Body mass index as an indicator of obstructive sleep apnea in pediatric Down syndrome

Objective

Our objective was to determine if higher body mass index (BMI) increases the likelihood of, obstructive sleep apnea (OSA) in pediatric Down syndrome (DS) patients.

Methods

We performed a, retrospective chart review of 63 DS patients evaluated by overnight polysomnography from December 1995 to February 2005. Patients aged less than 2 years were excluded. Remaining patients were grouped, according to presence (n = 19) or absence (n = 33) of OSA based on apnea hypopnea index (AHI). OSA, and non-OSA DS groups were age matched while blinded to patient attributes other than age and OSA, status. Patients without appropriate age matches were excluded. We recorded various patient information, including age, sex, height, weight, number of apneas, number of hypopneas, respiratory distress index (RDI), apnea-hypopnea index (AHI), lowest oxygen saturation during sleep, mean oxygen saturation, number of arousals per hour, and mean time spent in REM sleep. We calculated BMI using the, standard kg/m² formula and converted this into a Z-score.

Results

Fifty-two DS patients were analyzed with average age of 9.3 ± 4.5 years (10.2 ± 4.2 in 33 OSA patients, 7.8 ± 4.3 in 19 non-OSA patients). There were 28 males and 24 females. The OSA group mean BMI Z-score was 2.09 ± 0.94, and the non-OSA group Z-score was 1.4 ± 1.40. The Z-scores for BMI were statistically significant between OSA and non-OSA patients with p = 0.03 by t-test.

Conclusions

When age and sex adjusted, BMI has a statistically significant association with the presence of OSA in Down syndrome patients. The incidence of OSA also increases with increasing age in this population.     

口腔矫治器治疗阻塞性睡眠呼吸暂停综合征的近期疗效研究

目的探讨矫治器治疗阻塞性睡眠呼吸暂停综合征(OSAS)的方法、机制及适应症并进行疗效分析.方法选择诊断为OSAS的患者7例,男5例,女2例,戴入矫治器进行治疗.治疗前后摄头影测量片,并做PSG监测以评价疗效.结果7例OSAS患者戴入矫治器后,下颌骨位置改变至前伸位,咽腔结构及其周围软组织的位置关系均发生相应变化.Ve-PVe由4.8±0.82mm增加到6.3±1.9mm(P＜0.001),气道通气量增加.结论口腔矫治器是OSAS保守治疗的有效方法,对于下颌后缩、低角及无悬雍垂过长和软腭松驰下垂的轻中度OSAS患者效果良好.     

The effect of adenotonsillectomy on obstructive sleep apnea in children with Down syndrome*

Objective: Children with Down syndrome (DS) are liable to develop obstructive sleep apnea (OSA) due to many anatomical airway abnormalities. The tonsils and adenoid occupy part of the airway space, and their removal may be helpful in relieving airway obstruction. The aim of this study was to assess the effectiveness of adenotonsillectomy in the treatment of OSA in those children.

Methods: Fifty DS children with difficult breathing were recruited, and they were subjected to polysomnographic examination (PSG). Patients with apnea-hypopnea index (AHI)?>?1 were considered to have OSA. Adenotonsillectomy was performed for patients who had OSA and adenotonsillar hypertrophy, and after 3 months PSG was done for them with recording of the same preoperative parameters.

Results: Forty-three children demonstrated OSA on PSG, and they were included in the study. The preoperative mean AHI was 9.18 (±?6.17) that improved postoperatively to 2.72 (±?3.80) with its normalization in 72% of patients. Also, significant improvement of arousal index, minimum oxygen saturation, desaturation index, and peak end-tidal CO₂ was achieved postoperatively.

Conclusion: Adenotonsillectomy is an effective method for the treatment of OSA in children with DS. However, the condition may persist in some children who usually have airway narrowing at multiple levels.     

