concurrent obstructive sleep apnea(OSA),including 16 boys and 21 girls.CAI was positively correlated with the obstructive apnea-hypopnea index in central sleep apnea(CSA)patients with OSA(r=0.673,P<0.001)and had no significant correlation with the body mass index or age.Among the 56 CSA patients,4 had a CAI>20 times/h,including 1 case of Chiari malformation,2 cases of brainstem tumors,and 1 case of inherited metabolic disease.Conclusions The incidence of CA is lower compared to obstructive apnea.CSA patients often have concurrent OSA,and the severity of obstruction is the main factor affecting CAI.If CAI>20 times/h,it should be given high attention,and a comprehensive assessment of medical history and relevant imaging examinations are necessary to exclude underlying medical conditions causing CSA.