腺样体肥大儿童睡眠呼吸障碍的研究

目的　了解腺样体肥大儿童出现阻塞性睡眠呼吸障碍 (OSA)的比率、临床表现、腺样体肥大程度与多导睡眠图 (PSG)结果的相关性。方法　对 42例腺样体肥大住院患儿的临床资料、鼻咽侧位片、PSG结果进行前瞻性比较研究。结果　 42例腺样体肥大患儿中 3 3例 (78.6% )并OSA ;OSA患儿呼吸暂停、晨起疲倦表现与PSG结果中最长呼吸暂停时间的相关系数r =0 .2 16　P <0 .0 5 ,白天张口呼吸的频繁程度与呼吸暂停低通气指数 (AHI)、阻塞性呼吸暂停指数 (OAI)相关性的P分别 0 .0 15、0 .0 3 3 ;鼻咽侧位片A/n值与PSG结果相关性的P为 0 .0 5 5。结论　OSA在腺样体肥大患儿中出现比率较高 (78.6% ) ;腺样体肥大患儿中睡眠呼吸暂停及晨起疲倦表现与PSG最长呼吸暂停时间呈正相关。白天张口呼吸的频繁程度对OSA的严重程度有预测作用 ;A/n值与阻塞性呼吸暂停时间可能有一定相关性     

阻塞性呼吸睡眠暂停综合征18例

目的 探讨小儿阻塞性呼吸睡眠暂停综合征（OSAS）的临床特点。方法 收集确诊为OSAS的2～12岁患儿18例。其中男10例，女8例。分析其病因、临床表现、睡眠监测、合并症、并发症、误诊疾病、治疗方法及效果。结果 儿童OSAS主要表现为打鼾、张口呼吸、夜间呼吸暂停、易醒、多汗、遗尿、白天嗜睡、多动、行为异常、记忆力低下，经睡眠多导仪监测（PSG）结果为睡眠呼吸暂停低通气指数（AHI）增高，氧饱和度下降，常见病因为扁桃体及腺样体肥大。治疗方法主要为扁桃体摘除及腺样体刮除术。结论 儿童OSAS主要病因为腺样体和（或）扁桃体肥大。其主要临床表现为打鼾、张口呼吸、呼吸暂停。最有效治疗方法是手术摘除扁桃体和（或）腺样体。     

儿童阻塞性睡眠呼吸暂停低通气综合征

儿童阻塞性睡眠呼吸暂停低通气综合征(obstructivesleep apnea hypopnea syndrom e,OSAH S)的特征是睡眠过程中出现阵发性上气道部分或完全阻塞。相比单纯性打鼾,还伴有不同程度的氧饱和度降低、高碳酸血症及睡眠破碎。睡眠破碎导致一些儿童白天嗜睡,清晨觉醒困难和注意力不集中;而另一些儿童则表现为反常的白天多动而不是嗜睡,这可诊断为注意涣散多动症。OSA H S的常见症状包括睡眠不安和夜间鼾声响亮,有时可闻及间歇性喘息。此外,还可发生夜间遗尿、恶梦及晨起头痛。长期严重的OSAH S可能导致儿童生长发育迟缓、神经行为障碍、肺动…     

健康儿童和哮喘儿童睡眠紊乱状况调查比较

目的初步调查北京地区2~12岁健康儿童和哮喘儿童中睡眠呼吸障碍常见症状的发生率,比较二者的差异。 方法2002年6月至2003年6月间对北京6个近郊区县随机整群抽取6193例2~12岁健康儿童和北京儿童医院呼吸疾病专业门诊随机抽取的200例2~12岁缓解期哮喘儿童,由专人负责对家长进行儿童睡眠状况问卷调查。 结果哮喘儿童睡眠障碍症状发生率为47.0%(94例)。其中睡眠频繁鼾症发生率为11.0%(22例),喉头哽咽1.5%(3例),张口呼吸13.0%(26例),睡眠呼吸暂停1.5%(3例),磨牙8.0%(16例),梦呓7.0%(14例),梦游0.5%(1例),睡眠中肢体抽动4.0%(8例),睡眠不安28.5%(57例)。哮喘儿童睡眠障碍发生率较无呼吸道疾病的正常儿童高,其中睡眠频繁打鼾、睡眠不安、张口呼吸和睡眠呼吸暂停的发生率差异存在显著性意义(P<0.05)。 结论哮喘儿童睡眠障碍发生率高于无呼吸道疾病的正常儿童,其中睡眠频繁打鼾、睡眠不安、张口呼吸和睡眠呼吸暂停的发生率差异存在显著性意义,应引起重视。对哮喘儿童睡眠障碍的防治应进行进一步研究。     

