手术治疗腺样体肥大儿童阻塞性睡眠呼吸暂停综合征

目的　探讨腺样体切除术、腺样体扁桃体切除术对腺样体肥大儿童阻塞性睡眠呼吸暂停综合征(OSAS)的治疗作用。方法　对 2 0例腺样体肥大合并OSAS(OSAS组 )儿童手术前后的临床表现、多导睡眠图(PSG)检查结果进行前瞻性比较研究 ,并与同期住院的 1 0例单纯性腺样体肥大儿童 (对照组 )进行对照研究。结果　OSAS组的常见症状发生率与对照组差异无显著性 (P >0 .0 5 ) ;两组体块指数分别为 1 5 .4± 2 .5kg/m2 和1 7.6± 3.1kg/m2 ,差异无显著性 (P >0 .0 5 )。OSAS组与对照组的鼻咽侧位片A/n值、总睡眠时间、睡眠效率及S1、S2、慢波睡眠 (SWS)、快速眼动睡眠期 (REM)所占比例差异均无显著性 (P >0 .0 5 )。OSAS患儿术后呼吸暂停指数 (AI)、呼吸暂停低通气指数 (AHI)、阻塞性呼吸暂停指数 (OAI)较术前降低 (P <0 .0 5或 0 .0 1 ) ,REM所占比例较术前增高 (P <0 .0 5 )。结论　腺样体肥大合并OSAS的临床表现、鼻咽侧位片A/n值、睡眠结构与单纯腺样体肥大患儿无差别 ;腺样体肥大合并OSAS儿童手术治疗效果良好。     

Obesity and obstructive sleep apnea in children

The prevalence and severity of obesity in children and adolescent is dramatically increasing worldwide with a corresponding increase in the prevalence of obesity-associated morbidities particularly those involving OSAS and metabolic and cardiovascular sequelae. Obstructive sleep apnea and obesity hypoventilation syndrome are important and serious consequences of obesity, and may in fact mediate components of the association between obesity and metabolic and cardiovascular morbidities, most likely via potentiation of inflammatory cascades. It is anticipated that the increased prevalence of obesity in children and adolescents in our society will be accompanied by a steady increase in the incidence of OSAS. In this review, we will examine our current understanding of sleep-disordered breathing and associated morbidities in obese children, and summarize the range of therapeutic modalities currently available for this high-risk population.     

阻塞性睡眠呼吸暂停综合征儿童睡眠结构的改变

目的　研究阻塞性睡眠呼吸暂停综合征对儿童睡眠结构的影响。方法　对阻塞性睡眠呼吸暂停综合征患儿进行多导睡眠监测 ,并与同年龄组儿童睡眠结构正常值进行比较。结果　与正常值相比 ,阻塞性睡眠呼吸暂停综合征组的睡眠结构存在如下异常 :睡眠I期 :阻塞性睡眠呼吸暂停综合征组 ( 4 5 .8± 2 .0 ) % ,正常值 ( 2 .3± 1.1) % (t=2 2 .4 6 ,P <0 .0 1) ;睡眠Ⅱ期 :阻塞性睡眠呼吸暂停综合征组 ( 2 3.9±l.7) % ,正常值 ( 4 7.9士 4 .4 ) % (t =- 14 .18,P <0 .0 1) ;慢波睡眠 :阻塞性睡眠呼吸暂停综合征组 ( 15 .6± 1.8) % ,正常值 ( 2 1.1± 5 .0 ) % (t=- 3.12 3,P <0 .0 1) ;快动眼睡眠 :阻塞性睡眠呼吸暂停综合征组 ( 14 .7± 1.5 ) % ,正常值 ( 2 8.2± 4 .1) % (f =- 8.92 3,P <0 .0 1) ;差异均有显著性。结论　阻塞性睡眠呼吸暂停综合征可引起儿童睡眠结构的紊乱 ,主要表现为睡眠时频繁唤醒 ,睡眠片段化 ,浅睡眠增加 ,深睡眠和快动眼睡眠减少 ,导致患儿学习困难 ,智力下降 ,生长停滞。     

肥胖儿童阻塞性睡眠呼吸暂停的临床特征

目的 研究肥胖儿童合并阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的临床特征.方法 对在深圳市儿童医院呼吸科行多导睡眠监测的肥胖并诊断为OSA的33例7～15岁儿童的临床资料进行回顾性分析,并选取50例体重正常的、性别及年龄相匹配的OSA患儿作为对照组.结果 33例合并肥胖的OSA儿童中...     

Syndrome of obstructive sleep apnea in children]

Sleep apnea syndrome (SAS) in children has been identified only recently. Its incidence is unknown but seems to be rising. The cause is usually an obstruction (enlarged tonsils) that alters the fragile physiologic mechanisms responsible for maintaining the upper airways open when the child is sleeping. Diagnosis of SAS rests on clinical findings. The parents should be questioned as to the frequency over time of the various symptoms, of which most occur during the night: snoring, difficult breathing, respiratory pauses. Sleep polygraphy studies are indicated only in specific situations. The main cause is enlargement of the adenoids and tonsils. Cardiovascular complications may develop; weight gain and statural growth, psychomotor development and development of the face may be altered. Chronic snoring without apneas should be considered as a form of SAS. Treatment rests mainly on surgery (removal of the adenoids and tonsils).     