超声刀在治疗儿童阻塞性睡眠呼吸暂停低通气综合征中的应用

目的 探讨超声刀辅助下手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的可行性。方法 将38例入选儿童OSAHS患者分为A、B两组,A组(18例)用超声刀辅助下手术,B组(20例)采用传统方法手术,对术中出血量、手术时间、术后疼痛程度、术后伤口愈合情况及术后出血等几个方面进行对照观察研究。结果 术中出血量、手术时间及术后出血概率超声刀组较传统手术组明显减少,差异有统计学意义。超声刀术组与传统手术组在创面白膜生成及脱落时间、术后切口生长情况及术后疼痛方面差异无统计学意义。结论 超声刀辅助手术治疗儿童OSAHS具有微创、安全及可行性等特点,是一种治疗儿童OSAHS较好的方法。     

Questionnaire OSA-18 has poor validity compared to polysomnography in pediatric obstructive sleep apnea

Objective

To evaluate the diagnostic value of the quality-of-life instrument OSA-18 by comparing it with objective data from polysomnography in children with sleep-disordered breathing.

Study Design

Cross-sectional.

Patients and Methods

Full-night polysomnographic data were obtained from 225 subjects, 139 boys and 86 girls, median age 4.5 years (1–12) in our sleep laboratory. Their caregivers answered the OSA-18 quality-of-life instrument (range 18–126). The polysomnographic parameter, the apnea-hypopnea index (AHI) was compared with the total symptom score (TSS) and with the subscale of sleep disturbance (SD) from the OSA-18 questionnaire. Receiver operating characteristic (ROC) curves were created to test the predictive value of OSA-18.

Results

With the TSS of the OSA-18 at ≥60, compared with AHI levels of >1 and ≥5, the sensitivity was 55.2% and 59.3% respectively, and the specificity 40.9% and 48.4%, respectively. With the TSS > 80 and AHI levels of ≥5 and ≥10, the sensitivity was 24.6% and 32.1%, respectively. For the subscale of SD, the majority of the subjects showed poor correlation with the AHI values. The ROC area under the curve for different levels of the AHI (>1, ≥5, and ≥10) was 0.49, 0.57, and 0.56, respectively.

Conclusions

The OSA-18 questionnaire showed poor validity in detecting and predicting pediatric OSA. The majority of the children with severe OSA would not be correctly diagnosed if the OSA-18 were used as a dominant diagnostic tool.     

便携式睡眠监测仪对阻塞性睡眠呼吸暂停综合征的诊断价值

目前,一般认为整夜多导睡眠检测仪(PSG)是阻塞性睡眠呼吸暂停低通气综合征(OSAHS)诊断的金标准,但由于设备昂贵,检查程序复杂、对技术人员的要求太高等因素,限制了其临床的普及性及实用性。近年来,便携式睡眠检测仪(PMD)在临床的运用越来越受到重视,就便携式睡眠检测仪对OSAHS诊断价值的最新研究进展做一综述。     

男性阻塞性睡眠呼吸暂停低通气综合征患者快速眼动睡眠的特点分析

目的研究男性阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome, OSAHS）患者快速眼动（rapid eye movement,REM）睡眠的特点,探究睡眠呼吸暂停低通气指数（AHI）与男性REM睡眠的关系及临床意义。方法收集1235例在北京大学第三医院耳鼻咽喉科接受多导睡眠监测的男性个体,根据睡眠呼吸暂停低通气指数（AHI）分为正常对照、轻度、中度及重度4组,比较组间REM时长及所占比例。结果男性正常对照组REM期睡眠占总睡眠时长比例为（12.36±6.05）%,轻度OSAHS组为（11.97±6.53）%,中度OSAHS组为（11.26±5.58）%,重度OSAHS组为（8.73±5.32）%。随着AHI每增加10次/h,REM所占比例逐渐减少0.75%,且重度OSAHS患者REM期睡眠剥夺较轻中度组更为明显,差异具有统计学意义（P<0.001）。结论男性OSAHS患者随着AHI增加,REM睡眠减少,睡眠结构紊乱加重,且在重度OSAHS患者中更为显著。     