兰州市儿童肥胖与睡眠障碍的相关性分析

目的 调查兰州市儿童肥胖与睡眠障碍的流行情况及相互关系。方法 采用分层整群随机抽样的方法在甘肃省兰州市4个区选取3 283名小学生,进行体格检查和睡眠问卷调查,选出符合睡眠障碍和符合肥胖标准的两组儿童作为研究对象,同时随机选出既无睡眠障碍也无肥胖的健康儿童200名作为对照组。结果 3 283名儿童中,肥胖检出率为5.76%（189/3 283）,肥胖合并睡眠障碍的儿童占42.3%（80/189）。睡眠障碍检出率为16.24%（533/3 283）,睡眠障碍儿童中肥胖的检出率为24.6%（131/533）。肥胖儿童中,打鼾是最常见的睡眠障碍;肥胖合并睡眠障碍儿童中,阻塞性睡眠呼吸暂停低通气综合征的检出率为45%（36/80）。肥胖儿童睡眠障碍的检出率（42.3%）明显高于体重正常儿童（20.0%,40/200）,差异有统计学意义（P < 0.01）。结论 兰州市儿童肥胖和睡眠障碍之间关系密切,互为影响因素。     

儿童阻塞性睡眠呼吸暂停并发症的研究进展

阻塞性睡眠呼吸暂停（OSA）在儿童中的发病率约为1％－3％，过度肥胖，有颅面畸形或夜间打鼾的儿童比较容易发现并能得到及时治疗，但对大多数儿童来说，由于无明显症状而常被忽视，临床研究发现，长期患OSA而得不到治疗可导致患儿生长发育迟缓，高血压，肺心病以及智能发育障碍，严重的可以引起猝死，其病因主要是呼吸道堵[塞造成的缺氧和／或二氧化碳潴留，而经过适当的治疗如切除过度肥大的扁桃体和腺样,地有颅面及呼吸道畸形者做矫形手术或在夜间睡眠时给予适当的吸氧，均能不同程度地改善症状，因此人们越来越重视对其并发症的研究，以便尽可能地减少由于呼吸暂停对机体造成的损害，本文将就此作一综述。     

重度阻塞性睡眠呼吸暂停患儿临床预测模型研究

目的　建立习惯性打鼾患儿中重度阻塞性睡眠呼吸暂停（OSA）的临床预测模型,为临床诊疗提供依据。方法　选择2019年1月至12月就诊于首都医科大学附属北京儿童医院睡眠中心的3～12岁习惯性打鼾患儿。所有患儿完成一般资料收集、OSA-18问卷、PSQ-SRBD量表及多导睡眠监测。应用决策树方法构建重度OSA患儿的临床预测模型。结果　共纳入受试患儿1441例,根据PSG结果,重度OSA 1152例,非重度OSA 289例。重度OSA组年龄、男性比例、体重指数（BMI）、颈围/身高比、腹围/臀围比、SRBD量表呼吸维度、其他维度及总分均高于非重度OSA组（P均<0.01）。OSA-18问卷各个维度得分及总分在两组患儿间比较,差异无统计学意义（P均>0.05）。基于决策树构建的重度OSA患儿预测模型,对非重度OSA患儿预测精确率为90%,召回率76%,F1得分82%,对重度OSA患儿的预测精确率32%,召回率58%,F1得分41%,整体准确率为73%。 结论　该研究构建的重度OSA患儿临床预测模型整体准确率73%,有一定的预测价值,能为临床排除重度OSA患儿提供一定的依据,指导临床决策,但仍需更多的临床资料进一步优化模型。     

