儿童OSAHS不同诊断标准的差异研究

赵国强; 李彦如; 王小轶; 丁秀; 王春燕; 徐文; 韩德民

doi:10.13201/j.issn.1001-1781.2018.01.003

儿童OSAHS不同诊断标准的差异研究

- 1. 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科(北京, 100730);
- 2. 首都医科大学阻塞性睡眠呼吸暂停低通气综合征临床诊疗与研究中心;
- 3. 耳鼻咽喉头颈科学教育部重点实验室(首都医科大学)
基金项目:
国家重点研发计划项目（No：2017YFC0112500）；北京市医院管理局"使命"人才计划项目（No：SML20150201）

详细信息

通讯作者: 徐文,E-mail:xuwendoc@126.com; 韩德民,E-mail:enthandm@126.com

中图分类号: R563.8

收稿日期: 2017-09-20

Differential evaluation of diagnostic criteria for pediatric obstructive sleep apnea hypopnea syndrome

- 1. Department of Otolaryngoogy Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China;
- 2. Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis & Therapy and Research Centre, Capital Medical University;
- 3. Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education

More Information

Corresponding authors: XU Wen ; HAN Demin

Received Date: 20 September 2017

摘要

摘要: 目的：探讨在区分儿童睡眠呼吸障碍症状和生活质量的能力上，3种诊断标准的差异：美国胸科协会（ATS）、国际睡眠疾病分类标准（ICSD-3）及国内乌鲁木齐标准（草案）。探讨多导睡眠监测（PSG）指标与患儿生活质量量表（OSA-18）的关系。方法：选取2016-01-01-2017-04-30期间以打鼾为主诉在首都医科大学附属北京同仁医院睡眠监测中心行PSG的儿童，并根据ATS （AHI>5或OAI>1）、ICSD-3（OAHI ≥ 1）和乌鲁木齐标准（AHI>5或OAI>1且LSaO₂<92%）诊断并分组：单纯性鼾症（SS组）、ICSD组、ATS&ICSD组（ATS&ICSD1组、ATS&ICSD2组）；采集身高、体重等，并由监护人填写OSA-18。结果：最终共515例（男350例，女165例）患儿纳入研究，SS组、ICSD组、ATS&ICSD组各有315例、70例、130例。ICSD组和ATS&ICSD组患儿的体重、BMI显著高于SS组（P<0.05），同时ATS&ICSD组发育不良比例显著高于SS组（P<0.05）；校正身高、体重和BMI后，3组睡眠障碍维度评分均差异有统计学意义（P<0.05）。SS组、ICSD组和ATS&ICSD组中枢性呼吸暂停和低通气以外的呼吸事件的数目及指数，依次递增且均差异有统计学意义；ATS&ICSD2组除混合性呼吸暂停指数外均显著高于ATS&ICSD1组（P<0.05）。结论：儿童OSAHS的诊断应将OAHI ≥ 1作为标准，并结合LSaO₂<92%。
- 儿童 /
- 睡眠呼吸暂停低通气综合征,阻塞性
Abstract: Objective: To evaluate the difference of accessing pediatric sleep symptoms and living qualities between 3 diagnostic criteria:American Thoracic Society (ATS), International Classification of Sleep Disorder (ICSD-3), domestic Urumqi criterion (Draft); To investigate the relationship of PSG parameters and quality of life scale OSA-18.Method: Children with snoring who received PSG in Capital Medical University Beijing Tongren Hospital were recruited from Jan 2016 to Apr 2017. Subjects were diagnosed and grouped to SS, ICSD, ATS&ICSD (ATS&ICSD1, ATS&ICSD2) according to 3 criteria:ATS (AHI>5 or OAI>1), ICSD-3 (OAHI ≥ 1) and Urumqi (AHI>5 or OAI>1, with LSaO₂<92%). Subjects' height, weight as well as quality of life scale OSA-18 were recorded.Result: Five hundred and fifteen children were finally included (Male:350 cases, Female:165 cases). There were 315, 70 and 130 children in group SS, ICSD, ATS&ICSD respectively. Weights and BMI of ICSD and ATS&ICSD were significantly higher than those of SS (P<0.05), and dysplasia scale of ATS&ICSD was higher than SS (P<0.05); after adjusting height, weight and BMI, sub-scores of sleep disorder were statistically different between 3 groups (P<0.05). Numbers and indexes of respiratory events other than central apneas and hypopneas in group SS, ICSD and ATS&ICSD were increased sequentially and statistically different (P<0.05); numbers and indexes of respiratory events other than mixed apneas in ATS&ICSD2 were significantly higher than that of ATS&ICSD1 (P<0.05).Conclusion: OAHI ≥ 1/h combined with LSaO₂<92% should be used as pediatric OSAHS diagnostic criterion.
- children /
- sleep apnea hypopnea syndrome, obstructive

