肥胖儿童阻塞性睡眠呼吸暂停的临床特征

doi:10.7499/j.issn.1008-8830.2104155

摘要
图/表
参考文献(27)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (526 KB) [HTML]
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的研究肥胖儿童合并阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）的临床特征。方法对在深圳市儿童医院呼吸科行多导睡眠监测的肥胖并诊断为OSA的33例7~15岁儿童的临床资料进行回顾性分析，并选取50例体重正常的、性别及年龄相匹配的OSA患儿作为对照组。结果 33例合并肥胖的OSA儿童中，常见的日间症状前3位为：注意力不集中30例（91%），嗜睡22例（67%），晨起疲劳21例（64%）；夜间症状前3位为：打鼾27例（82%），张口呼吸20例（61%），出汗16例（48%）。与正常儿童参考值相比，肥胖OSA组和对照组两组患儿浅睡眠延长，深睡眠缩短，快速动眼期明显缩短，但两组之间这些指标的比较差异无统计学意义（P>0.05）。与对照组比较，肥胖OSA组呼吸暂停低通气指数和阻塞性呼吸暂停低通气指数均显著增加（P<0.05）；快速动眼期及非快速动眼期氧减指数均显著增加（P<0.05）；肥胖OSA组睡眠期间最低血氧饱和度显著低于对照组（P<0.05）。结论肥胖合并OSA儿童临床日间症状以注意力不集中、嗜睡、晨起疲劳为主，夜间症状以打鼾、张口呼吸、出汗为主。与体重正常OSA患儿相比，肥胖合并OSA儿童的睡眠结构无明显差别，但呼吸事件及血氧饱和度下降更严重。引用格式:

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	刘爱良
	郑跃杰
	苏喆
	魏菊荣
	杨琴
	王聪聪
	李佳慧

关键词 ：阻塞性睡眠呼吸暂停, 肥胖, 多导睡眠监测, 低通气, 儿童

Abstract：Objective To study the clinical features of obstructive sleep apnea (OSA) in children with obesity. Methods A retrospective analysis was performed on the medical data of 33 obese children aged 7-15 years, who were diagnosed with OSA and received polysomnography (PSG) in the Department of Respiratory Medicine in Shenzhen Children's Hospital. Fifty OSA children with normal body weight, matched for sex and age, were enrolled as the control group. Results Among the 33 obese children with OSA, the three most common daytime symptoms were inattention in 30 children (91%), somnolence in 22 children (67%), and morning fatigue in 21 children (64%), and the three most common nocturnal symptoms were snoring in 27 children (82%), mouth breathing in 20 children (61%), and sweating in 16 children (49%). Compared with the reference values of normal children, both the OSA + obesity group and the control group had prolonged light sleep, shortened deep sleep, and a significantly shortened rapid eye movement (REM) period, while there was no significant difference in these indices between the two groups (P>0.05). The apnea-hypopnea index, obstructive apnea/hypopnea index, and oxygen desaturation index in both REM and non-REM periods in the OSA +obesity group were significantly higher than those in the control group (P<0.05), while the lowest blood oxygen saturation during sleep was significantly lower in the OSA + obesity group (P<0.05). Conclusions The children with obesity and OSA have the main daytime symptoms of inattention, somnolence, and morning fatigue and the main nocturnal symptoms of snoring, mouth breathing, and sweating. There is no significant difference in sleep structure between OSA children with obesity and those with normal body weight; however, respiratory events and blood oxygen saturation decline are more severe in OSA children with obesity. Citation:

Key words： Obstructive sleep apnea Obesity Polysomnography Hypoventilation Child

收稿日期: 2021-04-28

通讯作者: 杨琴，女，副主任医师。Email：6468633@qq.com。 E-mail: 6468633@qq.com

作者简介: 刘爱良，女，硕士，主治医；

引用本文:

刘爱良,郑跃杰,苏喆等. 肥胖儿童阻塞性睡眠呼吸暂停的临床特征[J]. 中国当代儿科杂志, 2021, 23(9): 933-937.

LIU Ai-Liang,ZHENG Yue-Jie,SU Zhe et al. Clinical features of obstructive sleep apnea in children with obesity[J]. CJCP, 2021, 23(9): 933-937.

链接本文:

http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2104155 或 http://www.zgddek.com/CN/Y2021/V23/I9/933

	Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome[J]. Pediatrics, 2012, 130(3): 576-584. PMID: 22926173. DOI: 10.1542/peds.2012-1671.
	Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea[J]. Proc Am Thorac Soc, 2008, 5(2): 242-252. PMID: 18250218. PMCID: PMC2645255. DOI: 10.1513/pats.200708-135MG.
	3 马冠生, 米杰, 马军.中国儿童肥胖报告[R]. 北京: 人民卫生出版社, 2017.
	Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014[J]. JAMA, 2016, 315(21): 2292-2299. PMID: 27272581. PMCID: PMC6361521. DOI: 10.1001/jama.2016.6361.
	Xu ZF, Wu YX, Tai J, et al. Risk factors of obstructive sleep apnea syndrome in children[J]. J Otolaryngol Head Neck Surg, 2020, 49(1): 11. PMID: 32131901. PMCID: PMC7057627. DOI: 10.1186/s40463-020-0404-1.
	Chan KC, Au CT, Hui LL, et al. How OSA evolves from childhood to young adulthood: natural history from a 10-year follow-up study[J]. Chest, 2019, 156(1): 120-130. PMID: 30922948. DOI: 10.1016/j.chest.2019.03.007.
	Andersen IG, Holm JC, Hom?e P. Obstructive sleep apnea in children and adolescents with and without obesity[J]. Eur Arch Otorhinolaryngol, 2019, 276(3): 871-878. PMID: 30689039. DOI: 10.1007/s00405-019-05290-2.
	中国儿童OSA诊断与治疗指南制订工作组, 中华医学会耳鼻咽喉头颈外科学分会小儿学组, 中华医学会儿科学分会呼吸学组, 等. 中国儿童阻塞性睡眠呼吸暂停诊断与治疗指南(2020)[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(8): 729-747. PMID: 32791771. DOI: 10.3760/cma.j.cn115330-20200521-00431.
	9 中华人民共和国国家卫生和计划生育委员会. 学龄儿童青少年超重与肥胖筛查: WS/T 586-2018[S]. 北京: 中国标准出版社, 2018.
	Verhulst SL, Schrauwen N, Haentjens D, et al. Reference values for sleep-related respiratory variables in asymptomatic European children and adolescents[J]. Pediatr Pulmonol, 2007, 42(2): 159-167. PMID: 17186545. DOI: 10.1002/ppul.20551.
	Owens JA, Spirito A, McGuinn M. The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children[J]. Sleep, 2000, 23(8): 1043-1051. PMID: 11145319.
	Zreaqat M, Hassan R, Samsudin AR, et al. Prevalence of sleep-disordered breathing and its association with obesity among Saudi schoolchildren[J]. J Contemp Dent Pract, 2020, 21(9): 1022-1026. PMID: 33568590.
	Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine[J]. J Clin Sleep Med, 2012, 8(5): 597-619. PMID: 23066376. PMCID: PMC3459210. DOI: 10.5664/jcsm.2172.
	14 BerryRD. 睡眠医学基础[M]. 高和, 王莞尔, 段莹, 等. 译. 北京: 人民军医出版社, 2014: 81-82.
	Siriwat R, Wang L, Shah V, et al. Obstructive sleep apnea and insulin resistance in children with obesity[J]. J Clin Sleep Med, 2020, 16(7): 1081-1090. PMID: 32118578. PMCID: PMC7954072. DOI: 10.5664/jcsm.8414.
	Lo Bue A, Salvaggio A, Insalaco G. Obstructive sleep apnea in developmental age. A narrative review[J]. Eur J Pediatr, 2020, 179(3): 357-365. PMID: 31940071. DOI: 10.1007/s00431-019-03557-8.
	Can B, Can B. Change in overweight from childhood to early adulthood and risk of type 2 diabetes[J]. N Engl J Med, 2018, 378(26): 2537. PMID: 29952168. DOI: 10.1056/NEJMc1805984.
	Fobian AD, Elliott L, Louie T. A systematic review of sleep, hypertension, and cardiovascular risk in children and adolescents[J]. Curr Hypertens Rep, 2018, 20(5): 42. PMID: 29717377. DOI: 10.1007/s11906-018-0841-7.
	Capdevila OS, Kheirandish-Gozal L, Dayyat E, et al. Pediatric obstructive sleep apnea: complications, management, and long-term outcomes[J]. Proc Am Thorac Soc, 2008, 5(2): 274-282. PMID: 18250221. PMCID: PMC2645258. DOI: 10.1513/pats.200708-138MG.
	Gozal D, Kheirandish-Gozal L. Obesity and excessive daytime sleepiness in prepubertal children with obstructive sleep apnea[J]. Pediatrics, 2009, 123(1): 13-18. PMID: 19117855. DOI: 10.1542/peds.2008-0228.
	张丰珍, 王桂香, 许志飞, 等. 儿童重度OSAHS睡眠结构及相关因素分析[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(5): 441-446. PMID: 31163554. DOI: 10.13201/j.issn.1001-1781.2019.05.014.
	Yang LQ, Huang ZY, Zhong JW, et al. The characteristics and clinical significance of REM<10% in children with sleep-disordered breathing[J]. Int J Pediatr Otorhinolaryngol, 2018, 110: 53-56. PMID: 29859587. DOI: 10.1016/j.ijporl.2018.04.015.
	Hannon TS, Rofey DL, Ryan CM, et al. Relationships among obstructive sleep apnea, anthropometric measures, and neurocognitive functioning in adolescents with severe obesity[J]. J Pediatr, 2012, 160(5): 732-735. PMID: 22137667. PMCID: PMC3297729. DOI: 10.1016/j.jpeds.2011.10.029.
	Andersen IG, Holm JC, Hom?e P. Impact of weight-loss management on children and adolescents with obesity and obstructive sleep apnea[J]. Int J Pediatr Otorhinolaryngol, 2019, 123: 57-62. PMID: 31075707. DOI: 10.1016/j.ijporl.2019.04.031.
	Roche J, Isacco L, Masurier J, et al. Are obstructive sleep apnea and sleep improved in response to multidisciplinary weight loss interventions in youth with obesity? A systematic review and meta-analysis[J]. Int J Obes (Lond), 2020, 44(4): 753-770. PMID: 31911659. DOI: 10.1038/s41366-019-0497-7.
	Spilsbury JC, Storfer-Isser A, Rosen CL, et al. Remission and incidence of obstructive sleep apnea from middle childhood to late adolescence[J]. Sleep, 2015, 38(1): 23-29. PMID: 25325456. PMCID: PMC4262952. DOI: 10.5665/sleep.4318.
	Sever O, Kezirian EJ, Gillett E, et al. Association between REM sleep and obstructive sleep apnea in obese and overweight adolescents[J]. Sleep Breath, 2019, 23(2): 645-650. PMID: 30554324. DOI: 10.1007/s11325-018-1768-6.