Mellies Uwe, Dohna-Schwake Christian, Ragette Regine, Teschler Helmut, Voit Thomas
Abteilung allgemeine Kinderheilkunde/Schwerpunkt Neuropädiatrie, Zentrum für Kinderheilkunde, Universtitätsklinikum Essen, Deutschland.
Wien Klin Wochenschr. 2003 Dec 30;115(24):855-9. doi: 10.1007/BF03040405.
Sleep disordered breathing (SDB) is an inevitable complication of progressive neuromuscular disorders (NMD). Aim of the study was to prospectively investigate the impact of three months of non-invasive ventilation (NIV) on sleep and SDB-associated symptoms in children and adolescents with advanced NMD.
Twenty-two patients (11.1 +/- 4.3 years) with symptomatic SDB were enrolled in the study and evaluated with polysomnography and a symptom questionnaire. Twenty patients were treated with pressure assisted ventilation during sleep. The impact of NIV on SDB, sleep and symptoms was re-evaluated after 3 months of NIV.
In 2/22 patients, after adenotomy, SDB was no longer demonstrable. In the remaining 20 patients NIV improved SDB (Respiratory Disturbance Index 1.8 +/- 1.6 vs. 9.2 +/- 4.5/h; minimal SpO2 91 +/- 3 vs. 79 +/- 12%). Three months of treatment resulted in shortened sleep latency (17 +/- 13 vs. 42 +/- 38 minutes), improved sleep efficiency (95 +/- 3 vs. 89 +/- 9%) and less EEG-arousals (11 +/- 5 vs. 22 +/- 9/h, p < 0.001 for all). Sleep-stage proportion did not change. Patients reported significant improvements of sleep quality, morning headaches, mood, concentration and daytime sleepiness (p < 0.001 for all).
In children with NMD intermittent nocturnal NIV results in objective and subjective improvements of sleep quality and symptoms associated with SDB.
睡眠呼吸障碍（SDB）是进行性神经肌肉疾病（NMD）不可避免的并发症。本研究的目的是前瞻性调查三个月的无创通气（NIV）对患有晚期NMD的儿童和青少年睡眠及SDB相关症状的影响。
22例有症状性SDB的患者（11.1±4.3岁）纳入本研究，并用多导睡眠图和症状问卷进行评估。20例患者在睡眠期间接受压力辅助通气治疗。NIV治疗3个月后，重新评估NIV对SDB、睡眠和症状的影响。
22例患者中有2例在腺样体切除术后SDB不再明显。其余20例患者NIV改善了SDB（呼吸紊乱指数1.8±1.6比9.2±4.5/小时；最低血氧饱和度91±3%比79±12%）。三个月的治疗使睡眠潜伏期缩短（17±13比42±38分钟），睡眠效率提高（95±3%比89±9%），脑电图觉醒减少（11±5比22±9/小时，所有p<0.001）。睡眠阶段比例未改变。患者报告睡眠质量、晨起头痛、情绪、注意力和日间嗜睡有显著改善（所有p<0.001）。
对于患有NMD的儿童，夜间间歇性NIV可使睡眠质量及与SDB相关的症状在客观和主观上得到改善。
