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摘要: 目的 研究儿童出生体重与阻塞性睡眠呼吸暂停之间的关系。方法 回顾性分析2020年10月至2022年7月在河南省儿童医院耳鼻咽喉头颈外科行多导睡眠监测(polysomnography，PSG)儿童的睡眠资料及出生信息，分析不同出生体重儿童阻塞性睡眠呼吸暂停(obstructive sleep apnea，OSA)的检出率、严重程度、睡眠结构和呼吸参数之间的关系。结果 符合入选标准的儿童共2 778例，其中男1 833例，女945例。将入选的儿童按照出生体重分为小于胎龄儿(SGA)组122例，适于胎龄儿(AGA)组2 313例，大于胎龄儿(LGA)组343例。各组患儿之间行睡眠监测时的平均年龄差异无统计学意义(P=0.061)，SGA组、AGA组和LGA组中的男性儿童均多于女性儿童(P=0.001)。各组之间的现平均体重指数(BMI)差异有统计学意义，LGA组儿童的现平均BMI较高(17.51±4.01，P < 0.001)。不同出生体重组儿童的OSA严重程度不同(P=0.037)，OSA严重程度和出生体重之间呈强正相关性(r=0.992)。SGA组儿童快速动眼睡眠(REM)期较少[19.00(15.18，23.33)，P=0.012]，阻塞性呼吸暂停低通气指数(OAHI)较高[1.75(0.60，5.13)，P=0.019]，中枢性呼吸暂停低通气指数(CAHI)较低[0.10(0.00，0.50)，P=0.020]。LGA组和AGA组比较，睡眠结构和呼吸参数方面差异无统计学意义。对影响OAHI指数的因素进行多元回归分析发现，男童OAHI指数较女童高(95%CI 1.311~2.096，P < 0.001)，年龄与OAHI指数呈负相关(r=-0.105，95%CI 0.856~0.946，P < 0.001)，现BMI与OAHI指数呈正相关(r=0.037，95%CI 1.010~1.065，P=0.007)。LGA与OAHI指数呈正相关(r=0.346，95%CI 1.039~1.921，P=0.027)，且LGA与OAHI的相关性(r=0.346)高于SGA与OAHI的相关性(r=0.340)。结论 不同出生体重儿童的OSA发生率无明显差异，但大于胎龄儿的OSA严重程度更高。性别、年龄、BMI指数、大于胎龄儿均为儿童OSA发生的主要影响因素，临床应高度关注。Abstract: Objective To study the relationship between children's birth weight and obstructive sleep apnea(OSA).Methods The sleep data and birth information of children who underwent polysomnography in the Department of Otorhinolaryngology-Head and Neck Surgery of Henan Children's Hospital from October 2020 to July 2022 were retrospectively analyzed. The data of OSA detection rate, OSA severity, sleep structure and respiratory parameters in different birth weight groups were analyzed.Results A total of 2 778 children met the inclusion criteria, including 1 833 males and 945 females. According to birth weight, the selected children were divided into three groups: 122 small for gestational age(SGA) group, 2 313 appropriate for gestational age(AGA), and 343 large for gestational age(LGA) group. There was no significant difference in age between different groups(P=0.061). In each group, boys are significantly more numerous than girls(P=0.001). The difference in current body mass index(BMI) between groups was statistically significant: the current BMI was higher in the LGA group(17.51±4.01, P < 0.001). The severity of OSA was different in different birth weight groups(P=0.037). There was a strong positive correlation between the severity of OSA and birth weight(r=0.992). Children in the SGA group had shorter rapid eye movement(REM) sleep period(19.00[15.18, 23.33], P=0.012), higher obstructive apnea-hypopnea index(OAHI) values(1.75[0.60, 5.13], P=0.019), and had lower central apnea hypopnea index(CAHI) values(0.10[0.00, 0.50], P=0.020). There were no significant differences in sleep structure and respiratory parameters between the LGA group and the AGA group. Multiple regression analysis of the factors affecting the OAHI index showed that the OAHI index of boys was higher than that of girls(95%CI 1.311-2.096, P < 0.001), and age was negatively correlated with the OAHI index(r=-0.105, 95%CI 0.856-0.946, P < 0.001), current BMI and OAHI index were positively correlated(r=0.037, 95%CI 1.010-1.065, P=0.007). LGA was positively correlated with OAHI index(r=0.346, 95%CI 1.039-1.921, P=0.027), and the correlation between LGA and OAHI(r=0.346) was higher than that between SGA and OAHI(r=0.340).Conclusion There was no significant difference in the incidence of OSA in children with different birth weight groups, but the OSA severity of LGA group was higher. Gender, age, BMI index and large for gestational age were the influencing factors for the occurrence of OSA in children, which should be paid more attention to in clinical practice.
