A case-control study of obstructive sleep apnea-hypopnea syndrome in obese and nonobese chinese children

BACKGROUND: Obesity is a risk factor for obstructive sleep apnea-hypopnea syndrome (OSAHS) in adults. However, the prevalence of OSAHS in children is not clear, and the relationship between obesity and OSAHS remains controversial. METHODS: Obese children were recruited from the endocrinology, respiratory, and ear, nose, and throat clinics. Weight-matched, age-matched, and sex-matched children were recruited as control subjects. Standard questionnaires were administered, and a standardized physical examination was carried out. Lateral neck roentgenography, sleep polysomnography, full blood count, and arterial blood gas analysis were also performed. Children with body mass index z-scores of > 1.96 were considered to be obese. An adenoidal/nasopharygeal ratio of > 0.67 was considered to constitute adenotonsillar hypertrophy (ATH). OSAHS was defined as an apnea-hypopnea index (AHI) score of > 5 or obstructive apnea index (OAI) score of > 1. RESULTS: Ninety-nine obese children and 99 control subjects were recruited into the study. Obese patients had significantly higher AHI and OAI scores, and lower sleep efficiency and minimum arterial oxygen saturation (MinSao(2)) than control subjects. The prevalence of OSAHS was significantly higher in obese children with or without the ATH groups than their nonobese counterparts (odds ratio, 1.9 vs 108, respectively; 95% confidence interval, 1.21 to 4.7 vs 6.2 to 191, respectively). Obesity, tonsillar hypertrophy, and adenoid hypertrophy were independent risk factors for OSAHS (p < 0.001, p = 0.042, and p = 0.004, respectively). There was a positive correlation between the degree of obesity and AHI (r = 0.535; p < 0.001), and an inverse correlation between obesity and MinSao(2) (r = -0.507; p < 0.001). End-tidal CO(2), Paco(2), and bicarbonate levels were within the normal range. CONCLUSIONS: Obesity is a risk factor for OSAHS, and the degree of obesity is positively correlated with the severity of OSAHS.     

OSAHS合并牙周炎患者唾液IL-6和TNF-α水平的变化

目的:观测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)及OSAHS合并牙周炎患者唾液中TNF-α、IL-6水平的变化.方法:将研究对象分为OSAHS合并牙周炎组40例,OSAHS无牙周炎组35例,单纯牙周炎组30例,正常对照组25例.用ELISA法检测并比较4组患者非刺激性全唾液中TNF-α,IL-6水平.结果:OSAHS合并牙周炎组中TNF-α、IL-6浓度显著高于其余各组,差异有统计学意义(P＜0.05).并且OSAHS合并牙周炎组唾液中TNF-α、IL-6与附着丧失(AL)成正相关(P＜0.05).结论:OSAHS中的炎症过程可能是促使牙周炎加重的重要因素,OSAHS的程度可预测牙周炎发生的危险性.     

不同严重程度OSAHS伴慢阻肺对患者认知功能的影响

目的探讨不同严重程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴慢阻肺对患者认知功能影响。方法入住的116例OSAHS伴慢阻肺患者,依据睡眠呼吸暂停低通气指数(AHI)分为轻、中、重3组。进行简易智能精神状态检查量表(MMSE)检测,分析各组患者认知障碍发生情况。结果重度OSAHS伴慢阻肺组MMSE总分明显低于轻、中度OSAHS伴慢阻肺组,在记忆力、注意力和计算力、回忆能力得分明显低于轻、中度OSAHS伴慢阻肺组,差异有显著性统计学意义(P0.05);轻、中度OSAHS组MMSE总分及在记忆力、注意力和计算力、回忆能力得分比较,差异无统计学意义(P0.05)。结论重度OSAHS伴慢阻肺患者较轻、中度OSAHS患者认知功能明显下降,主要表现在记忆、计算、回忆方面的损害。     

OSAHS诊断:AG与PSG、头影测量比较研究

目的:比较AG监测与多导睡眠监测(PSG)和头颅侧位片头影测量结果,评价几种检查方法对于睡眠呼吸障碍疾病性质、严重程度及阻塞定位诊断的准确性。方法:利用美国杰西AG200系统对36名成年男性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行上气道-食道压力监测,将AG结果与PSG结果和头颅侧位片头影测量结果进行对比分析。结果:AG和PSG测得的AHI、最低血氧、阻塞性暂停低通气次数/h无差异;测得的平均血氧、阻塞性暂停次数/h有差异。头颅侧位片头影测量和AG对于主要阻塞平面的判定结果间有差异;头颅侧位片显示的某平面气道最小前后径与AG测得的平均每小时该平面阻塞次数在腭后区呈线性相关,在舌后区无线性相关关系。结论:AG系统具备了便携PSG的功能,能对睡眠呼吸疾病作出准确的初步定性诊断,且能较准确地进行上气道阻塞定性定位。     

