中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2008年
3期
169-173
,共5页
黄振云%刘大波%李志斌%钟建文%俞洁%谭宗瑜%孙昌志%周丽枫%陈倩
黃振雲%劉大波%李誌斌%鐘建文%俞潔%譚宗瑜%孫昌誌%週麗楓%陳倩
황진운%류대파%리지빈%종건문%유길%담종유%손창지%주려풍%진천
睡眠呼吸暂停,阻塞性%儿童%轻微脑损伤综合征
睡眠呼吸暫停,阻塞性%兒童%輕微腦損傷綜閤徵
수면호흡잠정,조새성%인동%경미뇌손상종합정
Sleep apnea,obstructive%Child%Attention deficit disorder with hyperactivity
目的 探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)儿童是否更易出现注意力缺陷和多动症状,并观察手术治疗前后睡眠呼吸紊乱及注意力缺陷和多动症状有无好转.方法 2004年6月至2007年5月经多道睡眠监测(polysomnography,PSG)确诊的OSAHS儿童80例为患儿组,其中有手术前后完整PSG监测资料的16例儿童进行睡眠结构和呼吸紊乱相关指标的分析.选择因声带小结就诊经PSG监测睡眠呼吸正常儿童30例为对照组.由神经科医生对所有儿童进行注意缺陷和多动症状分数(inattentionhyperactivity score,IHS)的评估,以IHS＞1.25判定为明显注意力缺陷和多动症状.患儿组均行腺样体切除或扁桃体+腺样体切除的手术治疗,术后6个月再次接受PSG监测及神经科医师的IHS评估,比较对照组与OSAHS患儿有关数据的差异.结果 ①患儿组术前和对照组的IHS的中位数分别为0.89和0.17,秩和检验差异有统计学意义(Z=-4.276,P＜0.05);手术前后患儿组的IHS的中位数分别为0.89和0.44,配对t检验差异有统计学意义(t=6.219,P＜0.05).②患儿组术前、术后和对照组分别有25例、9例和3例儿童的IHS>1.25,卡方检验示患儿组术前与对照组、术前与术后比较出现症状患儿的比率差异有统计学意义(x2值分别为5.192和9.56,P值均＜0.05).③患儿组中有完整资料的16例手术后呼吸紊乱指标及睡眠结构有明显改变,睡眠Ⅰ期减少,睡眠Ⅱ期、慢波睡眠及快动眼睡眠的比例显著增加(配对t检验t值分别为12.2、-5.4、-6.3和-8.1,P值均＜0.001)呼吸暂停低通气指数从13.9次/h下降到1.5次/h,最低血氧饱和度从0.855上升到0.940(t值分别为5.3和-3.7,P值均<0.01);术后和对照组相比,快速动眼睡眠的比例及最低血氧饱和度仍未达到对照组的水平.结论 较睡眠呼吸正常儿童而言,OSAHS患儿较易出现多动症状和注意缺陷的表现,手术治疗可明显改善OSAHS患儿的睡眠结构和多动、注意缺陷的症状.在诊断注意力缺陷多动障碍时,应注意有无睡眠呼吸紊乱的存在.
目的 探討阻塞性睡眠呼吸暫停低通氣綜閤徵(obstructive sleep apnea hypopnea syndrome,OSAHS)兒童是否更易齣現註意力缺陷和多動癥狀,併觀察手術治療前後睡眠呼吸紊亂及註意力缺陷和多動癥狀有無好轉.方法 2004年6月至2007年5月經多道睡眠鑑測(polysomnography,PSG)確診的OSAHS兒童80例為患兒組,其中有手術前後完整PSG鑑測資料的16例兒童進行睡眠結構和呼吸紊亂相關指標的分析.選擇因聲帶小結就診經PSG鑑測睡眠呼吸正常兒童30例為對照組.由神經科醫生對所有兒童進行註意缺陷和多動癥狀分數(inattentionhyperactivity score,IHS)的評估,以IHS＞1.25判定為明顯註意力缺陷和多動癥狀.患兒組均行腺樣體切除或扁桃體+腺樣體切除的手術治療,術後6箇月再次接受PSG鑑測及神經科醫師的IHS評估,比較對照組與OSAHS患兒有關數據的差異.結果 ①患兒組術前和對照組的IHS的中位數分彆為0.89和0.17,秩和檢驗差異有統計學意義(Z=-4.276,P＜0.05);手術前後患兒組的IHS的中位數分彆為0.89和0.44,配對t檢驗差異有統計學意義(t=6.219,P＜0.05).②患兒組術前、術後和對照組分彆有25例、9例和3例兒童的IHS>1.25,卡方檢驗示患兒組術前與對照組、術前與術後比較齣現癥狀患兒的比率差異有統計學意義(x2值分彆為5.192和9.56,P值均＜0.05).③患兒組中有完整資料的16例手術後呼吸紊亂指標及睡眠結構有明顯改變,睡眠Ⅰ期減少,睡眠Ⅱ期、慢波睡眠及快動眼睡眠的比例顯著增加(配對t檢驗t值分彆為12.2、-5.4、-6.3和-8.1,P值均＜0.001)呼吸暫停低通氣指數從13.9次/h下降到1.5次/h,最低血氧飽和度從0.855上升到0.940(t值分彆為5.3和-3.7,P值均<0.01);術後和對照組相比,快速動眼睡眠的比例及最低血氧飽和度仍未達到對照組的水平.結論 較睡眠呼吸正常兒童而言,OSAHS患兒較易齣現多動癥狀和註意缺陷的錶現,手術治療可明顯改善OSAHS患兒的睡眠結構和多動、註意缺陷的癥狀.在診斷註意力缺陷多動障礙時,應註意有無睡眠呼吸紊亂的存在.