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Key words:
- birth weight /
- child /
- sleep apnea /
- polysomnography
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表 1 不同出生体重组儿童的基本特征和OSA检出率
项目 SGA AGA LGA 例数 122 2 313 343 性别/例(%) 男 77(4.2) 1499(81.8) 257(14.0) 女 45(4.8) 814(86.1) 86(9.1) 平均年龄/岁 5.03±2.37 5.13±2.39 5.45±2.65 平均BMI/(kg/m2) 16.21±3.15 16.45±3.30 17.51±4.01 OSA检出率/% 63.11 55.90 56.85 
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表 2 不同出生体重组儿童的OSA严重程度
例(%) 项目 SGA AGA LGA 正常(OAHI≤1) 45(3.7) 1 022(84.1) 148(12.2) 轻度(1 < OAHI≤5) 45(4.4) 856(84.2) 116(11.4) 中度(5 < OAHI≤10) 14(6.7) 174(82.9) 22(10.5) 重度(OAHI>10) 18(5.4) 259(77.5) 57(17.1)
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表 3 不同出生体重组儿童的睡眠结构和呼吸参数
M(P25，P75) 参数 SGA AGA LGA H P 睡眠效率 81.90(73.63，89.25) 84.40(76.80，90.10) 83.30(74.90，90.20) 3.549 0.170 REM潜伏期 108.50(68.88，161.75) 111.50(72.50，151.38) 112.0(67.00，159.50) 0.080 0.961 N1/% 2.80(1.50，4.85) 2.70(1.40，4.40) 2.70(1.50，4.80) 2.117 0.347 N2/% 47.70(41.40，53.20) 46.60(41.40，51.88) 46.50(41.40，51.40) 1.207 0.547 N3/% 29.70(24.78，35.75) 28.50(24.30，33.40) 28.90(24.10，33.20) 1.992 0.369 REM/% 19.00(15.18，23.33) 20.70(17.20，24.60) 20.50(17.20，24.70) 8.785 0.012 平均血氧 97.00(96.00，98.00) 97.00(97.00，98.00) 97.00(96.00，98.00) 3.977 0.137 平均氧减 4.00(3.00，5.00) 4.00(3.00，5.00) 4.00(3.00，5.00) 4.100 0.129 最低氧饱和 89.00(83.75，92.00) 90.00(86.00，92.00) 89.00(86.00，92.00) 2.634 0.268 AHI 2.00(0.88，6.00) 1.70(0.80，4.10) 1.90(0.80，5.20) 4.691 0.096 OAI 0.30(0.08，0.90) 0.30(0.00，0.80) 0.30(0.00，1.10) 0.724 0.696 OAHI 1.75(0.60，5.13) 1.30(0.50，3.50) 1.30(0.50，4.10) 7.930 0.019 CAHI 0.10(0.00，0.50) 0.20(0.00，0.60) 0.20(0.00，0.50) 7.844 0.020
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表 4 影响OAHI指数的因素的多元回归分析
因素 系数 调整OR 95%CI P 性别 男 0.505 1.658 1.311~2.096 < 0.001 女 1.000 年龄 -0.105 0.900 0.856~0.946 < 0.001 BMI 0.037 1.037 1.010~1.065 0.007 出生体重 SGA 0.340 1.405 0.797~2.477 0.240 AGA 1.000 LGA 0.346 1.413 1.039~1.921 0.027 早产 是 -0.029 0.972 0.531~1.777 0.926 否 1.000 母亲生孩子时年龄 -0.002 0.998 0.975~1.022 0.862
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[1] Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome[J]. Pediatrics, 2012, 130(3): e714-755. doi: 10.1542/peds.2012-1672
[2] Tapia IE, Shults J, Doyle LW, et al. Perinatal Risk Factors Associated with the Obstructive Sleep Apnea Syndrome in School-Aged Children Born Preterm[J]. Sleep, 2016, 39(4): 737-742. doi: 10.5665/sleep.5618
[3] Rosen CL, Larkin EK, Kirchner HL, et al. Prevalence and risk factors for sleep-disordered breathing in 8-to 11-year-old children: association with race and prematurity[J]. J Pediatr, 2003, 142(4): 383-389. doi: 10.1067/mpd.2003.28
