中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
16期
1238-1242
,共5页
打鼾%睡眠呼吸暂停综合征%儿童%睡眠
打鼾%睡眠呼吸暫停綜閤徵%兒童%睡眠
타한%수면호흡잠정종합정%인동%수면
Snoring%Sleep apnea syndromes%Child%Sleep
目的 通过分析113例鼾症患儿的多导睡眠监测(PSG)结果,对单纯打鼾(PS)患儿以及轻、中、重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿的睡眠结构、心率情况以及脑电觉醒指数(Arl)等方面进行比较,综合分析其各自的特征.方法 回顾性分析2010年1月至2012年3月因睡眠呼吸紊乱症状在首都儿科研究所附属儿童医院耳鼻喉科门诊就诊并在睡眠中心进行PSG检查的113例患儿.对患儿进行PSG,所得数据经正态性检验后分别采用F检验和非参数检验进行统计.结果 (1)各组在年龄、睡眠时间、睡眠效率等方面差异均无统计学意义(均P ＞0.05).(2)睡眠结构方面,4组患儿的Ⅰ期睡眠所占百分比分别为PS组2.6％±1.4％、OSAHS轻度组5.4％±3.2％、中度组4.7％±1.9％、重度组8.9％±4.0％,差异有统计学意义(F=6.542,P=0.000)；各组的Ⅳ睡眠所占百分比分别为25.3％±5.6％、32.4％±11.1％、30.6％±9.0％、21.4％±10.8％,差异有统计学意义(F=7.544,P=0.000)；各组患儿快动眼睡眠(REM)期睡眠所占百分比分别为21.1％±8.6％、13.9％±4.0％、14.5％±4.9％、12.3％±6.9％,差异有统计学意义(F=11.204,P=0.000),而Ⅱ、Ⅲ期睡眠所占百分比差异均无统计学意义(均P＞0.05).(3)各组患儿REM期的平均心率分别为(85±11)、(90±14)、(95±10)、(101±l8)次/min,差异有统计学意义(F=6.452,P=0.000),各组患儿非快动眼睡眠(NREM)期的平均心率分别为(79±10)、(84±14)、(86±7)、(93±16)次/min,差异有统计学意义(F=5.369,P=0.002).(4)各组自发性脑电觉醒的总次数、在REM发生次数、在NREM发生次数,差异均有统计学意义(F=56.379、60.781、44.061,均P=0.000).呼吸相关性脑电觉醒的总次数、在REM发生次数、在NREM发生次数,差异均有统计学意义(F=79.250、36.137、65.239,均P=0.000).结论 儿童OSAHS发展到中、重度对心率的影响更明显.OSAHS患儿与PS患儿比较自发性脑电觉醒减少而呼吸相关的脑电觉醒增多,但OSAHS患儿其自发性脑电觉醒无论是在NREM期还是REM期并未随着OSAHS程度加重而继续减少,与呼吸相关的脑电觉醒是判断儿童OSAHS严重程度的客观指标.
目的 通過分析113例鼾癥患兒的多導睡眠鑑測(PSG)結果,對單純打鼾(PS)患兒以及輕、中、重度阻塞性睡眠呼吸暫停低通氣綜閤徵(OSAHS)患兒的睡眠結構、心率情況以及腦電覺醒指數(Arl)等方麵進行比較,綜閤分析其各自的特徵.方法 迴顧性分析2010年1月至2012年3月因睡眠呼吸紊亂癥狀在首都兒科研究所附屬兒童醫院耳鼻喉科門診就診併在睡眠中心進行PSG檢查的113例患兒.對患兒進行PSG,所得數據經正態性檢驗後分彆採用F檢驗和非參數檢驗進行統計.結果 (1)各組在年齡、睡眠時間、睡眠效率等方麵差異均無統計學意義(均P ＞0.05).(2)睡眠結構方麵,4組患兒的Ⅰ期睡眠所佔百分比分彆為PS組2.6％±1.4％、OSAHS輕度組5.4％±3.2％、中度組4.7％±1.9％、重度組8.9％±4.0％,差異有統計學意義(F=6.542,P=0.000)；各組的Ⅳ睡眠所佔百分比分彆為25.3％±5.6％、32.4％±11.1％、30.6％±9.0％、21.4％±10.8％,差異有統計學意義(F=7.544,P=0.000)；各組患兒快動眼睡眠(REM)期睡眠所佔百分比分彆為21.1％±8.6％、13.9％±4.0％、14.5％±4.9％、12.3％±6.9％,差異有統計學意義(F=11.204,P=0.000),而Ⅱ、Ⅲ期睡眠所佔百分比差異均無統計學意義(均P＞0.05).(3)各組患兒REM期的平均心率分彆為(85±11)、(90±14)、(95±10)、(101±l8)次/min,差異有統計學意義(F=6.452,P=0.000),各組患兒非快動眼睡眠(NREM)期的平均心率分彆為(79±10)、(84±14)、(86±7)、(93±16)次/min,差異有統計學意義(F=5.369,P=0.002).(4)各組自髮性腦電覺醒的總次數、在REM髮生次數、在NREM髮生次數,差異均有統計學意義(F=56.379、60.781、44.061,均P=0.000).呼吸相關性腦電覺醒的總次數、在REM髮生次數、在NREM髮生次數,差異均有統計學意義(F=79.250、36.137、65.239,均P=0.000).結論 兒童OSAHS髮展到中、重度對心率的影響更明顯.OSAHS患兒與PS患兒比較自髮性腦電覺醒減少而呼吸相關的腦電覺醒增多,但OSAHS患兒其自髮性腦電覺醒無論是在NREM期還是REM期併未隨著OSAHS程度加重而繼續減少,與呼吸相關的腦電覺醒是判斷兒童OSAHS嚴重程度的客觀指標.
