-
摘要: 目的 通过对复发性眩晕(recurrent vertigo of children，RVC)患儿客观睡眠情况的分析，探讨RVC患儿的睡眠情况与疾病之间的关系。方法 根据RVC诊断标准，选取RVC患儿(RVC组)50例和非RVC健康儿童(对照组)20例。根据眩晕问卷调查评分将RVC组按严重程度分为轻、中、重3组。所有入组人员均行连续多导睡眠监测(PSG)，应用SPSS 25.0统计学软件对PSG各项结果进行统计学分析。结果 ① RVC组与对照组在各期睡眠时间及总睡眠时间(total sleep time，TST)、睡眠效率(sleep efficiency，SE)间的差异有统计学意义(P < 0.05)，在睡眠潜伏期间的差异无统计学意义(P>0.05)。具体表现为RVC组患儿N1及N2期睡眠时间比例增高，N3及快速眼动微睡眠期睡眠时间比例降低，TST减少，SE减低。②RVC组睡眠呼吸暂停低通气指数的异常率，即AHI≥5次/h的比例及最低SpO2异常率均高于正常对照组，差异有统计学意义(P < 0.05)。③轻度组、中度组、重度组3组间的AHI及最低SpO2异常率比较差异有统计学差异(P < 0.05)。④RVC患儿的眩晕程度与AHI的异常率无显著相关性(P>0.05)；RVC患儿的眩晕程度与最低SpO2异常率呈负相关性(P < 0.05)。结论 RVC患儿常伴有睡眠障碍，临床医生应同时关注患儿的眩晕症状及睡眠情况。PSG可操作性强，而且无创，为儿童RVC的辅助检查提供了新的思路。积极改善眩晕症状，注意提升睡眠质量，对RVC患儿的综合治疗具有一定的临床意义。Abstract: Objective To explore the relationship between sleep status and the disease in children with recurrent vertigo(RVC) by analyzing the objective sleep condition of children with recurrent vertigo.Methods According to the diagnostic criteria of RVC, 50 children with RVC and 20 normal controls without RVC were selected. According to the vertigo questionnaire score, the RVC group was divided into mild, moderate and severe groups according to severity. Continuous polysomnography(PSG) was performed for all participants, and SPSS 25.0 statistical software was used to analyze the monitoring results.Results ① There were significant differences in sleep time of each period, total sleep time and sleep efficiency between RVC group and control group(P < 0.05), but there was no significant difference in sleep latency(P>0.05). The specific manifestations were that the proportion of sleep time in N1 and N2 phases increased, the proportion of sleep time in N3 and REM phases decreased, the total sleep time and sleep efficiency decreased in RVC group. ②The abnormal rate of sleep apnea hypopnea index, that is, the proportion of AHI≥5 times/h and the abnormal rate of lowest blood oxygen saturation in RVC group were higher than those in normal control group. There was significant difference between the two groups(P < 0.05). ③There were significant differences in the proportion of AHI≥5 times/h and lowest SpO2 among mild group, moderate group and severe group(P < 0.05). ④There was no significant correlation between the degree of vertigo and the abnormal rate of AHI in children with RVC, but there was a negative correlation between the degree of vertigo and the abnormal rate of lowest SpO2 in children with RVC.Conclusion Children with RVC are often accompanied by sleep disorders, clinicians should pay attention to both the symptoms of vertigo and sleep condition in children. Polysomnography is non-invasive and operable, providing a new idea to the auxiliary examination of RVC in children. It is of certain clinical significance for the comprehensive treatment of children with RVC to actively improve vertigo symptoms and pay attention to improving sleep quality.