儿童阻塞性睡眠呼吸障碍低通气综合征临床特点分析

目的分析儿童阻塞性睡眠呼吸障碍低通气综合征(OSAHS)的临床及多导睡眠监测(PSG)特点。方法选取2016年12月-2019年4月以打鼾或/伴张口呼吸症状就诊的患儿为研究对象,收集临床及PSG监测资料。根据PSG结果分为OSAHS组、单纯打鼾(PS)组及鼾症伴氧减组,分析各组患儿的临床资料及PSG结果。结果共入组408例患儿,中位年龄5岁(4～7岁),男260例、女148例。OSAHS患儿99例,PS患儿201例,鼾症伴氧减患儿42例。OSAHS组扁桃体肿大、腺样体肥大比例高于PS组,鼻炎/鼻窦炎比例低于PS组,OSAHS组的夜间打鼾、呼吸费力、呼吸暂停、夜尿比例均高于PS组,OSAHS组的日间思睡比例高于PS组和鼾症伴氧减组,差异均有统计学意义(P0.05)。OSAHS组的PSG监测NREM1期睡眠时间、鼾声指数均高于PS组,NREM3期比例低于PS组。OSAHS组及鼾症伴氧减组的最低血氧饱和度(LSaO_2)均低于PS组,差异有统计学意义(P0.05)。OSAHS组的呼吸暂停低通气指数(AHI)最高,呼吸暂停最长时间最长,其次为鼾症伴氧减组,差异均有统计学意义(P0.05)。多元logistic回归模型分析显示,腺样体肥大、肥胖、存在过敏性鼻炎/鼻窦炎是儿童OSAHS发生的独立危险因素(P0.05)。结论 OSAHS患儿存在睡眠结构紊乱,主要为NREM1期睡眠时间延长,NREM3期时间缩短。肥胖、腺样体肥大、鼻炎或鼻窦炎是OSAHS发生的危险因素。     

北京地区6～18岁肥胖儿童青少年睡眠障碍相关症状调查

目的了解北京地区6~18岁肥胖儿童青少年睡眠障碍相关症状的发生情况。方法2004-03-10对首都儿科研究所联合18家医疗单位所进行的北京市6个区县的19517例6~18岁儿童体重测量结果进行分析,根据中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准,共筛查出6~18岁肥胖儿童1888例。在此基础上,2005-03—2006-02,从中随机抽取了1100例6~18岁肥胖儿童和青少年,由专人负责对家长和儿童进行睡眠状况的问卷调查,合格问卷1000份,回收率为90.9%。结果北京地区1000例6~18岁肥胖儿童青少年睡眠障碍相关症状的发生率为38.7%,其中入睡时间超过0.5h发生率为7.5%,睡眠打鼾10.6%,张口呼吸为6.7%,憋醒0.5%,睡眠呼吸暂停为0.1%,睡眠恐惧感为2.4%,梦游或做噩梦2.4%,睡眠中肢体抽动为12.7%,过度出汗2.6%,遗尿0.1%,清晨起床困难9.0%,清晨起床感觉头痛1.4%,清晨起床感觉咽部发干5.8%,白天容易困倦4.8%,近半年学习成绩下降16.5%,性情急躁21.8%。不同症状的发生率存在性别和年龄差异,但城乡差异不明显。结论目前北京市肥胖儿童青少年睡眠障碍相关症状的发生率较高,应引起北京市儿科、儿保工作人员及儿童家长的重视。     

Down综合征患儿睡眠特征多导睡眠图的回顾性研究

目的 探讨Down综合征患儿的睡眠结构和基本睡眠参数的特点。方法 选取10例Down综合征患儿为Down组，采用染色体核型检查进行Down综合征的诊断，其中男7例，女3例，年龄中位数8岁2个月；选取声带小结患儿14例及突发性耳聋6例患儿为对照组，其中男12例，女8例，年龄中位数8岁9个月。两组患儿均接受整夜多导睡眠图监测，按中华医学会耳鼻咽喉科学分会制定的儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）诊疗指南（草案）中的标准进行呼吸事件的定义和OSAHS的诊断，阻塞性呼吸暂停指数（OAI）每小时≤1次或呼吸暂停低通气指数(AHI) 每小时≤5次，最低血氧饱和度(LSaO2)≥0.92可以排除OSAHS。应用Mann-Whitney U和精确概率检验，比较Down组和对照组的睡眠结构，并进行睡眠期LSaO2、OAI、AHI、脑电醒觉反应指数及睡眠期肢体运动事件指数的比较。结果 ①两组间在年龄、性别和体重指数等差异无统计学意义（P＞0.05）；②Down组和对照组比较，快动眼睡眠比例减少，且差异有显著统计学意义（Z=-2.6，P= 0.009）；③睡眠期LSaO2较对照组显著下降（P＜0.05），OAI、AHI及睡眠期肢体运动事件指数Down组较对照组显著升高（P＜0.05）；④10例Down综合征患儿中有6例符合OSAHS诊断，6例中有5例为男性。结论 Down综合征患儿存在睡眠呼吸紊乱，应使用多导睡眠检测的方法尽早发现睡眠呼吸紊乱的问题。     

Children and nocturnal snoring: Evaluation of the effects of sleep related respiratory resistive load and daytime functioning

