小儿阻塞性睡眠呼吸暂停综合征的临床及睡眠呼吸特征

Clinical characteristics of obstructive sleep apnea syndrome in children

目的 探讨小儿阻塞性睡眠呼吸暂停综合征 (OSAS)的临床特点 ,观察多导联睡眠监护仪对儿童OSAS的临床应用价值。方法 分析 60例OSAS患儿临床资料 ,应用睡眠呼吸监护仪 ,对 60例患儿术前及其中 40例扁桃体摘除术加 (或 )腺样体刮除术后患儿于夜间睡眠时做持续 7h以上记录 ,观察最长呼吸暂停时间、最长低通气时间、呼吸暂停和低通气次数及呼吸紊乱指数、睡眠期最低血氧饱和度、鼾声指数等 11项指标 ,并分组进行比较。结果 60例术前均有扁桃体和 (或 )增殖体肿大 ,睡眠时伴粗大鼾声、憋气等症状。睡眠监测结果 :最长呼吸暂停时间为 5 3 ( 8～ 178)s;呼吸暂停总时间为 3 11( 2 6～ 5 2 60 )s;呼吸暂停次数为 2 6( 3～ 2 40 )次 ;最长低通气时间为 41( 5～ 94)s ;低通气总时间170 ( 5～ 2 860 )s;低通气次数为 10 ( 1～ 85 )次 ;呼吸暂停指数为 4 1( 0 5～ 2 5 9) ;低通气指数为 1 4( 0～16 1) ;呼吸紊乱指数为 6 8( 0 5～ 3 8 2 ) ;鼾声指数为 81 7( 1 3～ 414 8) ;最低血氧饱和度 0 78( 0 2 5～0 93 )。在 2～ 7岁组和 7岁以上组之间比较 ,以上指标差异无显著意义。手术后 :患儿临床症状明显缓解 ,最长呼吸暂停时间、呼吸暂停总时间、最长低通气时间、低通气总时间较术前明显缩短 ,呼吸暂停次数、

Objective To explore the clinical features and diagnosis of obstructive sleep apnea syndrome (OSAS) in children. Methods Sixty children with OSAS were reviewed, every patient was monitored with polysomnography (PSG) for 7 hours at night for 11 parameters, including the longest apnea time (LAT), apnea and hypopnea index (AHI), the lowest oxygen saturation (SaO 2), and snore index etc., the parameters of the 2 groups were comparaed. Meanwhile, tonsillectomy and adenoidectomy were performed for 40 cases of OSAS, and the parameters obtained before and after operation were analyzed. Results Adenotonsillar hypertrophy and the loud snoring during sleep were found in all cases. The mean values of the PSG parameters were as follows: the longest apnea time was 53 (8-178) seconds (s); the total time of apnea was 310.5 (26-5 260) s; the time of apnea was 26 (3-240)s; the longest hypopnea time was 41 (5-94)s; the total times of hypopnea was 170 (5-2 860)s; the time of hypopnea was 10 (1-85); the apnea index was 4.1(0.5-25.9); the hypopnea index was 1.4(0-16.1); the apnea and hypopnea index (AHI) was 6.8(0.5-38.2); the snore index was 81.7 (1.3-414.8); the lowest saturation of oxygen was 0.78(0.25-0.93). There was not statistically significant difference in the parameters between 2-7 year group and over 7 year group (P>0.05). The parameters of postoperation group: the mean value of the longest apnea time was 15.5 (0-60) s; the total time of apnea was 56.4 (60-205) s; the time of apnea was 10.33 (0-40); the longest hypopnea time was 13.25 (0-30) s; the total times of hypopnea was 44.6 (0-73); the hypopnea time was 4.32 (0-30) s; the apnea index was 0.6 (0-12); the hypopnea index was 0.62 (0-4); the apnea and hypopnea index (AHI) was 1.25 (0.1-12); the snore index was 30.08 (1.8-102); the lowest oxygen saturation was 93.5% (64%-97%). Compared with preoperation groups there was a staististically significant difference (P<0.01). Clinically effective rate of the surgeries was over 90%. Conclusion Adenotonsillar hypertrophy seemed to be an important cause of OSAS in children. Snoring, dyspnea, apnea and low ventilation are the major clinical characteristics of OSAS in children. Confirmed diagnosis of the syndrome in children requires PSG recordings.