打鼾儿童睡眠中矛盾呼吸的临床意义初探

目的 了解胸腹矛盾呼吸在儿童夜间睡眠呼吸中的出现情况,探讨胸腹矛盾呼吸在儿童睡眠呼吸疾病诊断中的意义.方法 选取有睡眠呼吸障碍主诉的儿童38例为实验组;同期收集无睡眠打鼾、张口呼吸、呼吸暂停,无腺样体和(或)扁桃体肥大的儿童志愿者26例为对照组.所有入组儿童均进行整夜多道睡眠图(PSG)监测.根据记录数据判断矛盾呼吸,比较胸腹矛盾呼吸在两组儿童中出现的情况.结果 睡眠过程中胸腹矛盾呼吸在实验组和对照组中均有发生,矛盾呼吸总时间((-x)±s,以下同)实验组为:(70.1±40.4)min,对照组为(28.2±25.7)min,两组差异有统计学意义(t=5.060,P＜0.05);矛盾呼吸占总睡眠时间的比例(时间构成比)实验组与对照组分别为:17.9%±11.0%和7.3%±6.8%,两组差异有统计学意义(t=4.767,P＜0.05).依据儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的诊断和病情严重程度判断标准,把有睡眠呼吸障碍症状主诉的儿童,进一步分为实验组的正常-轻度组(18例)和中-重度组(20例).正常-轻度组儿童的矛盾呼吸表现比中-重度组和对照组儿童的更为明显,正常-轻度组、中-重度组和对照组儿童矛盾呼吸时间分别为(85.9±31.7)min、(55.8±42.7)min和(28.2±25.7)min,3组数据比较差异有统计学意义(F=15.897,P＜0.05);3组矛盾呼吸时间构成比分别为22.0%±10.2%、14.1%±10.5%和7.3%±6.8%,差异也有统计学意义(F=14.167,P＜0.05).结论 睡眠过程中过多胸腹矛盾呼吸的出现是一种异常的呼吸形式,矛盾呼吸可能是向低通气及呼吸暂停过度的异常呼吸形式,是气道阻力增加的表现,对睡眠呼吸疾病的诊断可能有提示作用.

A clinical study on paradoxical breathing during sleep in children

Objective Abnormal breathing during sleep included many patterns. In this study, we investigated paradoxical breathing patterns during sleep in children using standard polysomnography (PSG).Methods Children who come to the ENT because of snoring were included into the study consecutively.Those who had craniofacial anomalies, diabetes, chronic lung diseases, and neuromuscular diseases were excluded. At the same time -no sleep snoring children were include as controls. Thirty-eight snoring children and twenty-six no snoring children were recruited. Polysomnography (PSG) was performed on all subjects.We determined the frequency of paradoxical breathing patterns during sleep through blind analysis of polysomnograms obtained in all subjects and compared the difference between children with snoring and normal controls. Results The appearance of paradoxical breathing was assessed in all subjects. Among children with snoring, the apparent amount of paradoxical breathing time and the percent of paradoxical breathing time spent in total sleep time ((-x) ± s) were (70. 1 ± 40. 4) min and 17.9% ± 11.0% respectively.Comparing with control group ( 28. 2 ± 25.7 ) min and 7. 3% ± 6. 8%, there was obvious difference ( paradoxical breathing time t = 5. 060, percent of paradoxical breathing time t = 4. 767, P ＜ 0. 05 ). Thirtyeight snoring children were divided into normal-mild group ( eighteen children) and moderate-severe group (twenty children). The children whose PSG results were normal and mild had more paradoxical breathing time and the percent of paradoxical breathing time than moderate-severe group. The apparent amount of paradoxical breathing time of normal-mild group, moderate-severe group and control group were (85.9 ±31.7)min, ( 55.8 ± 42. 7 ) min and ( 28. 2 ± 25.7 ) min. Among the three groups, there was obvious difference ( F = 15. 897, P ＜ 0. 05 ). The percent of paradoxical breathing time of the three groups were 22.0% ±10.2%,14.1% ±10.5% and 7. 3% ±6.8% (F=14.167, P＜0.05). Conclusions Currently published polysomnographic scoring recommendations overlook some common breathing abnormalities during sleep that are associated with clinical complaints. Paradoxical breathing is abnormal breathing patterns during sleep and its appearance is used to aid in the identification of respiratory events.