中国循证儿科杂志
中國循證兒科雜誌
중국순증인과잡지
CHINESE JOURNAL OF EVIDENCE-BASED PEDIATRICS
2014年
3期
206-210
,共5页
张静%张清清%孙汀%江帆%殷勇%陈洁
張靜%張清清%孫汀%江帆%慇勇%陳潔
장정%장청청%손정%강범%은용%진길
阻塞性睡眠呼吸暂停低通气综合征%体重正常%多导睡眠监测%体脂肪%儿童
阻塞性睡眠呼吸暫停低通氣綜閤徵%體重正常%多導睡眠鑑測%體脂肪%兒童
조새성수면호흡잠정저통기종합정%체중정상%다도수면감측%체지방%인동
Obstructive sleep apnea hypopnea syndrome%Normal weight%Polysomnography%Body fat%Children
目的：分析体重正常的阻塞性睡眠呼吸暂停低通气综合征（ OSAHS）患儿体脂肪含量的影响因素，为OSAHS患儿肥胖的早期筛查及干预提供依据。方法从2012年1月至2013年12月在上海儿童医学中心门诊就诊的鼾症患儿和社区招募的健康儿童且行PSG监测者中选取：体重正常、行人体成分检测、年龄3~7岁儿童。分为病例组（ OSAHS轻度亚组、中重度亚组）和对照组（原发性鼾症亚组、健康儿童亚组），分析睡眠参数与人体成分的差异，以多元线性回归分析人体成分与睡眠结构和觉醒参数的相关性。结果病例组纳入58例，其中OSAHS中重度亚组30例，OSAHS轻度亚组28例；对照组63例，其中原发性鼾症亚组33例，健康儿童亚组30例。4个亚组间年龄、性别和BMI Z评分差异无统计学意义（P＞0.05）。①4个亚组在呼吸暂停低通气指数（AHI）、阻塞性呼吸暂停指数（OAI）、最低氧饱和度及呼吸相关脑电觉醒反应指数（RAI）、自发脑电觉醒反应指数（SAI）、睡眠压力指数（SPS）差异总体上有统计学意义（P＜0.05），亚组间两两比较显示，AHI、OAI、最低氧饱和度、RAI和SPS OSAHS轻度、OSAHS中重度亚组高于原发性鼾症亚组和健康儿童亚组（ P＜0.05）。②4个亚组间去脂体重、蛋白质、骨骼肌、静息代谢率、内脏脂肪面积、上臂围和腰臀比差异总体上无统计学意义，体脂肪含量和体脂肪百分比差异有统计学意义，其中OSAHS中重度亚组最高。③多元线性回归分析显示，体脂肪含量与SPS呈正相关（ r=0.641），与AHI、OAI、最低氧饱和度无显著相关性。结论 OSAHS可能与正常体重儿童的体脂肪含量增加相关，引起体脂肪含量增加的主要相关因素可能是睡眠片段化而非间歇性缺氧。
目的：分析體重正常的阻塞性睡眠呼吸暫停低通氣綜閤徵（ OSAHS）患兒體脂肪含量的影響因素，為OSAHS患兒肥胖的早期篩查及榦預提供依據。方法從2012年1月至2013年12月在上海兒童醫學中心門診就診的鼾癥患兒和社區招募的健康兒童且行PSG鑑測者中選取：體重正常、行人體成分檢測、年齡3~7歲兒童。分為病例組（ OSAHS輕度亞組、中重度亞組）和對照組（原髮性鼾癥亞組、健康兒童亞組），分析睡眠參數與人體成分的差異，以多元線性迴歸分析人體成分與睡眠結構和覺醒參數的相關性。結果病例組納入58例，其中OSAHS中重度亞組30例，OSAHS輕度亞組28例；對照組63例，其中原髮性鼾癥亞組33例，健康兒童亞組30例。4箇亞組間年齡、性彆和BMI Z評分差異無統計學意義（P＞0.05）。①4箇亞組在呼吸暫停低通氣指數（AHI）、阻塞性呼吸暫停指數（OAI）、最低氧飽和度及呼吸相關腦電覺醒反應指數（RAI）、自髮腦電覺醒反應指數（SAI）、睡眠壓力指數（SPS）差異總體上有統計學意義（P＜0.05），亞組間兩兩比較顯示，AHI、OAI、最低氧飽和度、RAI和SPS OSAHS輕度、OSAHS中重度亞組高于原髮性鼾癥亞組和健康兒童亞組（ P＜0.05）。②4箇亞組間去脂體重、蛋白質、骨骼肌、靜息代謝率、內髒脂肪麵積、上臂圍和腰臀比差異總體上無統計學意義，體脂肪含量和體脂肪百分比差異有統計學意義，其中OSAHS中重度亞組最高。③多元線性迴歸分析顯示，體脂肪含量與SPS呈正相關（ r=0.641），與AHI、OAI、最低氧飽和度無顯著相關性。結論 OSAHS可能與正常體重兒童的體脂肪含量增加相關，引起體脂肪含量增加的主要相關因素可能是睡眠片段化而非間歇性缺氧。
목적：분석체중정상적조새성수면호흡잠정저통기종합정（ OSAHS）환인체지방함량적영향인소，위OSAHS환인비반적조기사사급간예제공의거。방법종2012년1월지2013년12월재상해인동의학중심문진취진적한증환인화사구초모적건강인동차행PSG감측자중선취：체중정상、행인체성분검측、년령3~7세인동。분위병례조（ OSAHS경도아조、중중도아조）화대조조（원발성한증아조、건강인동아조），분석수면삼수여인체성분적차이，이다원선성회귀분석인체성분여수면결구화각성삼수적상관성。결과병례조납입58례，기중OSAHS중중도아조30례，OSAHS경도아조28례；대조조63례，기중원발성한증아조33례，건강인동아조30례。4개아조간년령、성별화BMI Z평분차이무통계학의의（P＞0.05）。①4개아조재호흡잠정저통기지수（AHI）、조새성호흡잠정지수（OAI）、최저양포화도급호흡상관뇌전각성반응지수（RAI）、자발뇌전각성반응지수（SAI）、수면압력지수（SPS）차이총체상유통계학의의（P＜0.05），아조간량량비교현시，AHI、OAI、최저양포화도、RAI화SPS OSAHS경도、OSAHS중중도아조고우원발성한증아조화건강인동아조（ P＜0.05）。②4개아조간거지체중、단백질、골격기、정식대사솔、내장지방면적、상비위화요둔비차이총체상무통계학의의，체지방함량화체지방백분비차이유통계학의의，기중OSAHS중중도아조최고。③다원선성회귀분석현시，체지방함량여SPS정정상관（ r=0.641），여AHI、OAI、최저양포화도무현저상관성。결론 OSAHS가능여정상체중인동적체지방함량증가상관，인기체지방함량증가적주요상관인소가능시수면편단화이비간헐성결양。
