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
161-166
,共6页
王燕%姜艳蕊%孙莞绮%宋沅瑾%董叔梅%殷勇%陈洁%江帆
王燕%薑豔蕊%孫莞綺%宋沅瑾%董叔梅%慇勇%陳潔%江帆
왕연%강염예%손완기%송원근%동숙매%은용%진길%강범
睡眠呼吸障碍%阻塞性睡眠呼吸暂停低通气综合征%高血压%多导睡眠监测%儿童
睡眠呼吸障礙%阻塞性睡眠呼吸暫停低通氣綜閤徵%高血壓%多導睡眠鑑測%兒童
수면호흡장애%조새성수면호흡잠정저통기종합정%고혈압%다도수면감측%인동
Sleep related breathing disorders%Obstructive sleep apnea hypopnea syndrome%Hypertension%Polysomnography%Children
目的：探讨儿童阻塞性睡眠呼吸暂停低通气综合征（ OSAHS）与血压的相关性。方法纳入2012年7月至2013年7月以睡眠打鼾为主诉于上海儿童医学中心睡眠障碍诊治中心就诊的3~18岁儿童青少年，行整夜多导睡眠图（ PSG）监测并测量睡前收缩压（ SBP）和舒张压（ DBP）。根据PSG监测结果分为非OSAHS组和OSAHS组，OSAHS组根据呼吸暂停低通气指数和最低血氧饱和度分为OSAHS轻、中和重度亚组。依据2010年中国儿童青少年血压参照标准诊断高血压。计算收缩压指数（ SBPI）和舒张压指数（ DBPI）。分析不同程度的OSAHS与血压的相关性。结果385例研究对象进入分析，平均年龄（5.5±2.3）岁，男262例，女123例。SBP（100.6±10.4）mmHg，DBP（63.2±8.5）mmHg，符合高血压诊断122例（31.7％），其中严重高血压42例（10.9％）。非OSAHS组261例（67.8％）；OSAHS组124例，其中轻、中和重度亚组分别有54、43和27例。BMI、BMI-Z评分、颈围、超重及肥胖患病率指标OSAHS组显著高于非OSAHS组。①OSAHS组SBP显著高于非OSAHS组，但调整年龄、性别和BMI-Z评分后SBP的组间差异无统计学意义。OSAHS轻、中和重度亚组SBP和DBP差异有统计学意义（ SBP：F=3.46，P=0.034；DBP：F=4.27，P=0.016），在调整了年龄、性别和BMI-Z评分后SBP和DBP的组间差异仍有统计学意义（ P＜0.05）。②非OSAHS组和OSAHS组SBPI和DBPI差异无统计学意义；OSAHS轻、中和重度亚组 SBPI 和 DBPI 差异有统计学意义（ SBPI：F =2.54，P =0.046；DBPI：F =3.25，P =0.042）。③OSAHS轻、中和重度亚组高血压检出率差异有统计学意义，调整了年龄、性别以及BMI-Z评分后，OSAHS重度亚组严重高血压的风险显著高于轻度亚组，OR=5.79（95％CI：1.45~23.11）。结论鼾症患儿高血压检出率显著高于正常人群，其中重度OSAHS患儿高血压及严重高血压的发生风险最高，提示应密切监测睡眠相关呼吸障碍患儿的血压。
目的：探討兒童阻塞性睡眠呼吸暫停低通氣綜閤徵（ OSAHS）與血壓的相關性。方法納入2012年7月至2013年7月以睡眠打鼾為主訴于上海兒童醫學中心睡眠障礙診治中心就診的3~18歲兒童青少年，行整夜多導睡眠圖（ PSG）鑑測併測量睡前收縮壓（ SBP）和舒張壓（ DBP）。根據PSG鑑測結果分為非OSAHS組和OSAHS組，OSAHS組根據呼吸暫停低通氣指數和最低血氧飽和度分為OSAHS輕、中和重度亞組。依據2010年中國兒童青少年血壓參照標準診斷高血壓。計算收縮壓指數（ SBPI）和舒張壓指數（ DBPI）。分析不同程度的OSAHS與血壓的相關性。結果385例研究對象進入分析，平均年齡（5.5±2.3）歲，男262例，女123例。SBP（100.6±10.4）mmHg，DBP（63.2±8.5）mmHg，符閤高血壓診斷122例（31.7％），其中嚴重高血壓42例（10.9％）。非OSAHS組261例（67.8％）；OSAHS組124例，其中輕、中和重度亞組分彆有54、43和27例。BMI、BMI-Z評分、頸圍、超重及肥胖患病率指標OSAHS組顯著高于非OSAHS組。①OSAHS組SBP顯著高于非OSAHS組，但調整年齡、性彆和BMI-Z評分後SBP的組間差異無統計學意義。OSAHS輕、中和重度亞組SBP和DBP差異有統計學意義（ SBP：F=3.46，P=0.034；DBP：F=4.27，P=0.016），在調整瞭年齡、性彆和BMI-Z評分後SBP和DBP的組間差異仍有統計學意義（ P＜0.05）。②非OSAHS組和OSAHS組SBPI和DBPI差異無統計學意義；OSAHS輕、中和重度亞組 SBPI 和 DBPI 差異有統計學意義（ SBPI：F =2.54，P =0.046；DBPI：F =3.25，P =0.042）。③OSAHS輕、中和重度亞組高血壓檢齣率差異有統計學意義，調整瞭年齡、性彆以及BMI-Z評分後，OSAHS重度亞組嚴重高血壓的風險顯著高于輕度亞組，OR=5.79（95％CI：1.45~23.11）。結論鼾癥患兒高血壓檢齣率顯著高于正常人群，其中重度OSAHS患兒高血壓及嚴重高血壓的髮生風險最高，提示應密切鑑測睡眠相關呼吸障礙患兒的血壓。
목적：탐토인동조새성수면호흡잠정저통기종합정（ OSAHS）여혈압적상관성。방법납입2012년7월지2013년7월이수면타한위주소우상해인동의학중심수면장애진치중심취진적3~18세인동청소년，행정야다도수면도（ PSG）감측병측량수전수축압（ SBP）화서장압（ DBP）。근거PSG감측결과분위비OSAHS조화OSAHS조，OSAHS조근거호흡잠정저통기지수화최저혈양포화도분위OSAHS경、중화중도아조。의거2010년중국인동청소년혈압삼조표준진단고혈압。계산수축압지수（ SBPI）화서장압지수（ DBPI）。분석불동정도적OSAHS여혈압적상관성。결과385례연구대상진입분석，평균년령（5.5±2.3）세，남262례，녀123례。SBP（100.6±10.4）mmHg，DBP（63.2±8.5）mmHg，부합고혈압진단122례（31.7％），기중엄중고혈압42례（10.9％）。비OSAHS조261례（67.8％）；OSAHS조124례，기중경、중화중도아조분별유54、43화27례。BMI、BMI-Z평분、경위、초중급비반환병솔지표OSAHS조현저고우비OSAHS조。①OSAHS조SBP현저고우비OSAHS조，단조정년령、성별화BMI-Z평분후SBP적조간차이무통계학의의。OSAHS경、중화중도아조SBP화DBP차이유통계학의의（ SBP：F=3.46，P=0.034；DBP：F=4.27，P=0.016），재조정료년령、성별화BMI-Z평분후SBP화DBP적조간차이잉유통계학의의（ P＜0.05）。②비OSAHS조화OSAHS조SBPI화DBPI차이무통계학의의；OSAHS경、중화중도아조 SBPI 화 DBPI 차이유통계학의의（ SBPI：F =2.54，P =0.046；DBPI：F =3.25，P =0.042）。③OSAHS경、중화중도아조고혈압검출솔차이유통계학의의，조정료년령、성별이급BMI-Z평분후，OSAHS중도아조엄중고혈압적풍험현저고우경도아조，OR=5.79（95％CI：1.45~23.11）。결론한증환인고혈압검출솔현저고우정상인군，기중중도OSAHS환인고혈압급엄중고혈압적발생풍험최고，제시응밀절감측수면상관호흡장애환인적혈압。
