Dayyat Ehab, Maarafeya Muna M A, Capdevila Oscar Sans, Kheirandish-Gozal Leila, Montgomery-Downs Hawley E, Gozal David
Kosair Children's Hospital Sleep Medicine and Apnea Center, Department of Pediatrics, University of Louisville, Louisville, Kentucky 40202, USA.
Pediatr Pulmonol. 2007 Apr;42(4):374-9. doi: 10.1002/ppul.20590.
To assess whether body position during sleep differs among children with obstructive sleep apnea (OSAS) and controls, and to assess the effects of body position, obesity, and tonsillar size on respiratory disturbance. Four hundred and thirty consecutive children with polysomnographically demonstrated OSAS. And 185 age-, gender-, and ethnically matched children (Controls) were compared. The effect of sleep body position on respiratory disturbance was examined in OSAS, and also in relation to obesity and tonsillar size. Children with OSAS spent more time in the supine position than Controls (P<0.01), with less time spent in the side position (P<0.005). Obstructive apnea and hypopnea index (AHI) was similar in the three sleep-related positions, but apnea index (AI) was significantly greater (4.6 +/- 0.7/hr TST) in the supine position than in the side position (2.7 +/- 0.3/hr TST; P<0.001) or prone position (3.3 +/- 0.5/hr TST; P<0.01). Tonsillar size was not a contributing factor to positional differences in AI or AHI. Obese OSAS children had increased prone position (20.4 +/- 2.0%TST vs. non-obese: 10.9 +/- 2.5%TST; P<0.05), and displayed increased AHI and AI while supine. Non-obese OSAS increased AHI in prone or side positions compared to supine (P<0.01), with no significant differences in position-dependent AI. Children with OSAS spend more time sleeping supine and less time on the side. Obese children with OSAS are more likely to sleep prone, suggesting that this position may promote upper airway patency in the presence of obesity. Although tonsillar size is not associated with positional differences in breathing, the presence or absence of obesity markedly modifies the effect of body position on respiratory disturbance.
评估阻塞性睡眠呼吸暂停（OSAS）患儿与对照组儿童睡眠时的体位是否存在差异，并评估体位、肥胖和扁桃体大小对呼吸紊乱的影响。连续纳入430例经多导睡眠图证实患有OSAS的儿童，并与185例年龄、性别和种族匹配的儿童（对照组）进行比较。研究了睡眠体位对OSAS患儿呼吸紊乱的影响，并分析了其与肥胖和扁桃体大小的关系。OSAS患儿仰卧位睡眠的时间比对照组更长（P<0.01），而侧卧位睡眠的时间更短（P<0.005）。阻塞性呼吸暂停低通气指数（AHI）在三种与睡眠相关的体位中相似，但仰卧位的呼吸暂停指数（AI）显著高于侧卧位（2.7±0.3次/小时总睡眠时间；P<0.001）或俯卧位（3.3±0.5次/小时总睡眠时间；P<0.01）（4.6±0.7次/小时总睡眠时间）。扁桃体大小不是AI或AHI体位差异的影响因素。肥胖的OSAS患儿俯卧位睡眠的时间增加（20.4±2.0%总睡眠时间，非肥胖患儿为10.9±2.5%总睡眠时间；P<0.05），仰卧位时AHI和AI升高。与仰卧位相比，非肥胖OSAS患儿在俯卧位或侧卧位时AHI升高（P<0.01），体位依赖性AI无显著差异。OSAS患儿仰卧位睡眠时间更长且侧卧位睡眠时间更短。肥胖的OSAS患儿更倾向于俯卧位睡眠，提示该体位可能在肥胖情况下促进上气道通畅。尽管扁桃体大小与呼吸的体位差异无关，但肥胖的存在或不存在显著改变了体位对呼吸紊乱的影响。