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目前在儿童阻塞性睡眠呼吸暂停综合征(OSAS)的因及诊断、治疗方面尚未形成统一看法。2002年美国儿协会在儿童OSAS的诊断和治疗的临床指引中提出如下点:(1)所有儿童都应接受是否有鼾声的筛查;(2)具有种高危因素的患儿应接受专业人士的指导;(3)具有心功能障碍的患儿不应再等待一些无关紧要的检查的评(4)诊断性评估在区别单纯鼾症和OSAS方面较有帮(5)扁桃体腺样体切除术对大部分患儿是一线治疗,对能接受手术治疗或手术治疗效果不好的患儿而言,气道续正压通气是另一选择;(6)具有高危因素的患儿术后应接受进一步的随访;(7)应对术后的患儿再…     

儿童阻塞性睡眠呼吸暂停综合征104例临床分析

为探讨儿童阻塞性睡眠呼吸暂停综合征(OSAS)诊断及治疗方法，对1997～2001年收治的104例被拟诊为OSAS的患儿进行临床资料总结。在无麻醉或表面麻醉下行腺样体切除术加单侧或双侧扁桃体挤切术92例，全麻下行腺样体切除术加单侧或双侧扁桃体剥离术12例。结果显示，术后随访半年～4年，打鼾、张口呼吸等症状消失59例(56．7％)，明显减轻28例(26．9％)，稍有改善14例(13．4％)，复发3例(2．88％)，总有效率83．6％。表明腺样体和扁桃体肥大是儿童OSAS最常见的病因，其早期诊断应依据详尽的病史和体格检查，PSG检查并不是确诊的唯一标准；手术治疗是目前最主要的治疗方法，而手术的彻底性是提高治愈率、防止复发的关键。     

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.     

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目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)儿童血氧饱和度(SpO2)的变化。方法选择于2009年7月至2010年3月因存在打鼾、睡眠张口呼吸、睡眠憋气或呼吸暂停等睡眠呼吸相关问题,在首都儿科研究所附属儿童医院进行整夜睡眠监测的141例患儿,以呼吸暂停低通气指数(AHI)>5作为OSAHS诊断标准,将入组儿童分为OSAHS组(78例)和非OSAHS组(63例),比较两组血氧指标、OSAHS儿童快速眼动期(REM期)和非快速眼动期(NREM期)的血氧指标。结果 OSAHS组和非OSAHS组相比,最低SpO2和氧减指数(ODI)差异具有统计学意义(Z=-3.64,-5.67,P<0.01),平均SpO2两者相比差异无统计学意义(Z=-0.90,P>0.05)。OSAHS组REM期和NREM期相比,ODI和每小时氧减事件时间差异存在统计学意义(Z=-5.568,-5.937,P<0.05),平均SpO2、最大氧减百分比和最长氧减时间差异无统计学意义(t=0.364,1.868,t=-0.33,P>0.05)。结论 OSAHS儿童存在SpO2的下降,而且REM期同NREM期相比,SpO2下降频率高,持续时间长...     

学龄前期和学龄期儿童阻塞性睡眠呼吸暂停综合征的比较研究

2001年3月—2004年2月,我们对60例学龄前期和学龄期儿童阻塞性睡眠呼吸暂停综合征（obstmctive sleepapnea syndrome,OSAS）的睡眠结构和睡眠呼吸障碍在不同睡眠阶段的表现进行了分析,旨在阐明阻塞性睡眠呼吸暂停综合征对不同年龄阶段儿童睡眠的影响及睡眠呼吸特征。     

Magnetic resonance imaging of obstructive sleep apnea in children

Sleep-disordered breathing has a spectrum of severity that spans from snoring and partial airway collapse with increased upper airway resistance, to complete upper airway obstruction with obstructive sleep apnea during sleeping. While snoring occurs in up to 20% of children, obstructive sleep apnea affects approximately 1–5% of children. The obstruction that occurs in obstructive sleep apnea is the result of the airway collapsing during sleep, which causes arousal and impairs restful sleep. Adenotonsillectomy is the first-line treatment of obstructive sleep apnea and is usually effective in otherwise healthy nonsyndromic children. However, there are subgroups in which this surgery is less effective. These subgroups include children with obesity, severe obstructive sleep apnea preoperatively, Down syndrome, craniofacial anomalies and polycystic ovarian disease. Continuous positive airway pressure (CPAP) is the first-line therapy for persistent obstructive sleep apnea despite previous adenotonsillectomy, but it is often poorly tolerated by children. When CPAP is not tolerated or preferred by the family, surgical options beyond adenotonsillectomy are discussed with the parent and child. Dynamic MRI of the airway provides a means to identify and localize the site or sites of obstruction for these children. In this review the authors address clinical indications for imaging, ideal team members to involve in an effective multidisciplinary program, basic anesthesia requirements, MRI protocol techniques and interpretation of the findings on MRI that help guide surgery.     