Objective To explore the relationship between obstructive sleep apnea hypopnea syndrome( OSAHS)and blood pressure in children. Methods Overnight polysomnography( PSG)was conducted in the Pediatric Sleep Center of Shanghai Jiaotong University School of Medicine affiliated to Shanghai Children's Medical Center for children aged 3-18 years,who were recruited in outpatient clinic from July 2012 to July 2013 with complaint of sleep snoring. Systolic blood pressure( SBP)and diastolic blood pressure( DBP)were measured for everyone before sleep in the evening. All children were divided into non-OSAHS group and OSAHS group according to PSG result,and then OSAHS group was divided into mild,moderate and severe subgroups according to apnea hypopnea index( AHI)and lowest oxygen saturation( LSaO2 ). The diagnosis of hypertension was made according to blood pressure reference standards for Chinese children and adolescents 2010. Systolic blood pressure index( SBPI)and diastolic blood pressure index( DBPI)were calculated. Then further analysis was was performed to evaluate the relationship between severities of OSHAS and blood pressure levels. Results A total of 385 children were enrolled in our study,with average age( 5. 5 ± 2. 3 ) years,262 boys,SBP(100. 6 ± 10. 4)mmHg and DBP(63. 2 ± 8. 5)mmHg. 122(31. 7%)children met the criteria of hypertension and 42(10. 9%)were severe hypertension. 261(67. 8%)children were in non-OSAHS group,124(32. 2%)were in OSAHS group. In the OSAHS group,54,43 and 27 children were classified into mild,moderate and severe subgroups respectively. Compared with non-OSAHS group,the OSAHS group had higher BMI,BMI-Z scores,neck circumference,prevalence of overweight and obesity. ①SBP of OSAHS group was higher than non-OSAHS group,but it lost significance after adjustment of age,sex and BMI-Z. Both of the SBP and DBP statistically varied among different OSAHS severity groups(SBP:F=3. 46,P=0. 034;DBP:F=4. 27,P=0. 016),even adjusted by age,sex and BMI-Z scores. ②SBPI and DBPI did not significantly differ between OSAHS and non-OSAHS groups. In the OSAHS group,SBPI and DBPI significantly varied among different severity subgroups(SBPI:F=2. 54,P=0. 046;DBP:F=3. 25,P=0. 042). ③The hypertension prevalence was significantly different among 3 OSAHS subgroups. Severe OSAHS children had higher risk of hypertension compared with mild OSAHS children,OR=2. 87(95%CI:1. 03~7. 99),for severe hypertension,the OR increased to 5. 79,(95%CI:1. 45-23. 11). Conclusion The prevalence of hypertension is higher in children with sleep snoring than the general population,especially in the children with severe OSAHS. More attention should be paid to monitoring blood pressure for the children with sleep disordered breathing.
