本文選題：睡眠呼吸暫停低通氣綜合癥　切入點：兒童　出處：《瀘州醫(yī)學(xué)院》2012年碩士論文

【摘要】：目的：回顧性分析兒童阻塞性睡眠呼吸暫停低通氣綜合癥（OSAHS）及兒童單純性鼾癥（PS，primary snoring）的睡眠結(jié)構(gòu)特點，并探討兩者之間的睡眠結(jié)構(gòu)是否存在著差異，同時將OSAHS組、PS組分別與正常年齡組的兒童睡眠結(jié)構(gòu)進行比較，，觀察OSAHS患兒與單純性鼾癥兒童睡眠結(jié)構(gòu)變化情況。方法：選取2009年4月～2012年3月在四川省華西醫(yī)院睡眠中心因為打鼾而就診并行多導(dǎo)睡眠監(jiān)測的6～9歲兒童，共84名。其中男57名，女27名。平均年齡（7.27±1.16）歲，平均體重（29.26±10.88）kg，平均BMI（17.90±5.34）kg/m~2。在夜間睡眠中存在著如下表現(xiàn)：睡眠中打鼾、張口呼吸、呼吸困難甚至出現(xiàn)呼吸暫停、白天有嗜睡、注意力不集中等。84名兒童根據(jù)國內(nèi)兒童OSAHS診斷標(biāo)準(zhǔn)分為OSAHS組和單純性鼾癥組（PS組），采用美國偉康公司生產(chǎn)的Alice5多導(dǎo)睡眠儀進行整夜睡眠呼吸監(jiān)測（PSG）。對OSAHS兒童（OSAHS組）與單純性打鼾兒童（PS組）的睡眠結(jié)構(gòu)以及身高、體重、年齡、最低氧飽和度等一般情況指標(biāo)進行統(tǒng)計學(xué)比較分析，觀察異同。同時，再分別與國內(nèi)參考文獻上同年齡組（6～9歲）的正常兒童的睡眠結(jié)構(gòu)進行比較，觀察它們之間有無差異。對單純性鼾癥組（PS組）與OSAHS組兩組兒童分別進行組內(nèi)相關(guān)性分析，觀察呼吸暫停低通氣指數(shù)（AHI）與Ⅲ＋Ⅳ期睡眠所占總睡眠期的百分比，微覺醒指數(shù)（MI），REM期睡眠所占總睡眠期百分比等指標(biāo)之間是否存在線性聯(lián)系。結(jié)果：經(jīng)人工校正分析后的多導(dǎo)睡眠圖分析結(jié)果顯示單純性鼾癥組（PS組）和OSAHS組的睡眠結(jié)構(gòu)特點如下所示：睡眠潛伏期（16.61±26.47vs15.66±19.11min）、睡眠效率（87.15%±7.30%vs87.11%±10.85%）、Ⅰ期睡眠百分比（14.70%±11.49%vs18.31%±10.73%）、Ⅱ期睡眠百分比（40.72%±16.48%vs39.55%±15.17%）、Ⅲ＋Ⅳ期（慢波睡眠期）百分比（34.90%±15.22%vs30.33%±12.52%）、REM期百分比（9.69%±5.14%vs11.83%±7.24%）差異無統(tǒng)計學(xué)意義（P＞0.05）。但單純性鼾癥組（PS組）與OSAHS組的MI（微覺醒指數(shù)）（7.49±3.09vs14.76±9.70次/h）、最低SaO2（88.12%±7.79%vs79.41%±14.24%）相比具有顯著差異性（P＜0.01）。再將前述PS組以及OSAHS組分別與國內(nèi)同年齡組（6～9歲）兒童的睡眠結(jié)構(gòu)（引用數(shù)據(jù)）進行比較得出：兩組兒童（OSAHS組和PS組）與正常組兒童睡眠結(jié)構(gòu)各項指標(biāo)相比均具有統(tǒng)計學(xué)意義（P＜0.05），具體表現(xiàn)為：Ⅰ期睡眠比例增加，Ⅱ期睡眠比例減少，Ⅲ＋Ⅳ期睡眠比例增加（深睡眠比例增加），REM期睡眠比例減少。相關(guān)性分析結(jié)果：對PS組與OSAHS組的AHI分別與Ⅲ＋Ⅳ期睡眠百分比、微覺醒指數(shù)（MI）、REM期睡眠百分比等指標(biāo)進行兩變量相關(guān)分析，發(fā)現(xiàn)只有OSAHS組的AHI與微覺醒指數(shù)（MI）具有顯著相關(guān)性，其Pearson相關(guān)系數(shù)為0.524，P=0.000（P＜0.01）。PS組的AHI與MI、Ⅲ+Ⅳ%、REM%以及OSAHS組的AHI與Ⅲ+Ⅳ%、REM%均不具有相關(guān)性（P＞0.05）。結(jié)論：OSHAS與單純性鼾癥（PS）的兒童睡眠結(jié)構(gòu)差異不明顯，各期睡眠比例接近，睡眠結(jié)構(gòu)相似。與正常兒童相比，OSAHS和單純性鼾癥（PS）均可導(dǎo)致兒童睡眠結(jié)構(gòu)紊亂，引起一系列的臨床表現(xiàn)。具體的改變表現(xiàn)為Ⅰ期睡眠與Ⅲ+Ⅳ期睡眠（慢波睡眠，SWS）增加，Ⅱ期睡眠以及REM期睡眠減少。兒童睡眠結(jié)構(gòu)變得紊亂。且根據(jù)相關(guān)性分析結(jié)果顯示，OSAHS兒童的AHI越高，微覺醒指數(shù)（MI）就越高，相比單純性鼾癥（PS）的兒童而言，具有更多的覺醒，睡眠更易片段化。
[Abstract]:Objective: a retrospective analysis of children with obstructive sleep apnea hypopnea syndrome (OSAHS) and children with snoring (PS, primary, snoring) sleep structure characteristics, and to explore the sleep structure between them and whether there are differences, while the OSAHS group, PS group compared with the normal sleep structure in children age group