Twenty-five children, age range 2 to 14 years (mean age=7), were referred to the Stanford University Sleep Disorders Clinic for various clinical symptoms, including excessive daytime somnolence, heavy nocturnal snoring, and abnormal daytime behavior. All children (10 girls and 15 boys) were polygraphically monitored during sleep. No sleep apnea syndrome or oxygen desaturation was revealed. However, each child presented significant respiratory resistive load during sleep associated with electrocardiographic R-R interval and endoesophageal pressure swings. The most laborious breathing occurred during REM sleep. Second degree atrioventricular blocks were also noted. Tonsillectomy and/or adenoidectomy was performed in every case and resulted in a complete disappearance or substantial amelioration of the reported symptoms. Objective evaluation by Multiple Sleep Latency Test and Wilkinson Addition Test confirmed the beneficial effect of surgery.     

儿童神经肌肉疾病患者的睡眠呼吸障碍特征分析

目的 分析神经肌肉疾病(NMD)患儿的睡眠呼吸障碍(SDB)特征,提高对儿童NMD合并SDB的诊治认识.方法 回顾性分析既往确诊NMD且行多导睡眠监测(PSG)的18例患儿(NMD组)的病例资料,选取同期睡眠习惯异常、无神经肌肉疾病且PSG显示睡眠结构正常的11例儿童作为对照组.比较两组患儿的SDB日夜间症状、阻塞性睡...     

Sleep-related abdominal muscle behavior during partial or complete obstructed breathing in prepubertal children

We have evaluated the influence of nonrapid eye movement (NREM), REM sleep, and arousal on abdominal muscle contractions during snoring and/or obstructive apnea in 10 prepubertal children. All children were known habitual snorers and eight had a sleep apnea index above 10. During stage 3-4 non-REM sleep, non-apneic breathing with snoring was always associated with the presence of expiratory abdominal muscle electromyogram (EMG) discharges. During non-REM sleep apneas, abdominal muscle EMG discharges increased from the beginning to the end of each apnea. Termination of non-REM sleep apnea was marked by an "EEG arousal" in 12% of the apneic events and by a "movement arousal" in the other 88%. The highest abdominal muscle EMG discharge was always observed during the arousal response. During "phasic" REM sleep, abdominal muscle EMG discharges were absent during both nonapneic breathing (with or without snoring) and obstructive apneas. All REM sleep apneas ended with a "movement arousal," during which abdominal muscle EMG discharges were observed. Thus, abdominal muscle EMG discharges associated with "arousal" were seen independent of the immediately preceding sleep state.     

Low daytime pulse oximetry reading is associated with nocturnal desaturation and obstructive sleep apnea in children with sickle cell anemia

A retrospective medical record review was established to test the hypothesis that in children with sickle cell anemia (SCA), a daytime oxygen saturation (SpO(2)) 相似文献   

Symptoms of sleep disturbances among children at two general pediatric clinics

OBJECTIVE: We assessed the frequency of childhood sleep problems at 2 general pediatric clinics.Study design: Parents of 1038 unselected children (554 boys) aged 2.0 to 13.9 years completed a validated Pediatric Sleep Questionnaire while waiting for appointments. RESULTS: Habitual snoring was reported in 176 (17%) of the children. Criterion scores suggestive of sleep-disordered breathing were found in 115 (11%) of the children, in 29% of children at the clinic for neurologic indications, and in 21% of children at the clinic for noninfectious respiratory indications. Insomnia (ie, unrefreshing sleep or difficulty with sleep onset, sleep maintenance, or early morning awakening from sleep) was reported in 430 (41%) of the children; > or =2 symptoms were present in 191 (18%) of the children. Excessive daytime sleepiness was suggested in 148 (14%) of the children, and 390 (38%) had symptoms of sleep terrors, sleepwalking, or nocturnal bruxism. CONCLUSIONS: Sleep problems such as sleep-disordered breathing, insomnia, excessive sleepiness, and parasomnias are frequent among children seen at general pediatric practices.     

Obstructive sleep apnoea in children

Habitual snoring is a very common problem in the paediatric population, especially in preschool children. The differentiation of snoring children into those with primary snoring and those with obstructive sleep apnoea (OSA) is difficult on clinical grounds and the gold standard investigation remains the overnight polysomnogram. The epidemiology of sleep-disordered breathing and OSA in children is changing, in part in relation to the rising prevalence of overweight and obesity in young people. There is also increasing recognition of the adverse neurodevelopmental sequelae that can be associated with OSA, and possibly with milder manifestations of sleep-disordered breathing such as primary snoring. It is therefore important that paediatricians are aware of the problems of sleep-disordered breathing in children, and that a detailed sleep history is part of routine clinical assessment when sleep-related breathing disturbance is suspected or possible.     