阻塞性睡眠呼吸暂停低通气综合征患儿扁桃体腺样体切除术临床疗效分析

目的 评价扁桃体腺样体切除术对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿的临床疗效。方法 行扁桃体及腺样体切除术患儿80例,术前、术后3个月或6个月行多道睡眠描记术（PSG）监测及OSA-18量表生活质量调查,分析手术疗效、PSG参数及OSA-18评分的变化。结果 80例患儿治愈70例（87%）,显效8例（10%）,有效2例（3%）,总有效率为100%。显效及有效的10例中8例合并变应性鼻炎经治疗变应性鼻炎后症状明显改善,另2例肥胖者经控制体质量后症状减轻。术后呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO2）、OSA-18总分与术前比较差异有统计学意义（P<0.05）。结论 扁桃体、腺样体切除术是治疗儿童OSAHS的有效方法,同时应治疗合并的其他上呼吸道阻塞因素。PSG结合OSA-18调查表可对患儿进行手术前后主客观的综合评价。     

阻塞性睡眠呼吸暂停综合征患儿T细胞亚群水平及相关指标的分析

目的 :检测阻塞性睡眠呼吸暂停综合征 (OSAS)患儿外周血T细胞亚群的变化 ,探讨OSAS对其细胞免疫功能的影响。方法 :应用APAAP桥联酶标法测定OSAS组和正常对照组外周血淋巴细胞表型 ,并将结果与睡眠检测指标进行相关性分析。结果 :OSAS组与正常对照组比较 ,CD4 、CD8 、CD4 /CD8 差异均有统计学意义 (均P <0 .0 1) ;CD4 、CD8 、CD4 /CD8 与呼吸暂停指数无相关性 ;与最低血氧饱和度 (LSaO2 )和病程有相关性 ,LSaO2 越低、病程越长 ,对T细胞亚群的影响越大 (P <0 .0 5 )。结论 :OSAS患儿细胞免疫功能低下。     

The role of sleep position in obstructive sleep apnea syndrome

We analyzed the role of sleep position in obstructive sleep apnea syndrome (OSAS). The polysomnograms of 120 patients with sleep apnea syndrome were analyzed. We associated the apnea hypopnea index (AHI) of the supine position with the AHI of the other positions. Patients were stratified in a group of positional patients (PP) (AHI supine ≥ 2 × AHI other positions) and a group of non-positional patients (NPP). In 55.8% of our patients, OSAS was position dependent. PP patients were significantly (6.7 years) younger. BMI and AHI were higher in the NPP group, but the difference was not significant. Level of obstruction in the upper airway (retropalatinal vs retrolingual vs both levels) as assessed by sleep endoscopy was not significantly different between the two groups. Total sleep time (TST) was equal in both groups, but the average time in supine position was 37 min longer in the PP group. This study confirms the finding that in more than 50% of patients, OSAS is position dependent. Apart from age, no patient characteristics were found indicating the position dependency. Overall AHI does not identify positional OSAS.     

Physiotherapy in obstructive sleep apnea syndrome: preliminary results

Apneic patients have hypotonia of the lingual and supra-hyoid muscles. The dysfunction of theses muscles leading to a collapse of the upper airway is responsible for the apnea. The goal of this study, designed as a before-after trial, is to determine the effect of lingual and supra-hyoid muscle strengthening on obstructive sleep apnea. Thirty-four patients with obstructive sleep apnea were included (consecutive sample). Only 16 patients completed the study. The treatment consisted of 30 sessions of transcutaneous neuromuscular stimulation administered to the submental region associated with muscular exercises. The effect on apneic events was analyzed with a polysomnography before and after the treatment. Thirteen patients could be analyzed for the statistical studies. The mean apnea-hypopnea index (AHI) decreased from 32.9 to 20.6 (Wilcoxon rank test: P=0.017). Seven patients ended the study with an AHI of less than 10, and three more patients decreased their AHI by more than 50%. This treatment significantly decreased the AHI in most of the patients. A larger study with more patients and with a long-term follow-up is necessary to determine the place of physiotherapy in the treatment of obstructive sleep apnea.     

悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停综合征60例报告

为探讨阻塞性睡眠呼吸暂停综合征的治疗方法，对６０例本病患者行悬雍垂腭咽成形术，其疗效分布是：显效５０％，进步３３．３％，无效１６．７％，总有效率为８３．３％。需要注意的关键是：①严格选择病例；②局麻下手术；③术中心电，血氧及血压监测；④重度ＯＳＡＳ患者术前行气管切开术；⑤术前吸氧，应用抗炎，止血药物，避免术后并发症发生。     

体重指数对阻塞性睡眠呼吸暂停低通气综合征的影响

目的了解体重指数（BMI）对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的影响。方法比较非肥胖组与肥胖组在呼吸紊乱指数（AHI）、最低血氧饱和度（LSaO2）、最长呼吸事件、平均呼吸事件间的差异。应用多元线性回归分析性别、年龄、体重指数（BMI）等因素对AHI、LSaO2的综合影响。结果非肥胖组的AHI小于肥胖组,LSaO2大于肥胖组,差异均有统计学意义。两组间最长呼吸事件与平均呼吸事件比较无统计学意义。BMI每增加1kg／m^2,女性患者的AHI增加3．058次／h,在BMI相等的情况下,男性患者的AHI比女性患者高10．311次／h。BMI每增加1kg／m^2,女性患者的LSaO2下降1．290％,在BMI相等的情况下,男性患者的LSaO2比女性患者低4．189％。结论随着BMI的增加OSAHS严重程度也逐渐增加,对男性的影响作用更明显。     

阻塞性睡眠呼吸暂停低通气综合征对青年患者血压的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对青年患者血压的影响。方法选取1999年1月-2011年6月在我院行睡眠监测的1469例青年患者,按2009年中华医学会耳鼻咽喉头颈外科学分会咽喉学组制定的诊断标准,将患者按呼吸暂停低通气指数（AHI）分为11个组,分别统计各组OSAHS伴发高血压病的例数,并进行列联表分析。分析各组患者年龄、体重指数（BMI）、AHI、最低血氧饱和度（LSaO：）与高血压的相关性。结果①1469例患者中,1188例确诊为OSAHS;557例（46．9％）患者伴发高血压,其中301例（54．5％）为单纯性舒张期高血压（isolateddias—tolichypertension,IDH）,233例（42．2％）是双相高血压（systolo—diastolichypertension,SDH）。②年龄、AHI、BMI与舒张期血压和收缩期血压呈正相关（r=0．156、0．289、0．299;r=0．168、0．333、0．255,P〈0．01）,LSaO：与舒张期血压和收缩期血压呈负相关（r=-0．282,-0．307,P〈0．01）并且都是高血压发生的独立相关因素。③组2与组3,组4与组5,组6与组10,其高血压病发率无明显差异（x2=1．361,x2=0．668,r=1．186,P〉0．05）。组1与组2,组2、3与组4,组4、5与组7,组11与其他各组之间高血压病发率存在明显差异（x2=2．251,x2=9．883,x2=4．136,r=4．672,P〈0．05）。结论青年OSAHS对血压,尤其是舒张期血压产生明显影响,年龄、AHI、BMI、LSaO。可能是高血压的独立相关因素。     

Optimal continuous positive airway pressure level in korean patients with obstructive sleep apnea syndrome

Objectives

The aim of this study was to investigate optimal continuous positive airway pressure (CPAP) level, to examine the factors affecting optimal CPAP level, and to develop a predictive equation for optimal CPAP level in Korean patients with obstructive sleep apnea syndrome (OSAS).

