儿童阻塞性睡眠呼吸暂停低通气综合征的诊断

Diagnosis of pediatric obstructive sleep apnea hypopnea syndrome

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapneahypopneasyndrome ,OSAHS)的临床特征及诊断 ,分析多导睡眠监测特点。方法 对病史、常规体检可疑的 49例患儿行头颅侧位摄片、纤维鼻咽镜检查及睡眠呼吸监测。结果 患儿多有明确的打鼾、憋气的病史 ,并存在扁桃体、腺样体肥大引起的上气道狭窄。多导睡眠仪 (polysomnography ,PSG)监测 41例 ,其中单纯性打鼾 1例、上气道阻力综合征 5例、OSAHS 35例 ;另 8例经AutosetⅠ监测诊断为OSAHS。结论 儿童OSAHS临床表现与成人有一定差异 ,以阻塞性低通气伴有数量不等的呼吸暂停发作、阶段性低血氧为主要特征 ,无明显睡眠结构紊乱 ,呼吸紊乱一般不伴有微觉醒发生 。

Objective To discuss the clinical feature and diagnosis of pediatric obstructive sleep apnea hypopnea syndrome(OSAHS) and analyze characteristics of polysomnography Methods Cephalometric analysis, fibrous endoscopic examination and sleep breathing studies were performed in 49 cases with suspected complaints and signs Results Most of them had marked history about snore, sleep apnea and signs of upper airway obstruction caused by enlargement of tonsil and/or adenoid Polysomnography(PSG) was gived to 41 cases who was proved 1 case with primary snore,5 cases with upper airway resistance syndrome,35 cases with OSAHS Another 8 cases with OSAHS were diagnosed by Autoset I studies Conclusion Many features of pediatric OSAHS are different from adult OSAHS The common symptom of pediatric OSAHS include snore, restless sleep, struggling to breathe, abnormal paradoxical chest/abdomen motion, mouth breathing, failure to thrive Obesity and excessive daytime sleepiness are little present Severe cases may be associated with cor pulmonale PSG play an important role in exact diagnosis of pediatric sleep related breathing disorder The results demonstrate that pediatric OSAHS are characterized by partial upper airway obstruction, more or less apnea and associated with staged desaturation They have little sleep structrue disorder and difficulty breathing are not associated with arousal Apnea hypopnea index(AHI), lowest oxygen saturation(LSaO 2) and desaturation index below 90%(SIT90%) are very important factors to measure about serious degree of pediatric OSAHS