Zhao Qiuhong, Sherrill Duane L, Goodwin James L, Quan Stuart F
SIROW, College of Social and Behavioral Sciences, University of Arizona, AZ, USA.
Open Epidemiol J. 2008;1:1-9. doi: 10.2174/1874297100801010001.
This study analyzed the association between the Respiratory Disturbance Index (RDI) and two behavior measures, the Conners' Parent Rating Scale (CPRS-R) and the Child Behavior Checklist (CBCL) in school-aged children to determine whether there is an optimal threshold of Sleep-disordered Breathing (SDB) associated with increased risk of behavior problems. METHODS: The Tucson Children's Assessment of Sleep Apnea Study (TuCASA) is an observational cohort study of 6-11 year old Caucasian and Hispanic children designed to assess the anatomic, physiologic and neurocognitive correlates of SDB. 403 children with both polysomnography (PSG) and behavioral data were included in this analysis. Three definitions of SDB were used: RDI independent of oxygen desaturation (RDI0), RDI with 2% oxygen desaturation (RDI2) and RDI with 3% oxygen desaturation (RDI3). T-scored behavioral data were dichotomized at a cutoff point of 65, a score indicative of moderate to severe clinical impairment. Logistic regression was used to access the risk associated with SDB. RESULTS: The analyses conducted using three different definitions of RDI suggest that the likelihood of having a clinically significant CPRS-R or CBCL subscale score was not necessarily progressive or linear across RDI categories. Cutoff points and prevalences for each definition of RDI proposed to be indicators of clinically significant SDB were RDI0 ≥ 7 (19.38%), RDI2 ≥ 2 (29.38%) and RDI3 ≥ 0.5 (23.96%) events per hour of sleep. Behaviors such as CPRS oppositional, social problems, psychosomatic and CBCL somatic complaints, social problems and aggressive behaviors were found to be significantly associated with SDB. CONCLUSIONS: This analysis found an increased risk of behavior problems such as somatic complaints, oppositional or aggressive behaviors and social problems associated with sleep-disordered breathing in school-aged children. RDI cut points for three definitions of SDB are proposed: 7 for RDI0, 2 for RDI2, and 0.5 for RDI3 respectively.
本研究分析了学龄儿童呼吸紊乱指数（RDI）与两种行为测量方法，即康纳斯父母评定量表（CPRS-R）和儿童行为检查表（CBCL）之间的关联，以确定是否存在与行为问题风险增加相关的睡眠呼吸障碍（SDB）最佳阈值。方法：图森儿童睡眠呼吸暂停评估研究（TuCASA）是一项针对6至11岁白种人和西班牙裔儿童的观察性队列研究，旨在评估SDB的解剖学、生理学和神经认知相关性。本分析纳入了403名同时有多导睡眠图（PSG）和行为数据的儿童。使用了三种SDB定义：独立于氧饱和度降低的RDI（RDI0）、伴有2%氧饱和度降低的RDI（RDI2）和伴有3%氧饱和度降低的RDI（RDI3）。行为数据的T分数在65分的临界点进行二分法划分，该分数表明存在中度至重度临床损害。使用逻辑回归来评估与SDB相关的风险。结果：使用RDI的三种不同定义进行的分析表明，在RDI类别中，具有临床显著CPRS-R或CBCL子量表分数的可能性不一定是渐进的或线性的。为每种RDI定义提议的作为临床显著SDB指标的临界点和患病率分别为：RDI0≥7（19.38%）、RDI2≥2（29.38%）和RDI3≥0.5（23.96%）次事件/小时睡眠。发现诸如CPRS对立、社交问题、心身问题以及CBCL躯体主诉、社交问题和攻击行为等行为与SDB显著相关。结论：本分析发现学龄儿童中与睡眠呼吸障碍相关的行为问题风险增加，如躯体主诉、对立或攻击行为以及社交问题。提出了SDB三种定义的RDI临界点：RDI0为7、RDI2为2、RDI3为0.5。
