Rosen C L, D'Andrea L, Haddad G G
Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510.
Am Rev Respir Dis. 1992 Nov;146(5 Pt 1):1231-4. doi: 10.1164/ajrccm/146.5_Pt_1.1231.
Although obstructive sleep apnea (OSA) occurs in the pediatric population, diagnostic criteria have not been established. Since criteria for adult OSA are well established, we asked whether commonly used adult criteria, such as the apnea index (based on the number of obstructive apnea [OA] events per hour), would identify children with serious sleep-related upper airway obstruction. Polysomnographic data were analyzed from 20 children (ages 8 months to 16 yr) with clinical evidence of upper airway obstruction during sleep (loud snoring and labored breathing) and who had cyclic oscillations of oxyhemoglobin saturation (SaO2) during sleep. The overnight studies included sleep state (EEG, EOG, and EMG), SaO2, ECG, nasal (end-tidal CO2) and oral (thermistor) airflow, chest and abdominal movement (inductance plethysmography), and video camera and behavioral observations. Measurements included the number of obstructive events > or = 10 s, the number of desaturations (> or = 5% decrease lasting > or = 5 s), the number of desaturation episodes to < 90%, < 85%, and < 80% lasting > 5 s, and the percentage of sleep time with SaO2 values < 90%. Gas exchange was impaired as evidenced by cyclic decreases in SaO2 and elevated PETCO2 values (maximum value 58 +/- 6 mm Hg). The children experienced 175 +/- 168 (range 6 to 609) episodes of decreased SaO2 > 5%, with an average minimum SaO2 of 66 +/- 13% (range 30 to 85%). The average number of apnea events was only 1.9 +/- 3.2 events/h (range 0 to 10.4).(ABSTRACT TRUNCATED AT 250 WORDS)
尽管小儿群体中会发生阻塞性睡眠呼吸暂停（OSA），但其诊断标准尚未确立。由于成人OSA的标准已明确，我们探究常用的成人标准，如呼吸暂停指数（基于每小时阻塞性呼吸暂停[OA]事件的数量），是否能识别出患有严重睡眠相关上气道阻塞的儿童。对20名儿童（年龄8个月至16岁）的多导睡眠图数据进行了分析，这些儿童有睡眠期间上气道阻塞的临床证据（大声打鼾和呼吸费力），且睡眠期间氧合血红蛋白饱和度（SaO2）有周期性波动。夜间研究包括睡眠状态（脑电图、眼电图和肌电图）、SaO2、心电图、鼻腔（呼气末二氧化碳）和口腔（热敏电阻）气流、胸部和腹部运动（感应体积描记法）以及摄像机和行为观察。测量指标包括阻塞事件持续≥10秒的数量、血氧饱和度下降的数量（≥5%下降持续≥5秒）、血氧饱和度下降至<90%、<85%和<80%且持续>5秒的发作次数，以及SaO2值<90%的睡眠时间百分比。SaO2的周期性下降和呼气末二氧化碳分压（PETCO2）值升高（最大值58±6毫米汞柱）表明气体交换受损。儿童经历了175±168次（范围6至609次）SaO2下降>5%的发作，平均最低SaO2为66±13%（范围30至85%）。呼吸暂停事件平均数量仅为1.9±3.2次/小时（范围0至10.4次）。（摘要截短于250字）
