Xu Zhifei, Cheuk Daniel Ka Leung, Lee So Lun
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, People's Republic of China.
Chest. 2006 Dec;130(6):1765-71. doi: 10.1378/chest.130.6.1765.
To determine whether parents' observation, clinical examination, and lateral upper airway radiograph are useful in detecting clinically significant obstructive sleep apnea (OSA) in children.
We retrospectively reviewed data of 50 children aged 4 to 18 years who were consecutively referred to a sleep clinic for suspected OSA. All subjects underwent clinical assessments including standardized history collection, physical examination, and lateral neck radiograph for measurement of postnasal space. Each child underwent overnight polysomnography on the night of clinical assessments. Patients with clinically significant OSA, defined as apnea-hypopnea index (AHI) > 5, were compared with primary snorers, defined as AHI < or = 5.
Thirty-one children had clinically significant OSA, and 19 children were primary snorers. The prevalence of risk factors including allergic rhinitis, obesity, and craniofacial anomaly was similar between the two groups. Observable apnea during sleep, nocturnal enuresis, intrusive naps, mouth breathing, enlarged tonsils, and radiologic features of upper airway narrowing due to adenoid hypertrophy were found to be predictors for clinically significant OSA. Combining upper airway narrowing and mouth breathing or nocturnal enuresis had a sensitivity of 90.3%, and combining all six predictors had a sensitivity of 93.5% of detecting OSA.
Combining clinical and radiologic findings might be helpful to screen for children with clinically significant OSA who need earlier investigation and intervention.
确定家长观察、临床检查及上气道侧位片在检测儿童具有临床意义的阻塞性睡眠呼吸暂停（OSA）方面是否有用。
我们回顾性分析了50名4至18岁因疑似OSA而连续转诊至睡眠诊所的儿童的数据。所有受试者均接受临床评估，包括标准化病史采集、体格检查以及用于测量鼻后间隙的颈部侧位片。每个孩子在临床评估当晚均接受整夜多导睡眠监测。将具有临床意义的OSA患者（定义为呼吸暂停低通气指数（AHI）>5）与原发性打鼾者（定义为AHI≤5）进行比较。
31名儿童患有具有临床意义的OSA，19名儿童为原发性打鼾者。两组间包括变应性鼻炎、肥胖和颅面畸形在内的危险因素患病率相似。睡眠中可观察到的呼吸暂停、夜间遗尿、发作性睡病、口呼吸、扁桃体肿大以及腺样体肥大导致的上气道狭窄的放射学特征被发现是具有临床意义的OSA的预测因素。将上气道狭窄与口呼吸或夜间遗尿相结合检测OSA的敏感度为90.3%，将所有六个预测因素相结合的敏感度为93.5%。
结合临床和放射学检查结果可能有助于筛查出需要早期检查和干预的具有临床意义的OSA儿童。