Sleep-disordered breathing symptoms are associated with poorer cognitive function in 5-year-old children

OBJECTIVE: To assess the relation of sleep-disordered breathing (SDB) symptoms in children to neurocognitive function. STUDY DESIGN: A cross-sectional, population-based study of 205 5-year-old children. A parent-completed questionnaire was used to ascertain SDB symptoms, defined as frequent snoring, loud or noisy breathing during sleep, or witnessed sleep apnea. Polysomnography (PSG) data were available in 85% of children. Standardized neurocognitive tests were administered by a trained psychometrist unaware of the children's SDB status. Children with (n=61) and without SDB symptoms were compared using analysis of variance to adjust for demographic and respiratory health variables. RESULTS: Children with SDB symptoms scored significantly lower than those without SDB symptoms on tests of executive function (95.5 vs 99.9 on NEPSY Attention/Executive Core Domain, P=.02; 10.4 vs 11.2 on Wechsler Preschool and Primary Scale of Intelligence, Revised [WPPSI-R] Animal Pegs test, P=.03), memory (96.8 vs 103.0 on NEPSY Memory Domain, P=.02), and general intellectual ability (105.9 vs 111.7 on WPPSI-R Full Scale IQ, P=.02). There were no significant differences on a computerized continuous performance task. These findings persisted when children with PSG evidence of obstructive sleep apnea (OSA) were excluded from analysis. CONCLUSION: Even in the absence of OSA, SDB symptoms are associated with poorer executive function and memory skills and lower general intelligence in 5-year-old children.     

Night-to-night variability of polysomnography in children with suspected obstructive sleep apnea

OBJECTIVES: To determine whether a single polysomnographic night was a valid measure of obstructive sleep apnea syndrome (OSAS) in children with symptoms of sleep-disordered breathing. STUDY DESIGN: The night-to-night variability of respiratory and sleep parameters was measured prospectively in 30 snoring children aged 1.6 to 11.3 years (mean +/- SD, 4.1 +/- 2) by using 2 nocturnal polysomnograms performed 7 to 27 days apart (14 +/- 5 days). RESULTS: The mean of the respiratory variables including apnea index, apnea/hypopnea index, arterial oxygen saturation, and end-tidal partial pressure of carbon dioxide were not significantly different from night to night. Among the sleep parameters, there was no significant night-to-night difference in sleep efficiency, arousal index, percent rapid eye movement, or percent of slow wave sleep. Only the percentage of stage 2 was significantly different between the nights. The polysomnographic clinical diagnosis remained the same on both nights for all children, although the disease severity differed slightly in 2 patients. CONCLUSIONS: There is little clinically significant night-to-night variability in pediatric polysomnography, and no first-night effect. These data suggest that a single polysomnographic night is an adequate measure of the OSAS in children with symptoms of sleep-disordered breathing.     

Prevalence of habitual snoring and sleep-disordered breathing in preschool-aged children in an Italian community

OBJECTIVE: To measure the prevalence of habitual snoring and sleep-disordered breathing in preschool-aged children. STUDY DESIGN: Cross-sectional survey with parental report and overnight ambulatory monitoring of children 3 to 6 years of age in 8 kindergartens (n = 604). Parents reported the child's information through an interviewer-based questionnaire or by a brief telephone interview. Snoring, oxygen saturation, body position, and heart rate were recorded for 1 night at home. RESULTS: Data were obtained on 98.5% of 604 children (447 questionnaires, 74%; 148 telephone interviews, 24.5%); groups were similar for sex and age. Two hundred sixty-five children had ambulatory monitoring at home. Habitual snoring (always and often) was reported in 34.5% and breathing cessation in 18.6%. Habitual snoring was associated with parental report of daytime symptoms (P =.001) and daytime somnolence (P =.032). Pathologic snoring was present in 12% of children (95% CI, 7.9-16.1). On multivariate analysis, parental report of habitual snoring was the strongest determinant of pathologic snoring (OR, 12.23; 95% CI, 3.56-41.94). Oxygen desaturation index > or =5 per hour was found in 13% of children (95% CI, 8.7-17.3). CONCLUSIONS: Parental report of habitual snoring is very common. Children with habitual snoring are more likely to have objectively measured snoring and daytime morbidity.