摘要
目的探讨阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）患儿和单纯鼾症儿童的脑电醒觉反应指数（arousal index，ArI）的特点，以及ArI与最低动脉血氧饱和度（lowest SaO2，LSaO2）、呼吸暂停低通气指数（AHI）的关系。方法2007年3月至2008年2月因疑似OSAHS而进行多道睡眠监测的102例儿童作为研究对象，OSAHS的诊断依据乌鲁木齐指南。符合OSAHS诊断的66例纳入OSAHS组，另外36例纳入单纯鼾症组。两组之间年龄、性别及体重指数均衡性检验差异无统计学意义。两组之间进行呼吸相关性、肢体运动相关性、自发性ArI和总ArI的比较，并进行OSAHS组ArI和LSaO2与AHI的相关性研究。将OSAHS患儿按照AHI分成3组（AHI≤10次／h为轻度组、10次／h〈AHI≤20次／h为中度组及AHI〉20次／h为重度组），探讨3组之间ArI的差异。结果OSAHS组和单纯鼾症组比较（Mann—Whitney U法秩和检验），呼吸相关性ArI及总ArI显著高于单纯鼾症组（z值分别为-3．866、-3．148，P值均〈0．01），自发性ArI明显低于单纯鼾症组（z=-2．791，P=0．005），差异均有统计学意义。OSAHS患儿不同病情程度3组之间比较，可见随着OSAHS严重程度的增加，呼吸相关ArI也增加，且改变具有统计学意义（P值均〈0．05）。Spearman秩相关分析发现，呼吸相关性ArI与AHI呈正相关（r=0．734，P=0．000），ArI与LSaO2无相关关系。OSAHS组睡眠Ⅰ期比率较单纯鼾症组增多，REM期减少，且差异有统计学意义（z值分别为-2．423、-3．519，P值均〈0．01）。结论OSAHS患儿的自发性ArI减少，呼吸相关性ArI增高，在OSAHS患儿的睡眠质量评估中，呼吸相关性ArI更能反映睡眠片段化随病情变化的程度。
Objective To explore the difference of arousal index between the children with obstructive sleep apnea-hypopnea syndrome （OSAHS） and children with primary snoring. Furthermore, to explore the correlation between the above mentioned arousals and the apnea-hypopnea index （AHI） and lowest oxygen saturation （LSaO2）. Methods Between March 2007 and February 2008, 102 children suspected of OSAHS underwent overnight polysomnogram monitoring in our medicine sleep center. OSAHS was diagnosed according to the general criterion [ Draft of gnidelines for the diagnosis and treatment of pediatric sleep apnea hypopnea syndrome （Urumqi） which was published in Chin J Otorhinolaryngol Head Neck Surg in February, 2007]. One-hundred and two children were divided into two groups according to the guidelines. Sixty six children [56 boys, 10 girls; aged 4 - 17 years, （7.01 ±2. 24）years （x^-±s） ]who were diagnosed as OSAHS were enrolled in study group and 36 children [29 boys, 7 girls; aged 4 - 13 years, （7. 44± 2. 68 ） years ] who were diagnosed as primary snoring made up control group. The difference of spontaneous arousal index, total arousal index and arousal index related to respiratory stimuli and limb movement were compared between the two groups. Besides this, the correlation between spontaneous arousal index,total arousal index and arousal index related to respiratory stimuli and limb movement and AHI and LSaO2 were also analyzed. Furthermore, the study group were divided into three subgroups according to AHI （ ≤10 times/h, 10 times/h 〈 AHI≤20 times/h, 〉20 times/h ）. Spontaneous arousal index, total arousal index and arousal index related to respiratory stimuli and limb movement were compared among the three groups. Results The increased total arousal index and arousal index related to respiratory stimuli and the decreased spontaneous arousal index of study group were significant as compared to those of control group （Mann-Whitney U, z value, -3. 148, -3. 866, -2. 791 ; P value, 0. 002
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2008年第12期929-934,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