목적 통과분석113례한증환인적다도수면감측(PSG)결과,대단순타한(PS)환인이급경、중、중도조새성수면호흡잠정저통기종합정(OSAHS)환인적수면결구、심솔정황이급뇌전각성지수(Arl)등방면진행비교,종합분석기각자적특정.방법 회고성분석2010년1월지2012년3월인수면호흡문란증상재수도인과연구소부속인동의원이비후과문진취진병재수면중심진행PSG검사적113례환인.대환인진행PSG,소득수거경정태성검험후분별채용F검험화비삼수검험진행통계.결과 (1)각조재년령、수면시간、수면효솔등방면차이균무통계학의의(균P ＞0.05).(2)수면결구방면,4조환인적Ⅰ기수면소점백분비분별위PS조2.6％±1.4％、OSAHS경도조5.4％±3.2％、중도조4.7％±1.9％、중도조8.9％±4.0％,차이유통계학의의(F=6.542,P=0.000)；각조적Ⅳ수면소점백분비분별위25.3％±5.6％、32.4％±11.1％、30.6％±9.0％、21.4％±10.8％,차이유통계학의의(F=7.544,P=0.000)；각조환인쾌동안수면(REM)기수면소점백분비분별위21.1％±8.6％、13.9％±4.0％、14.5％±4.9％、12.3％±6.9％,차이유통계학의의(F=11.204,P=0.000),이Ⅱ、Ⅲ기수면소점백분비차이균무통계학의의(균P＞0.05).(3)각조환인REM기적평균심솔분별위(85±11)、(90±14)、(95±10)、(101±l8)차/min,차이유통계학의의(F=6.452,P=0.000),각조환인비쾌동안수면(NREM)기적평균심솔분별위(79±10)、(84±14)、(86±7)、(93±16)차/min,차이유통계학의의(F=5.369,P=0.002).(4)각조자발성뇌전각성적총차수、재REM발생차수、재NREM발생차수,차이균유통계학의의(F=56.379、60.781、44.061,균P=0.000).호흡상관성뇌전각성적총차수、재REM발생차수、재NREM발생차수,차이균유통계학의의(F=79.250、36.137、65.239,균P=0.000).결론 인동OSAHS발전도중、중도대심솔적영향경명현.OSAHS환인여PS환인비교자발성뇌전각성감소이호흡상관적뇌전각성증다,단OSAHS환인기자발성뇌전각성무론시재NREM기환시REM기병미수착OSAHS정도가중이계속감소,여호흡상관적뇌전각성시판단인동OSAHS엄중정도적객관지표.
Objective To analyze the characteristics of sleep structure,heart rate and arousal index (ArI) in children with primary snoring (PS) and mild,moderate or severe obstructive sleep apnea hypopnea syndrome (OSAHS).Methods A total of 113 children with sleep disorders were enrolled from January 2010 to March 2012 at Affiliated Children's Hospital,Capital Institute of Pediatrics.All of them underwent polysomnogram (PSG) and the data were analyzed statistically by SPSS 19.0.Results (1) No statistical difference existed in age,sleeping time or sleeping efficacy between PS and all OSAHS groups (all P ＞0.05).(2) The proportion of stage Ⅰ sleeping was 2.6％ ± 1.4％ in PS group,5.4％ ± 3.2％ in mild OSAHS group,4.7％ ± 1.9％ in moderate OSAHS group and 8.9％ ± 4.0％ in severe OSAHS group (F =6.542,P =0.000).The proportion of stage Ⅳ sleeping was 25.3％ ± 5.6％ in PS group,32.4％ ± 11.1％ in mild OSAHS group,30.6％ ±9.0％ in moderate OSAHS group and 21.4％ ±10.8％ in severe OSAHS group (F =7.544,P =0.000).The proportion of stage rapid eye movement (REM) sleeping was 21.1％ ± 8.6％ in PS group,13.9％ ± 4.0％ in mild OSAHS group,14.5％ ± 4.9％ in moderate OSAIHS group and 12.3％ ±6.9％ in severe OSAHS group(F=11.204,P=0.000).The proportion of stage Ⅱ and Ⅲ sleeping had no statistical difference among four groups.(3) The average heart rate in stage REM sleeping of four groups was (85 ±11),(90 ±14),(95 ±10) and (101 ±18) beats per minute(F=6.452,P=0.000)and (79 ± 10),(84 ± 14),(86 ±7) and (93 ± 16) beats per minute in stage NREM sleeping(F =5.369,P =0.002).(4) In four groups,the difference of total count of spontaneous arousal,the spontaneous arousal count in stage REM and non-rapid eye movement (NREM) sleeping were all statistically significant (F =56.379,60.781,44.061,all P =0.000).And the difference of total count of respiratory arousal,the median of respiratory arousal count in stage REM and NREM sleeping were all statistically significant (F =79.250,36.137,65.239,all P =0.000).Conclusions Heart rate is affected more obviously in moderate-severe OSAHS children.As compared with PS counterparts,OSAHS children had a reduction of spontaneous arousal and an increase of respiratory arousal.But the occurrence of spontaneous arousal of OSAHS children does not decrease with the progress of OSAHS in either stage REM or stage NREM.