Objective To investigate the effect of obstructive sleep apnea hypopnea syndrome( OSAHS ) on the body fat volume of the normal-weight children,to provide the basis for early screening and actively intervention to the obese children. Methods Consecutive OSAHS children( ages 3-7 years ) were recruited from Shanghai Children 's Medical Center as the case group,and non-OSAHS children and non-snoring healthy children as the control group. Both of the 2 groups underwent the overnight polysomnography( PSG)and assay to test the composition of the body. The case group was divided into 2 subgroups according to the apnea hypopnea index( AHI):mild OSAHS subgroup( AHI 5-10 times per hour )and moderate-severe OSAHS subgroup( AHI≥10 times per hour). The relation was analyzed between the sleep architectures,sleep arousal parameters and the body composition of the body of the three subgroups of the case group and the control group. The relation between sleep architecture,arousal parameters and the body composition of the body was studied by multiple linear regression analysis. Results There were 58 cases recruited into the case group. Mild OSAHS subgroup include 28 cases with mild OSAHS and 30 cases with moderate-severe OSAHS,and 63 cases for the control group. Age,gender and BMI Z-score were not significantly different among 4 subgroups(P>0. 05). ① There was significant difference in AHI,obstructive apnea index(OAI),nadir SpO2 and respiratory arousal index( RAI),spontaneous arousal index( SAI),sleep pressure score( SPS)in the 4 subgroups. The AHI, OAI,nadir SpO2 ,RAI and SPS of mild and moderate-severe OSAHS subgroup were siginificantly higher than those in primary snoring subgroup and healthy children subgroup. ②There was no statistically difference in fat free mass,protein,skeletal muscle, resting metabolic rate,visceral fat area,arm circumference and waist hip ratio among the 4 subgroups. Body fat volume and the percentage of body fat were different among the 4 subgroups,with the highest levels in the moderate-severe group. ③The multiple linear regression analysis indicated that a positive correlation between the body fat volume and the SPS(r=0. 641),however it was not correlated with AHI,OAI or nadir SpO2 . Conclusion OSAHS maybe associated with the increased body fat volume in the normal-weight children,and it appears to correlate with the sleep fragmentation,but not with the intermittent hypopnea. Introducing SPS interpretation in PSG scoring of normal body weight OSAHS children is helpful in order to make early intervention to prevent the concurrency of obesity.
