阻塞性睡眠呼吸暂停综合征儿童睡眠结构的改变

Changes of sleep architecture in children with obstructive sleep apnea syndrome

目的 研究阻塞性睡眠呼吸暂停综合征对儿童睡眠结构的影响。方法 对阻塞性睡眠呼吸暂停综合征患儿进行多导睡眠监测 ,并与同年龄组儿童睡眠结构正常值进行比较。结果 与正常值相比 ,阻塞性睡眠呼吸暂停综合征组的睡眠结构存在如下异常 :睡眠I期 :阻塞性睡眠呼吸暂停综合征组 ( 4 5 .8± 2 .0 ) % ,正常值 ( 2 .3± 1.1) % (t=2 2 .4 6 ,P <0 .0 1) ;睡眠Ⅱ期 :阻塞性睡眠呼吸暂停综合征组 ( 2 3.9±l.7) % ,正常值 ( 4 7.9士 4 .4 ) % (t =- 14 .18,P <0 .0 1) ;慢波睡眠 :阻塞性睡眠呼吸暂停综合征组 ( 15 .6± 1.8) % ,正常值 ( 2 1.1± 5 .0 ) % (t=- 3.12 3,P <0 .0 1) ;快动眼睡眠 :阻塞性睡眠呼吸暂停综合征组 ( 14 .7± 1.5 ) % ,正常值 ( 2 8.2± 4 .1) % (f =- 8.92 3,P <0 .0 1) ;差异均有显著性。结论 阻塞性睡眠呼吸暂停综合征可引起儿童睡眠结构的紊乱 ,主要表现为睡眠时频繁唤醒 ,睡眠片段化 ,浅睡眠增加 ,深睡眠和快动眼睡眠减少 ,导致患儿学习困难 ,智力下降 ,生长停滞。

Objective To explore how obstructive sleep apnea syndrome (OSAS) affects children's sleep architecture.Methods Eighty-three children with OSAS were reviewed; every patient was monitored with polysomnography for 7 hours at night for 11 parameters, including the number of arousal, snoring index,nadir O 2 desaturation, stage Ⅰ%, stage Ⅱ%, slow wave sleep (SWS)% and rapid eye movement (REM) %. The basis for diagnosis of OSAS was the widely accepted pediatric diagnostic criteria of apnea/hypopnea index, apnea/hypopnea index of > 1 episode/hour, nadir O 2 dosaturation < 92%. Sleep was scored manually according to the standard set by Rechtechaffen. Results In OSAS group, the number of arousal was 22. 5±1.4, snoring index was 70. 6±16. 5, nadir SaO 2 was (73. 8±1.9) %. OSAS group had increased stage I : (45. 8±2. 0) % vs. ( 2. 3±1.1 ) %, t = 22. 46, P < 0. 01 and decreased stage Ⅱ:(23.9±1.7)% vs. (47.9±4.4)%, t= -14.18, P<0.01, SWS (15.6±1.8)% vs. (21.1±5.0)%,t=-3.123, P<0.01, REM (14.7±1.5)% vs. (28.2±4.1)%, t= -8.923, P<0.01.Conclusion The severity of OSAS relates to changes of sleep architecture in children.Intermittent nocturnal hypoxia secondary to apnea/hypopnea, and frequent electroencephalogram arousals from sleep may result in significant sleep fragmentation. Children with OSAS had learning problems and failure to thrive.