-
Key words:
- recurrent vertigo /
- children /
- polysomnography
-
-
表 1 一般资料比较
组别 例数 性别/例 年龄/岁 BMI 男 女 RVC组 50 22 28 11.0[8.75，12.00] 24.0[21.75，25.23] 对照组 20 10 10 10.5[8.5，12.00] 24.0[21.00，25.75] χ2值/U值 0.207 491.0 0.906 P值 0.649 464.5 0.641 
下载: 导出CSV
表 2 RVC组和对照组各项睡眠监测指标比较
组别 TST/min SE/% SL/min 睡眠比例/% N1期 N2期 N3期 REM期 RVC组 351.27±71.58 67.41±11.53 28.31±19.76 14.35±3.97 59.54±5.15 9.08±4.12 17.03±3.86 对照组 483.21±65.62 85.36±9.31 26.54±16.98 4.10±1.08 53.23±4.37 18.61±2.79 24.06±1.59 检验值 -4.214 -3.875 -0.281 8.453 11.142 -7.625 -4.315 P值 0.015 0.003 0.757 < 0.001 < 0.001 < 0.001 0.008
下载: 导出CSV
表 3 RVC组和对照组睡眠监测的AHI及最低血氧异常构成比
例(%) 组别 例数 AHI 最低SpO2 正常 轻度 中度 重度 正常 轻度 中度 重度 RVC组 50 27(54.00) 10(20.00) 6(12.00) 7(14.00) 29(58.00) 12(24.00) 4(8.00) 5(10.00) 对照组 20 16(80.00) 3(15.00) 1(5.00) 0 17(85.00) 2(10.00) 1(5.00) 0 χ2值 4.076 4.622 P值 0.044 0.032
下载: 导出CSV
表 4 轻、中、重度RVC三组AHI和最低SpO2异常率比较
例(%) 组别 AHI 最低SpO2 正常 异常 正常 异常 轻度组 12(57.1) 9(42.9) 16(76.2) 5(23.8) 中度组 13(68.4) 6(31.6) 12(63.2) 7(36.8) 重度组 2(20.0) 8(80.0) 1(10.0) 9(90.0) χ2值 6.605 13.467 P值 0.037 0.001
下载: 导出CSV
表 5 不同眩晕程度的患儿AHI及最低SpO2异常率的分布
% 组别 AHI异常率 最低SpO2异常率 轻度组 42.9 23.8 中度组 31.6 36.8 重度组 80.0 90.0 rs值 0.744 -0.944 P值 0.466 0.021
下载: 导出CSV
-
[1] Li CM, Hoffman HJ, Ward BK, et al. Epidemiology of Dizziness and Balance Problems in Children in the United States: A Population-Based Study[J]. J Pediatr, 2016, 171: 240-247. e1-3. doi: 10.1016/j.jpeds.2015.12.002
[2] Davitt M, Delvecchio MT, Aronoff SC. The Differential Diagnosis of Vertigo in Children: A Systematic Review of 2726 Cases[J]. Pediatr Emerg Care, 2020, 36(8): 368-371.
[3] Dunker K, Schnabel L, Grill E, et al. Recurrent Vertigo of Childhood: Clinical features and prognosis[J]. Front Neurol, 2022, 13: 1022395. doi: 10.3389/fneur.2022.1022395
[4] 凌霞, 张赛, 申博, 等. 儿童前庭性偏头痛和儿童复发性眩晕: Bárány协会前庭疾病分类委员会和国际头痛协会诊断标准共识文件[J]. 神经损伤与功能重建, 2021, 16(8): 435-439. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKF202108001.htm
[5] Gallina S, Dispenza F, Kulamarva G, et al. Obstructive sleep apnoea syndrome(OSAS): effects on the vestibular system[J]. Acta Otorhinolaryngol Ital, 2010, 30(6): 281-284.
[6] 韩曦. 阻塞性睡眠呼吸暂停低通气综合征患者冷热试验特征[D]. 天津医科大学, 2015.