Methods

A total of 202 patients with OSAS who underwent successful manual titration for CPAP treatment were included in this study. Correlations between the optimal CPAP level and baseline data including anthropometric and polysomnographic variables were analyzed. A predictive equation for optimal CPAP level was developed based on anthropometric and polysomonographic data.

Results

The mean optimal CPAP level in 202 patients with OSAS was 7.8±2.3 cm H₂O. The mean optimal CPAP level in the mild, moderate, and severe OSAS groups was 6.0±1.3, 7.4±1.9, and 9.1±2.1 cm H₂O, respectively. The apneahypopnea index (AHI) (r=0.595, P<0.001), arousal index (r=0.542, P<0.001), minimal SaO₂ (r=-0.502, P<0.001), body mass index (BMI) (r=0.494, P<0.001), neck circumference (r=0.265, P<0.001), and age (r=-0.164, P=0.019) were significantly correlated with optimal CPAP level. The best predictive equation according to stepwise multiple linear regression analysis was: Optimal CPAP level (cm H₂O)=0.681+(0.205×BMI)+(0.040×AHI). Forty-two percent of the variance in the optimal CPAP level was explained by this equation (R²=0.42, P<0.001).

Conclusion

A predictive equation for optimal CPAP level in Korean patients with OSAS was developed using AHI and BMI, which can be easily measured during the diagnostic process.     

阻塞性睡眠呼吸暂停低通气综合征患者的病情评估问题

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome, OSAHS）影响患者的生活质量,可引起心脑血管等多系统并发症,准确评估其病情严重程度,有助于判断其预后。多导睡眠监测（polysomnography,PSG）是目前诊断OSAHS的“金标准”,但是其主要参数呼吸紊乱指数及最低血氧饱和度并不能准确反映患者的病情严重程度,常常与患者的主观感觉严重程度分离,而一些嗜睡量表及生活质量量表与患者的主观因素有关,客观性和可重复性较差,因此有必要制定全方位多角度综合评估方法。     

Metabolic alterations in children with obstructive sleep apnea

Importance

The incidence of obesity is rising in the United States and has been linked to Obstructive Sleep Apnea (OSA) even in young children. Understanding the role that obesity and OSA play in alterations in metabolic variables that can lead to serious health issues is essential to the care and counseling of affected children.

Objectives

To evaluate the association of alterations in metabolic variables, including insulin resistance, to OSA in young, obese children.

Design

Retrospective, case-control series.

Setting

Tertiary care children's hospital.

Participants

Obese children aged 2-12 years who had undergone overnight polysomography and routine laboratory testing for lipid levels, fasting glucose, and insulin from January 1, 2006 to December 31, 2012 were identified from a TransMed Bio-Integration Suite and Epic's clarity database search.

Results

A total of 76 patients were included for analysis. Forty-three (56.6%) were male, and the mean age was 8.3 ± 2.5 years (range, 2.4–11.9 years). The mean body mass index (BMI) z score was 2.8 ± 0.75 (range, 1.7–6.3), and all patients were obese (BMI z score > 95th percentile). Twenty two patients (28.9%) had an apnea–hypopnea index (AHI) <1/h (no OSA), 27 (35.5%) an AHI≥1 < 5/h, 12 (15.8%) had an AHI ≥5 < 9.99/h, and 15 (19.7%) had an AHI≥10/h. There was no significant difference in total cholesterol, triglycerides, high and low density lipoprotein levels, systolic and diastolic blood pressure in those patients with or without OSA. Fasting insulin, blood glucose, and homeostasis model assessment (HOMA) were significantly higher in patients with OSA compared to those with no OSA (p < 0.01). AHI correlated to alterations in insulin as well as glucose homeostasis on multivariate analysis. Results from logistic regression analysis showed that fasting insulin (p < 0.01), and HOMA (p < 0.01) predicted severe OSA independent of age, gender, and BMI z score in these patients.

Conclusion

Metabolic alterations in glucose and insulin levels, known to be associated with obesity and increased risk for cardiovascular disease, appear to relate to the severity of OSA in young children.