小儿阻塞性睡眠呼吸暂停综合征的临床及睡眠呼吸特征

目的　探讨小儿阻塞性睡眠呼吸暂停综合征 (OSAS)的临床特点 ,观察多导联睡眠监护仪对儿童OSAS的临床应用价值。方法　分析 60例OSAS患儿临床资料 ,应用睡眠呼吸监护仪 ,对 60例患儿术前及其中 40例扁桃体摘除术加 (或 )腺样体刮除术后患儿于夜间睡眠时做持续 7h以上记录 ,观察最长呼吸暂停时间、最长低通气时间、呼吸暂停和低通气次数及呼吸紊乱指数、睡眠期最低血氧饱和度、鼾声指数等 11项指标 ,并分组进行比较。结果　 60例术前均有扁桃体和 (或 )增殖体肿大 ,睡眠时伴粗大鼾声、憋气等症状。睡眠监测结果 :最长呼吸暂停时间为 5 3 ( 8～ 178)s;呼吸暂停总时间为 3 11( 2 6～ 5 2 60 )s;呼吸暂停次数为 2 6( 3～ 2 40 )次 ;最长低通气时间为 41( 5～ 94)s ;低通气总时间170 ( 5～ 2 860 )s;低通气次数为 10 ( 1～ 85 )次 ;呼吸暂停指数为 4 1( 0 5～ 2 5 9) ;低通气指数为 1 4( 0～16 1) ;呼吸紊乱指数为 6 8( 0 5～ 3 8 2 ) ;鼾声指数为 81 7( 1 3～ 414 8) ;最低血氧饱和度 0 78( 0 2 5～0 93 )。在 2～ 7岁组和 7岁以上组之间比较 ,以上指标差异无显著意义。手术后 :患儿临床症状明显缓解 ,最长呼吸暂停时间、呼吸暂停总时间、最长低通气时间、低通气总时间较术前明显缩短 ,呼吸暂停次数、     

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阻塞性睡眠呼吸暂停综合征(obstructivesleepapnea syndrome,OSAS),也称阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypoventilationsyndrome,OSAHS),是指以呼吸暂停或低通气为特征的睡眠呼吸疾病,其是以睡眠中间断性上呼吸道部分或完全梗阻为特点的睡眠性呼吸紊乱。OSAS是睡眠医学研究的一个重要领域,有2/3的睡眠疾病患者涉及OSAS。20世纪60年代起,OSAS逐渐受到重视和研究。1965年Gastaut、Jung和Kuhlo等[1]通过对1例诊断为Pickwickian综合征的患者进行电生理研究,发现其睡眠中反复出现呼吸暂停。随后Lugaresi和Guil…     

儿童阻塞性睡眠呼吸暂停综合征60例治疗分析

目的　探讨儿童阻塞性睡眠呼吸暂停综合征 (OSAS)的治疗方法。方法　对 6 0例OSAS患儿进行多导睡眠图 (PSG)监测 ,均行扁桃体摘除和 (或 )增殖体刮除术 ,术后 3个月对其中 4 0例患儿进行治疗效果评价。结果　经手术治疗后 ,患儿最长呼吸暂停时间由 (6 5 2± 5 1 2 )s降至 (16 4± 8 2 )s ,呼吸紊乱指数由 9 6± 9 0降至 1 2± 2 6 ,最低氧饱和度由 (74 4± 15 2 ) %提高到 (89 3± 8 1) % ,P值均 <0 0 1,临床症状明显改善。结论　扁桃体和 (或 )增殖体肥大是引起儿童OSAS最主要的病因 ,而扁桃体摘除和 (或 )增殖体刮除术是治疗儿童OSAS最有效的手段     

The effects of obstructive sleep apnea syndrome due to adenotonsillar hypertrophy on the cardiovascular system in children

Obstructive sleep apnea syndrome (OSAS) due to adenotonsillar hypertrophy (ATH) is a common and important problem in children. OSAS can lead to significant cardiopulmonary complications, poor growth and problems with learning and behavior. Many studies in the literature show that OSAS due to ATH causes pulmonary hypertension, ventricular hypertrophy and systemic hypertension in the pediatric population. In this review, we discuss the effects of ATH on cardiac function. It is well known that as a child grows, the nasopharyngeal passage becomes enlarged, helping to improve OSAS. Based on this, we discuss the possible positive effect of this age-related improvement on the obstruction of cardiovascular disturbances. Finally, the possible relationship between the duration of OSAS and the timing of surgery with the permanency of cardiovascular disturbances is discussed.