[4] Spilsbury JC, Storfer-Isser A, Kirchner HL, et al. Neighborhood disadvantage as a risk factor for pediatric obstructive sleep apnea[J]. J Pediatr, 2006, 149(3): 342-347. doi: 10.1016/j.jpeds.2006.04.061
[5] Paavonen EJ, Strang-Karlsson S, Räikkönen K, et al. Very low birth weight increases risk for sleep-disordered breathing in young adulthood: the Helsinki Study of Very Low Birth Weight Adults[J]. Pediatrics, 2007, 120(4): 778-784. doi: 10.1542/peds.2007-0540
[6] Chen T, Hughes ME, Wang H, et al. Prenatal, Perinatal, and Early Childhood Factors Associated with Childhood Obstructive Sleep Apnea[J]. J Pediatr, 2019, 212: 20-27. e10. doi: 10.1016/j.jpeds.2019.05.053
[7] Hibbs AM, Johnson NL, Rosen CL, et al. Prenatal and neonatal risk factors for sleep disordered breathing in school-aged children born preterm[J]. J Pediatr, 2008, 153(2): 176-182. doi: 10.1016/j.jpeds.2008.01.040
[8] 丘小汕, 邵肖梅, 叶鸿瑁. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
[9] Berry RB, Brooks R, Gamaldo C, et al. AASM Scoring Manual Updates for 2017(Version 2.4)[J]. J Clin Sleep Med, 2017, 13(5): 665-666. doi: 10.5664/jcsm.6576
[10] 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. doi: 10.3760/cma.j.cn115330-20200521-00431
[11] Kang KT, Weng WC, Lee PL, et al. Age-and gender-related characteristics in pediatric obstructive sleep apnea[J]. Pediatr Pulmonol, 2022, 57(6): 1520-1526. doi: 10.1002/ppul.25900
[12] Inoshita A, Kasai T, Matsuoka R, et al. Age-stratified sex differences in polysomnographic findings and pharyngeal morphology among children with obstructive sleep apnea[J]. J Thorac Dis, 2018, 10(12): 6702-6710. doi: 10.21037/jtd.2018.11.09
[13] Horne RSC, Ong C, Weichard A, et al. Are there gender differences in the severity and consequences of sleep disordered in children?[J]. Sleep Med, 2020, 67: 147-155. doi: 10.1016/j.sleep.2019.11.1249
[14] Brockmann PE, Koren D, Kheirandish-Gozal L, et al. Gender dimorphism in pediatric OSA: Is it for real?[J]. Respir Physiol Neurobiol, 2017, 245: 83-88. doi: 10.1016/j.resp.2016.11.010
[15] Inoshita A, Kasai T, Matsuoka R, et al. Age-stratified sex differences in polysomnographic findings and pharyngeal morphology among children with obstructive sleep apnea[J]. J Thorac Dis, 2018, 10(12): 6702-6710. doi: 10.21037/jtd.2018.11.09
[16] Vohr BR, Heyne R, Bann CM, et al. Extreme Preterm Infant Rates of Overweight and Obesity at School Age in the SUPPORT Neuroimaging and Neurodevelopmental Outcomes Cohort[J]. J Pediatr, 2018, 200: 132-139. e3. doi: 10.1016/j.jpeds.2018.04.073
[17] 蔡越, 张颖, 张皓, 等. 上海市5岁儿童出生体重及现身体质量指数与龋病关系研究[J]. 中国实用口腔科杂志, 2020, 13(11): 670-673.