OSAHS病人气道呼吸阻力测定的临床分析

目的探讨阻塞性睡眠呼吸暂停低通气综合征病人呼吸阻抗力的临床意义。方法选取70例OSAHS和肺通气功能检测正常的病人为研究对象,按照呼吸暂停低通气指数(AHI)分成轻、中、重度,探讨两组病人呼吸阻抗力的差异。结果两组病人采用4 Hz和16 Hz两个振荡频率进行比较,发现中重度组病人阻力增加较为显著,但差异无显著性(P>0.05),但是采用8 Hz时显示两者差异具有显著性(P<0.05)。结论研究示OSAHS病人肺功能正常时,其小气道可有病变。脉波振荡肺功能(IOS)对于诊断OSAHS具有临床意义。     

OSAHS患者咽部解剖与呼吸驱动的关系研究

目的 探讨OSAHS患者咽腔形态与呼吸驱动(p0.1)的关系.方法 随机选取OSAHS患者35例,进行仰卧位睡眠状态下呼吸驱动测定及螺旋CT扫描,针对轻度(AHI ＜20)、中重度(AHI＞ 20)两组患者进行研究.结果 睡眠状态下,①中重度组软腭长度,软腭厚度,颏舌肌宽度及舌体面积明显增加(P＜0.05),软腭后区最小气道面积明显减小(P＜0.05);②中重度组P0.1的下降更为明显(P＜0.05).③中重度组颏舌肌宽度与P0.1有明显负相关性(r=-0.574,P＜0.05).结论 睡眠状态下,咽腔狭窄程度与OSAHS病情相关,随着OSAHS患者病情加重,颏舌肌的代偿作用增加,当代偿到一定程度时出现呼吸驱动的降低.     

BiPAP治疗慢性阻塞性肺疾病合并OSAHS的疗效分析

目的观察双水平气道正压通气(BiPAP)治疗慢性阻塞性肺疾病(COPD)并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法将48例COPD合并OSAHS患者(即重叠综合征OS)进行BiPAP治疗10 d后,对其治疗前后的血气分析、多导睡眠监测(PSG)以及肺功能进行比较。结果治疗后患者血气分析值PaO2、PaCO2以及肺功能FEV1/FVC%较治疗前明显好转(P<0.05),PSG监测呼吸睡眠暂停低通气指数(AHI)、最长呼吸暂停时间、平均及最低血氧饱和度、慢波深睡眠、总呼吸暂停次数较治疗前明显好转(P<0.05)。结论对于COPD合并OSHAS的重叠综合征患者,BiPAP治疗效果确切。     

中重度阻塞性睡眠呼吸低通气综合征UPPP联合鼻内镜手术的综合治疗

目的分析阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的临床资料,探讨中重度OSAHS患者的治疗经验。方法对56例中重度OSAHS患者,实施UPPP手术联合鼻中隔矫正等多平面手术,其中部分不接受CPAP治疗的重症OSAHS患者实施气管切开术,予以控烟、戒酒等行为治疗等综合治疗措施,术后随访6个月以上,判断疗效。对是否行气管切开手术的两组患者的年龄、打鼾病史、BMI等进行比较分析。结果患者术后打鼾明显减轻,呼吸暂停次数明显减少,血压、血糖等控制较为理想,气管切开术的重症患者出院前能顺利拔管。两组患者打鼾病史、BMI比较有统计学意义,气管切开组患者的打鼾病史较长[（13.40±9.74）年/（7.98±3.04）年,P=0.02]、年龄普遍偏大[（45.74±6.27）岁/（41.76±9.76）岁,P=0.11）、BMI指数提示超重和肥胖居多[（32.38±10.34）/（26.34±3.15）,P=0.02]。结论 UPPP联合鼻内镜手术的综合治疗是中重度OSAHS的有效措施;对于病史较长、年龄偏大、超重甚至肥胖的重度OSAHS患者,气管切开术是重要的预防措施之一。