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。

Retrospective polysomnographic analysis of sleep-disordered breathing in children with Down syndrome

Objective Otolaryngologic or ear, nose,and throat(ENT)problems are common in children with Down syndrome. In this retrospective study, we aimed to compare the sleep architecture and principal variables of polysomnography(PSG) between children with Down syndrome and other children without sleep disordered breathing and Down syndrome, and to determine the characteristics of sleep architecture and principal variables of PSG in children with Down syndrome.Methods From 2005 to 2007, ten children with Down syndrome were enrolled in Down group(male:7 vs female:3). The median patient age were 8 years and 2 months old, with a range of 7 years and 8 months to 9 years and 11 months. With the median age of 8 years and 9 months, fourteen children with vocal nodule and six children with sudden deafness were enrolled in control group from 2004 to 2007. All children underwent overnight PSG monitoring. The children in control group with sleep-disordered breathing and Down syndrome were excluded. The sleep architecture and obstructive apnea index(OAI), hypopnea index(HI), lowest oxygen saturation (LSaO2), arousals index and leg movement index were compared between the Down group and control group. Respiratory event and OSAHS were diagnosed according to the general criterion (Draft of guidelines for the diagnosis and treatment of pediatric sleep apnea hypopnea syndrome (Urumqi) published in Chin J Otorhinolaryngol Head Neck Surg in february, 2007). An apnea hypopnea index greater than 5times/hr or obstructive apnea index greater than 1 times/hr and lowest oxygen saturation less than 92% were required for defining the presence of OSAHS. Chromosome karyotyping assay was used to dignose the Down syndrome.Results ①The two groups were matched for gender, age and body mass index（P＞0.05）。②When compared with that of control group, the stageⅠ%,StageⅡ%, StageⅢ% and StageⅣ% of Down group were not significantly different. The rapid eye movement%(REM%) of the Down group was 11.3% while REM% of control group was 20.5%. The decrease of REM% was significantly different between the Down group and the control group（Z=-2.6,P=0.009﹚.③An increase of OAI, HI and leg movement index and decrease of SaO2 in Down group were more significant than that in control group(median: 5.6, 3.8, 18.8, 61 versus median: 0.27, 0.63, 7.6, 94 )（P＜0.05﹚.The median arousals index of the Down group was 13.7 while that of control group was 6.2, however, the difference of arousals index between the Down group and the control group was not significant（Z=-0.441, P=0.659）.④All Down syndrome children had respiratory pauses during sleep, 6 of them justfied the diagnosis of OSAHS. Five of the 6 children were boys.Conclusions Sleep disordered breathing could be observed in children with Down syndrome. Baseline PSG was recommended in children with Down syndrome. However, larger and more detailed population studies were requried to further define an association between OSAHS and Down syndrome(age,sex,etc.).