OSAHS儿童与单纯性鼾症儿童睡眠结构分析

发布时间：2018-04-02 17:18

  本文选题：睡眠呼吸暂停低通气综合症　切入点：儿童　出处：《泸州医学院》2012年硕士论文

【摘要】：目的：回顾性分析儿童阻塞性睡眠呼吸暂停低通气综合症（OSAHS）及儿童单纯性鼾症（PS，primary snoring）的睡眠结构特点，并探讨两者之间的睡眠结构是否存在着差异，同时将OSAHS组、PS组分别与正常年龄组的儿童睡眠结构进行比较，，观察OSAHS患儿与单纯性鼾症儿童睡眠结构变化情况。方法：选取2009年4月～2012年3月在四川省华西医院睡眠中心因为打鼾而就诊并行多导睡眠监测的6～9岁儿童，共84名。其中男57名，女27名。平均年龄（7.27±1.16）岁，平均体重（29.26±10.88）kg，平均BMI（17.90±5.34）kg/m~2。在夜间睡眠中存在着如下表现：睡眠中打鼾、张口呼吸、呼吸困难甚至出现呼吸暂停、白天有嗜睡、注意力不集中等。84名儿童根据国内儿童OSAHS诊断标准分为OSAHS组和单纯性鼾症组（PS组），采用美国伟康公司生产的Alice5多导睡眠仪进行整夜睡眠呼吸监测（PSG）。对OSAHS儿童（OSAHS组）与单纯性打鼾儿童（PS组）的睡眠结构以及身高、体重、年龄、最低氧饱和度等一般情况指标进行统计学比较分析，观察异同。同时，再分别与国内参考文献上同年龄组（6～9岁）的正常儿童的睡眠结构进行比较，观察它们之间有无差异。对单纯性鼾症组（PS组）与OSAHS组两组儿童分别进行组内相关性分析，观察呼吸暂停低通气指数（AHI）与Ⅲ＋Ⅳ期睡眠所占总睡眠期的百分比，微觉醒指数（MI），REM期睡眠所占总睡眠期百分比等指标之间是否存在线性联系。结果：经人工校正分析后的多导睡眠图分析结果显示单纯性鼾症组（PS组）和OSAHS组的睡眠结构特点如下所示：睡眠潜伏期（16.61±26.47vs15.66±19.11min）、睡眠效率（87.15%±7.30%vs87.11%±10.85%）、Ⅰ期睡眠百分比（14.70%±11.49%vs18.31%±10.73%）、Ⅱ期睡眠百分比（40.72%±16.48%vs39.55%±15.17%）、Ⅲ＋Ⅳ期（慢波睡眠期）百分比（34.90%±15.22%vs30.33%±12.52%）、REM期百分比（9.69%±5.14%vs11.83%±7.24%）差异无统计学意义（P＞0.05）。但单纯性鼾症组（PS组）与OSAHS组的MI（微觉醒指数）（7.49±3.09vs14.76±9.70次/h）、最低SaO2（88.12%±7.79%vs79.41%±14.24%）相比具有显著差异性（P＜0.01）。再将前述PS组以及OSAHS组分别与国内同年龄组（6～9岁）儿童的睡眠结构（引用数据）进行比较得出：两组儿童（OSAHS组和PS组）与正常组儿童睡眠结构各项指标相比均具有统计学意义（P＜0.05），具体表现为：Ⅰ期睡眠比例增加，Ⅱ期睡眠比例减少，Ⅲ＋Ⅳ期睡眠比例增加（深睡眠比例增加），REM期睡眠比例减少。相关性分析结果：对PS组与OSAHS组的AHI分别与Ⅲ＋Ⅳ期睡眠百分比、微觉醒指数（MI）、REM期睡眠百分比等指标进行两变量相关分析，发现只有OSAHS组的AHI与微觉醒指数（MI）具有显著相关性，其Pearson相关系数为0.524，P=0.000（P＜0.01）。PS组的AHI与MI、Ⅲ+Ⅳ%、REM%以及OSAHS组的AHI与Ⅲ+Ⅳ%、REM%均不具有相关性（P＞0.05）。结论：OSHAS与单纯性鼾症（PS）的儿童睡眠结构差异不明显，各期睡眠比例接近，睡眠结构相似。与正常儿童相比，OSAHS和单纯性鼾症（PS）均可导致儿童睡眠结构紊乱，引起一系列的临床表现。具体的改变表现为Ⅰ期睡眠与Ⅲ+Ⅳ期睡眠（慢波睡眠，SWS）增加，Ⅱ期睡眠以及REM期睡眠减少。儿童睡眠结构变得紊乱。且根据相关性分析结果显示，OSAHS儿童的AHI越高，微觉醒指数（MI）就越高，相比单纯性鼾症（PS）的儿童而言，具有更多的觉醒，睡眠更易片段化。
[Abstract]:Objective: a retrospective analysis of children with obstructive sleep apnea hypopnea syndrome (OSAHS) and children with snoring (PS, primary, snoring) sleep structure characteristics, and to explore the sleep structure between them and whether there are differences, while the OSAHS group, PS group compared with the normal sleep structure in children age group OSAHS, observation of children and simple snoring children sleep structure changes. Methods: from April 2009 to March 2012 in West China Hospital of Sichuan province sleep center that snoring and visits the polysomnography monitoring children 6~9 years of age were 84. There were 57 males and 27 females. The average age (7.27 + 1.16) years old, average weight (29.26 + 10.88) kg, average BMI (17.90 + 5.34) kg/m~2. has the performance in the night of sleep: sleep snoring, mouth breathing, breathing difficulties and even apnea, daytime sleepiness, attention Concentration of.84 children according to the diagnostic criteria of OSAHS children were divided into OSAHS group and simple snoring group (PS group), the Respironics production company Alice5 overnight polysomnography sleep apnea monitoring (PSG). The OSAHS children (OSAHS group) and simple snoring children (PS group). Sleep structure and height, weight, age, the lowest oxygen saturation and other general index statistics comparative analysis, observation of similarities and differences. At the same time, respectively, and domestic references on the same age group (6~9 years old) to compare the sleep structure of normal children, to observe whether the differences between them. The simple snoring group (PS group) were analyzed within group correlation with OSAHS group of two groups of children, to observe the apnea hypopnea index (AHI) and III + IV sleep percentage of total sleep time, arousal index (MI), REM sleep total sleep percentage index Whether there is a linear relationship. Results: after manual correction analysis after polysomnography analysis showed simple snoring group (PS group) and OSAHS group of sleep structure characteristics are as follows: sleep latency (16.61 + 26.47vs15.66 + 19.11min), sleep efficiency (87.15% + 7.30% vs87.11% + 10.85%), percentage of sleep phase I (14.70% + 11.49%vs18.31% + 10.73%), percentage of sleep phase II (40.72% + 16.48%vs39.55% + 15.17%), III + IV (slow wave sleep) percentage (34.90% + 15.22%vs30.33% + 12.52%), the percentage of REM phase (9.69% + 5.14% vs11.83% + 7.24%) there was no statistically significant difference (P > 0.05) but only. Snoring group (PS group) and OSAHS group (MI microarousal index) (7.49 + 3.09vs14.76 + 9.70 /h), the lowest SaO2 (88.12% + 7.79%vs79.41% + 14.24%) compared with significant difference (P < 0.01). Then the PS group and OSAHS group were with the same age group (6 锝

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