[18] Yamada T, Akaishi R, Yamada T, et al. Risk of cerebral palsy associated with neonatal encephalopathy in macrosomic neonates[J]. J Obstet Gynaecol Res, 2014, 40(6): 1611-1617. doi: 10.1111/jog.12367
[19] Soheilipour F, Shiri S, Ahmadkhaniha HR, et al. Risk factors for attention-deficit/hyperactivity disorder: a case-control study in 5 to 12 years old children[J]. Med Pharm Rep, 2020, 93(2): 175-180.
[20] Qiao Y, Zhang T, Liu H, et al. Joint association of birth weight and physical activity/sedentary behavior with obesity in children ages 9-11 years from 12 countries[J]. Obesity(Silver Spring), 2017, 25(6): 1091-1097.
[21] Wang J, Liu E, Wang Y, et al. Association of early pregnancy body mass index and children's birth weight with risk of being overweight in childhood[J]. Am J Hum Biol, 2018, 30(5): e23174. doi: 10.1002/ajhb.23174
[22] Martínez Cuevas E, Muñoz Peláez C, Ordax Carbajo E, et al. Sleep apnoea-hypopnoea syndrome in the obese and non-obese: Clinical, polysomnographical and clinical characteristics[J]. An Pediatr(Engl Ed), 2021, 95(3): 147-158.
[23] Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea[J]. Proc Am Thorac Soc, 2008, 5(2): 242-252. doi: 10.1513/pats.200708-135MG
[24] Narang I, Mathew JL. Childhood obesity and obstructive sleep apnea[J]. J Nutr Metab, 2012, 2012: 134202.
[25] 李晶, 杨屈扬, 许莹, 等. 儿童肥胖与阻塞性睡眠呼吸暂停的相关性研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(4): 318-322. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2023.04.017
[26] Haataja P, Korhonen P, Ojala R, et al. Hospital admissions for lower respiratory tract infections after early-, late-, and post-term birth[J]. Paediatr Perinat Epidemiol, 2020, 34(2): 139-149. doi: 10.1111/ppe.12631
[27] 季立, 方明, 陆文敏, 等. 9443例新生儿听力筛查结果分析[J]. 听力学及言语疾病杂志, 2018, 26(6): 661-663. doi: 10.3969/j.issn.1006-7299.2018.06.023
[28] Oommen SP, Santhanam S, John H, et al. Neurodevelopmental Outcomes of Very Low Birth Weight Infants at 18-24 Months, Corrected Gestational Age in a Tertiary Health Centre: A Prospective Cohort Study[J]. J Trop Pediatr, 2019, 65(6): 552-560. doi: 10.1093/tropej/fmz006
[29] Sahni R, Polin RA. Physiologic underpinnings for clinical problems in moderately preterm and late preterm infants[J]. Clin Perinatol, 2013, 40(4): 645-663. doi: 10.1016/j.clp.2013.07.012
[30] 叶秀霞, 孙建华, 黄萍, 等. 早产低出生体重儿健康相关生活质量的临床研究[J]. 中国儿童保健杂志, 2012, 20(12): 1070-1073.
[31] Chen T, Hughes ME, Wang H, et al. Prenatal, Perinatal, and Early Childhood Factors Associated with Childhood Obstructive Sleep Apnea[J]. J Pediatr, 2019, 212: 20-27. e10. doi: 10.1016/j.jpeds.2019.05.053
[32] Paavonen EJ, Strang-Karlsson S, Räikkönen K, et al. Very low birth weight increases risk for sleep-disordered breathing in young adulthood: the Helsinki Study of Very Low Birth Weight Adults[J]. Pediatrics, 2007, 120(4): 778-784. doi: 10.1542/peds.2007-0540
[33] Weigelt A, Bleck S, Huebner MJ, et al. Impact of premature birth on cardiopulmonary function in later life[J]. Eur J Pediatr, 2023, 182(7): 3265-3274. doi: 10.1007/s00431-023-04952-y
[34] Allinson JP, Chaturvedi N, Wong A, et al. Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study[J]. Lancet, 2023, 401(10383): 1183-1193. doi: 10.1016/S0140-6736(23)00131-9
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