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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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