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参考文献(19)

[1]	MARCUS C L, BROOKS L J, DRAPER K A, et al.Diagnosis and management of childhood obstructive sleep apnea syndrome[J].Pediatrics, 2012, 130:576-584.
[2]	LUMENG J C, CHERVIN R D.Epidemiology of pediatric obstructive sleep apnea[J].Pro Am Thorac Soc, 2008, 5, 2:242-252.
[3]	LI A M, SO H K, AU C T, et al.Epidemiology of obstructive sleep apnoea syndrome in Chinese children:a two-phase community study[J].Thorax, 2010, 65:991-997.
[4]	XU Z F, SHEN K L.The epidemiology of snoring and obstructive sleep apnea/hypopnea in Mainland China[J].Biol Rhythm Res, 2010, 41:225-233.
[5]	ARCHBOLD K H, GIORDANI B, RUZICKA D L, et al.Cognitive executive dysfunction in children with mild sleep-disordered breathing[J].Biol Res Nursing, 2004, 5:168-176.
[6]	MARCUS C L, OMLIN K, BASINKI D J, et al.Normal polysomnographic values for children[J].Am Rev Respiratory Dis, 1992, 146:1235-1239.
[7]	SATEIA M J.International classification of sleep disorders-third edition:highlights and modifications[J].Chest, 2014, 146:1387-1394.
[8]	中华耳鼻咽喉头颈外科杂志编委会.儿童阻塞性呼吸暂停低通气综合征诊疗指南草案(乌鲁木齐, 2006)[J].中华耳鼻咽喉头颈外科杂志, 2007, 42(2):83-84.
[9]	ESPEJO M R.WHO child growth standards:Methods and development[J].J R Stat Soc, 2007, 170:512-512.
[10]	FRAMCP R A, ROSENFELD R M, RAO M.First place——resident clinical science award 1999.Quality of life for children with obstructive sleep apnea[J].Otolaryngol Head Neck Surg, 2000, 123:9-16.
[11]	KANG K T, WENG W C, YEH T H, et al.Validation of the Chinese version OSA-18 quality of life questionnaire in Taiwanese children with obstructive sleep apnea[J].J Formos Med Assoc, 2014, 113:454-462.
[12]	BERRY R B, BUDHIRAJA R, GOTTLIEB D J, 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, 8:597-619.
[13]	BERRY R B, BROOKS R, GAMALDO C E, et al.The AASM manual for the scoring of sleep and associated events:Rules, Terminology and Technical Specifications, Vension 2.2.www.aasmnet.org.Darien, Illinois:American Academy of Sleep Medicine, 2015.
[14]	LANDE M B, HOOPER S R, BATISKY D L, et al.Sleep disordered breathing as measured by SRBD-PSQ and neurocognition in children with hypertension[J].Am J Hypertens, 2015, 28:552-558.
[15]	BOYNTON G, VAHABZADEH A, HAMMOUD S, et al.Validation of the STOP-BANG questionnaire among patients referred for suspected obstructive sleep apnea[J].J Sleep Disor Treat Care, 2013, 2:4-6.
[16]	CHERVIN R D, WEATHERLY R A, GARETZ S L, et al.Pediatric sleep questionnaire:prediction of sleep apnea and outcomes[J].Arch Otolaryngol Head Neck Surg, 2007, 133:216-222.
[17]	GUILLEMINAULT C, KOROBKIN R, WINKLE R.A review of 50children with obstructive sleep apnea syndrome[J].Lung, 1981, 159:275-287.
[18]	WITMANS M B, KEENS T G, DAVIDSON WARD S L, et al.Obstructive hypopneas in children and adolescents:normal values[J].Am J Respir Crit Care Med, 2003, 168:1540-1547.
[19]	CHAN J, EDMAN J C, KOLTAI P J.Obstructive sleep apnea in children[J].Am Fam Physician, 2004, 69:1147-1154.