목적 탐토조새성수면호흡잠정저통기종합정(obstructive sleep apnea hypopnea syndrome,OSAHS)인동시부경역출현주의력결함화다동증상,병관찰수술치료전후수면호흡문란급주의력결함화다동증상유무호전.방법 2004년6월지2007년5월경다도수면감측(polysomnography,PSG)학진적OSAHS인동80례위환인조,기중유수술전후완정PSG감측자료적16례인동진행수면결구화호흡문란상관지표적분석.선택인성대소결취진경PSG감측수면호흡정상인동30례위대조조.유신경과의생대소유인동진행주의결함화다동증상분수(inattentionhyperactivity score,IHS)적평고,이IHS＞1.25판정위명현주의력결함화다동증상.환인조균행선양체절제혹편도체+선양체절제적수술치료,술후6개월재차접수PSG감측급신경과의사적IHS평고,비교대조조여OSAHS환인유관수거적차이.결과 ①환인조술전화대조조적IHS적중위수분별위0.89화0.17,질화검험차이유통계학의의(Z=-4.276,P＜0.05);수술전후환인조적IHS적중위수분별위0.89화0.44,배대t검험차이유통계학의의(t=6.219,P＜0.05).②환인조술전、술후화대조조분별유25례、9례화3례인동적IHS>1.25,잡방검험시환인조술전여대조조、술전여술후비교출현증상환인적비솔차이유통계학의의(x2치분별위5.192화9.56,P치균＜0.05).③환인조중유완정자료적16례수술후호흡문란지표급수면결구유명현개변,수면Ⅰ기감소,수면Ⅱ기、만파수면급쾌동안수면적비례현저증가(배대t검험t치분별위12.2、-5.4、-6.3화-8.1,P치균＜0.001)호흡잠정저통기지수종13.9차/h하강도1.5차/h,최저혈양포화도종0.855상승도0.940(t치분별위5.3화-3.7,P치균<0.01);술후화대조조상비,쾌속동안수면적비례급최저혈양포화도잉미체도대조조적수평.결론 교수면호흡정상인동이언,OSAHS환인교역출현다동증상화주의결함적표현,수술치료가명현개선OSAHS환인적수면결구화다동、주의결함적증상.재진단주의력결함다동장애시,응주의유무수면호흡문란적존재.
Objective To observe the symptoms of inattention,hyperactivity among obstructive sleep apnea hypopnea syndrome(OSAHS) children,also to investigate the effects of surgery(tonsillectomy and adenoidectomy or adenoidectomy alone)on the changes of sleep architecture and inattention-hyperactivity score(HIS). Methods Between June 2004 and may 2007,eighty children diagnosed as OSAHS with overnight polysomnography(PSG) were included in this study,only sixteen children had complete pre-op and post-op PSG data. Thirty children with vocal cord nodules were selected as control group. DSM-Ⅳ-derived HIS was evaluated by neurologist. All OSAHS children accepted surgery(tonsillectomy and adenoidectomy or adenoidectomy alone) and HIS evaluation. The pre-op and post-op sleep architecture and than that it in control group(0.89 vs 0.17)and the difference was significant(Z=-4.276,P＜0.05).OSAHS children had pre-op HIS greater than 1.25 and nine had post-op HIS greater than 1.25,while only three children in control group had HIS greater than 1.25. The difference was statistically significant(x2=data,a decrease in the percentage of phase 1 sleep and an increase in the percentage of phase 2 sleep,slow wave sleep(SWS) and rapid eye movement(REM) sleep were observed in six months after surgery and the difference was significant(t=12.2,-5.4,-6.3,-8.1 respectively,P＜0.001). After surgery,apneahypopnea index(AHI) decreased from 13.9 times/h to 1.5 times/h while lowest saturation of blood oxygen (LSaO2) increased from 0.855 to 0.940(t=5.3,-3.7 respectively,P＜0.01). REM sleep percentage and LSaO2 was still lower than that of control group six months after surgery. Conclusions Children with OSAHS showed significantly impaired attention and hyperactivity as compared with control group.Improvement of behavior and sleep architecture were observed after dnoidectomy and tonsillectomy.