OSAHS, observation of children and simple snoring children sleep structure changes. Methods: from April 2009 to March 2012 in West China Hospital of Sichuan province sleep center that snoring and visits the polysomnography monitoring children 6~9 years of age were 84. There were 57 males and 27 females. The average age (7.27 + 1.16) years old, average weight (29.26 + 10.88) kg, average BMI (17.90 + 5.34) kg/m~2. has the performance in the night of sleep: sleep snoring, mouth breathing, breathing difficulties and even apnea, daytime sleepiness, attention Concentration of.84 children according to the diagnostic criteria of OSAHS children were divided into OSAHS group and simple snoring group (PS group), the Respironics production company Alice5 overnight polysomnography sleep apnea monitoring (PSG). The OSAHS children (OSAHS group) and simple snoring children (PS group). Sleep structure and height, weight, age, the lowest oxygen saturation and other general index statistics comparative analysis, observation of similarities and differences. At the same time, respectively, and domestic references on the same age group (6~9 years old) to compare the sleep structure of normal children, to observe whether the differences between them. The simple snoring group (PS group) were analyzed within group correlation with OSAHS group of two groups of children, to observe the apnea hypopnea index (AHI) and III + IV sleep percentage of total sleep time, arousal index (MI), REM sleep total sleep percentage index Whether there is a linear relationship. Results: after manual correction analysis after polysomnography analysis showed simple snoring group (PS group) and OSAHS group of sleep structure characteristics are as follows: sleep latency (16.61 + 26.47vs15.66 + 19.11min), sleep efficiency (87.15% + 7.30% vs87.11% + 10.85%), percentage of sleep phase I (14.70% + 11.49%vs18.31% + 10.73%), percentage of sleep phase II (40.72% + 16.48%vs39.55% + 15.17%), III + IV (slow wave sleep) percentage (34.90% + 15.22%vs30.33% + 12.52%), the percentage of REM phase (9.69% + 5.14% vs11.83% + 7.24%) there was no statistically significant difference (P > 0.05) but only. Snoring group (PS group) and OSAHS group (MI microarousal index) (7.49 + 3.09vs14.76 + 9.70 /h), the lowest SaO2 (88.12% + 7.79%vs79.41% + 14.24%) compared with significant difference (P < 0.01). Then the PS group and OSAHS group were with the same age group (6 锝

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