儿童重度OSAHS睡眠结构及相关因素分析

Analysis of sleep structure and related factors in children with severe obstructive sleep apnea-hypopnea syndrome

目的:探讨重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿的睡眠结构及相关影响因素。方法:对在我院睡眠中心行睡眠监测并诊断为重度OSAHS的250例患儿进行归纳总结,根据AHI分为3组:20<AHI≤40为A组(159例),40<AHI≤60为B组(57例),AHI>60为C组(34例),对3组患儿的基本情况、睡眠参数(睡眠有效率、潜伏期、睡眠分期、睡眠指数等)、术前清醒状态及睡眠后的动脉血气、术前心脏彩超结果等进行统计学分析。结果:3组患儿的体质指数(BMI)与呼吸紊乱指数(AHI)、低通气指数(OAHI)、最低血氧饱和度(LSaO_2)比较差异均有统计学意义(P<0.01),且BMI与AHI呈相关性(r=0.251)。3组患儿睡眠有效率、睡眠潜伏期、快动眼睡眠(REM)潜伏期比较差异均有统计学意义(均P<0.01)。C组与A组比较,1期睡眠比例增加38%,3+4期睡眠比例减少19%,REM期比例减少14%,差异有统计学意义;A组与B组比较差异无统计学意义。AHI与NREM期和REM期的ODI均有明显的线性相关性(r_1=0.663,r_2=0.499,均P<0.001),且REM期ODI(63.8±35.0)明显高于NREM期(29.7±36.0),差异有统计学意义(P=0.000),占睡眠周期的68%。65例患儿AHI与睡眠状态后动脉血气中患儿SaO_2呈明显负相关(r=0.444,P=0.000),与清醒状态下SaO_2无明显相关。44例手术患儿完善术前心脏彩超,C组与A组患儿的室间隔厚度、左心室内径、主肺动脉内径间比较差异均有统计学意义(P<0.05),A组与B组差异无统计学意义,主动脉瓣环内径、左心房前后径、舒张末期前后径、射血分数、右心室前后径比较差异均无统计学意义(P>0.05)。结论:肥胖是影响OSAHS严重程度的重要因素,OSAHS越重,1期睡眠比例明显增加,3+4期睡眠及REM期比例明显减少。患儿的睡眠有效率、睡眠潜伏期、REM潜伏期与病情严重程度明显相关,儿童睡眠时低氧血症的严重程度与AHI明显相关,且主要发生在REM期。重度OSAHS是发生心血管并发症的危险因素。

Objective:To investigate the sleep structure and related factors in children with severe obstructive sleep apnea-hypopnea syndrome(OSAHS).Method:We summarized the characteristics of 250 children withsevere OSAHS diagnosed by polysomnography(PSG)in our hospital from January 1,2017 to December 31,2017.According to AHI,the patients were divided into three groups,159 in group A with 20<AHI≤40,57 in group B with 40<AHI≤60,and 34 in group C with AHI>60.We collected the basic data,sleep parameters(sleep efficiency,latency,sleep stage,sleep index,etc.),preoperative arterial blood gas test results(awake and post-sleep state),echocardiographic findings of the three groups.Statistical comparisons between groups were performed with SPSS19.0.Result:BMI,AHI,OAHI,LSaO2 was significantly different with among the three groups(all P<0.01),and there was a linear correlation between BMI and AHI(r=0.251).There was significant differences in sleep efficiency(SE),sleep latency(SO),and rapid eye movement(REM)latency among the three groups.Compared with group A,the proportion of sleep in stage 1 increased by 38%,the proportion of sleep in stage 3+4 was decreased by 19%,and the proportion of REM was decreased by 14%in group C.There was no significant difference between group A and B.There was a significant linear correlation between AHI and ODI in NREM and REM,respectively(r1=0.663,r2=0.499,P<0.001),and the ODI in REM(63.8±35.0)was significantly higher than that in NREM(29.7±36.0),accounting for 68%of the sleep.Sixty-five children had received preoperative arterial blood gas test(awake and post-sleep state).There was a significant negative correlation between AHI and SaO2 after sleep(r=-0.444,P=0.000),and no significant correlation in awake state.Forty-four patients underwent preoperative echocardiographic examination.There was significant differences between group A and C in interventricular septum thickness,left ventricular diameter,and main pulmonary artery diameter(P<0.05).There was no significant difference between group A and B.There were no significant differences in aortic annulus diameter,left atrial diameter,left ventricular end diastolic dimension(LVEDD),ejection fraction(EF),and right ventricular anteroposterior diameter among the groups(P>0.05).Conclusion:Obesity is an important factor affecting the severity of OSAHS.As the severity of disease increased,the proportion of awakening time and stage1 of sleep increased,but stage 3,4 and REM decreased significantly.The SE,SO,and REM latency were significantly associated with the severity of OSAHS.The severity of hypoxemia is significantly related to AHI,and mainly occur in REM stage.Severe OSAHS is risk factor for cardiovascular complications.