Li Albert M, Wing Yun Kwok, Cheung Agnes, Chan Dorothy, Ho Crover, Hui Stephen, Fok Tai Fai
Department of Psychiatry, Shatin Hospital, Shatin, The Chinese University of Hong Kong, Hong Kong.
Chest. 2004 Nov;126(5):1467-72. doi: 10.1378/chest.126.5.1467.
There are limited data on the night-to-night variability of childhood sleep-related disordered breathing (SDB). We aim to assess for the presence of first-night effect (FNE) and to examine whether a single-night sleep study is adequate in the assessment of childhood SDB.
In a case-control study investigating whether obesity is a risk factor for childhood SDB, the night-to-night variability of sleep and respiratory variables were studied.
Forty-six obese children from a pediatric obesity clinic and 44 age- and sex-matched normal weight control subjects from local schools.
All subjects underwent two consecutive overnight polysomnographic studies. An obstructive apnea index (OAI) >/= 1/h was considered diagnostic of SDB.
The mean age of the children was 11.21 years (SD 2.21). Forty-four obese children and 43 control subjects completed the 2-night study. Based on the criterion of the worst OAI over the 2 nights, 13 subjects were found to have SDB, 12 subjects were primary snorers, and 62 were normal subjects. In all subjects, the sleep efficiency improved and sleep-onset latency was reduced on the second night. While there was a rebound of rapid eye movement sleep with the associated worsening of respiratory indexes (mainly accounted for by an increase in central apneas and hypopneas) evident in normal subjects, there was a significant improvement of respiratory disturbances in the SDB group on the second night. The first-night polysomnography would have correctly identified 84.6% of cases as defined by the criteria of the worst OAI over the 2 nights. All cases missed by the first-night study had only borderline OAI.
The phenomenon of FNE in children was well demonstrated in our study. We proposed that a single-night sleep study is adequate and more cost-effective in assessing for childhood SDB.
关于儿童睡眠相关呼吸障碍（SDB）的夜间变异性数据有限。我们旨在评估首夜效应（FNE）的存在情况，并研究单夜睡眠研究在儿童SDB评估中是否足够。
在一项调查肥胖是否为儿童SDB危险因素的病例对照研究中，对睡眠和呼吸变量的夜间变异性进行了研究。
来自儿科肥胖诊所的46名肥胖儿童以及来自当地学校的44名年龄和性别匹配的正常体重对照受试者。
所有受试者均连续进行了两晚的多导睡眠图研究。阻塞性呼吸暂停指数（OAI）≥1次/小时被视为SDB的诊断标准。
儿童的平均年龄为11.21岁（标准差2.21）。44名肥胖儿童和43名对照受试者完成了两晚的研究。根据两晚中最差OAI的标准，发现13名受试者患有SDB，12名受试者为原发性打鼾者，62名受试者正常。在所有受试者中，第二晚的睡眠效率提高，入睡潜伏期缩短。虽然正常受试者中快速眼动睡眠出现反弹，同时呼吸指标恶化（主要由中枢性呼吸暂停和呼吸浅慢的增加引起），但SDB组第二晚的呼吸紊乱有显著改善。首夜多导睡眠图按照两晚中最差OAI的标准可正确识别84.6%的病例。首夜研究漏诊的所有病例OAI仅处于临界值。
我们研究中充分证明了儿童存在FNE现象。我们提出，单夜睡眠研究在评估儿童SDB方面足够且更具成本效益。