[7] 张莉, 刘冰, 刘海红, 等. 高刺激率ABR与儿童复发性眩晕的相关性[J]. 中华耳科学杂志, 2015, 13(3): 416-418. doi: 10.3969/j.issn.1672-2922.2015.03.007
[8] 石艳艳, 李宁, 朱巧英, 等. 眩晕患者同型半胱氨酸及叶酸变化及其与疾病严重程度关系研究[J]. 国际检验医学杂志, 2019, 40(23): 2850-2853. doi: 10.3969/j.issn.1673-4130.2019.23.008
[9] 中华耳鼻咽喉头颈外科杂志编委会, 中华医学会耳鼻咽喉科学分会. 儿童阻塞性睡眠呼吸暂停低通气综合征诊疗指南草案(乌鲁木齐)[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(2): 83-84. doi: 10.3760/j.issn:1673-0860.2007.02.002
[10] Qian S, Wang Y, Zhang X. Inhibiting Histamine Signaling Ameliorates Vertigo Induced by Sleep Deprivation[J]. J Mol Neurosci, 2019, 67(3): 411-417. doi: 10.1007/s12031-018-1244-6
[11] Goto F, Tsutumi T, Arai M, et al. [Somatic symptoms in those hospitalized for dizziness or vertigo][J]. Nihon Jibiinkoka Gakkai Kaiho, 2010, 113(9): 742-750. doi: 10.3950/jibiinkoka.113.742
[12] 李欣, 陈雯婧, 李娟, 等. 不同年龄眩晕患者OSAHS构成比的相关性分析[J]. 中华耳科学杂志, 2020, 18(2): 262-267. doi: 10.3969/j.issn.1672-2922.2020.02.008
[13] Wu J, Liu C, Yu H, et al. Clinical characteristics of sleep disorders in patients with vestibular migraine[J]. Sleep Breath, 2020, 24(4): 1383-1388. doi: 10.1007/s11325-019-01994-1
[14] 王理想, 张道培, 宋艳坤, 等. 前庭性偏头痛与睡眠障碍共病机制的研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(2): 149-152. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2022.02.016
[15] Kim SK, Kim JH, Jeon SS, et al. Relationship between sleep quality and dizziness[J]. PLoS One, 2018, 13(3): e0192705. doi: 10.1371/journal.pone.0192705
[16] 陈正侬, 殷善开. 儿童良性阵发性眩晕[J]. 临床耳鼻咽喉头颈外科杂志, 2007, 192(4): 187-189. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH200704023.htm
[17] Lee JO, Park SH, Kim HJ, et al. Vulnerability of the vestibular organs to transient ischemia: implications for isolated vascular vertigo[J]. Neurosci Lett, 2014, 558: 180-185. doi: 10.1016/j.neulet.2013.11.016
[18] 费樱平, 郑芸. 眩晕与睡眠障碍的研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(12): 1214-1216, 1220. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201912028.htm
[19] Pace A, Milani A, Rossetti V, et al. Evaluation of Vestibular Function in Patients Affected by Obstructive Sleep Apnea Performing Functional Head Impulse Test(fHIT)[J]. Nat Sci Sleep, 2022, 14: 475-482.
[20] Yan G, Li F, Tao Z, et al. Effects of Vestibular Damage on the Sleep and Expression Level of Orexin in the Hypothalamus of Rats and Its Correlation with Autophagy and Akt Tumor Signal Pathway[J]. J Oncol, 2022, 2022: 2514555.
-
| 引用本文: |
邵永良, 刘南仙, 张爱英, 等. 复发性眩晕患儿连续多导睡眠监测分析[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(4): 258-262. doi: 10.13201/j.issn.2096-7993.2023.04.004
|
| Citation: |
SHAO Yongliang, LIU Nanxian, ZHANG Aiying, et al. Analysis of continuous polysomnography in children with recurrent vertigo[J]. J Clin Otorhinolaryngol Head Neck Surg, 2023, 37(4): 258-262. doi: 10.13201/j.issn.2096-7993.2023.04.004
|