Rosenberg Eran, Elkrinawi Soliman, Goldbart Aviv, Leiberman Alberto, Tarasiuk Ariel, Tal Asher
Department of Pediatrics B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer Sheba, Israel.
Harefuah. 2009 May;148(5):295-9, 351.
Obstructive sleep apnea syndrome (OSAS) has been reported among children aged 3-6 years. Adenotonsillar hypertrophy is the most common cause of OSAS. The upper airway obstruction results in repeated obstructive apneas and hypopneas, associated with oxygen desaturations and sleep fragmentation. OSAS in children is associated with higher respiratory morbidity as well as significant clinical consequences, mainly neurocognitive and behavioral problems, impaired growth and cardiac dysfunction. The objectives of the present study were to determine the clinical and sleep characteristics of OSAS in children younger than 2 years, and to evaluate morbidity and health care utilization of infants with OSAS. This retrospective study included 35 children younger than 2 years of age, referred for polysomnography because of suspected OSAS. The controL group included healthy children, matched by age, gender and pediatrician.
A total of 33 infants were diagnosed with OSAS. Mean apnea/hypopnea index [AHI) was 18.7 +/- 18.1 events/ hour [range 1.3-90.2]. In 10 infants a pattern of intermittent hypoxemia was observed. Infants with OSAS demonstrated a higher number of primary care clinic visits (20.8 +/- 14 vs. 12.1 +/- 6.6, P < 0.02). A higher percentage of children with OSAS visited the emergency room (60.6% vs. 32.2%, P < 0.03), and was hospitalized (36.3% vs. 12.9%, P < 0.03). Duration of hospitalization was also higher in the OSAS group [23.2 +/- 14.1% vs. 3 +/- 2.1%, P < 0.05). The number of drug prescriptions was higher among the study group [25.9 +/- 21.8% vs. 13.6 +/- 10.1, P < 0.03). Thirteen patients underwent adenoidectomy with or without tonsillectomy, resulting in improvement of AHI, decreasing from 26.4 +/- 24 before to 3.6 +/- 4.5 events per hour after surgery (p < 0.01).
OSAS can be found in infants younger than 2 years of age. OSAS at this young age is characterized by a higher morbidity in comparison to healthy children. Early diagnosis and treatment may prevent morbidity in young children with OSAS.
据报道，3至6岁儿童中存在阻塞性睡眠呼吸暂停综合征（OSAS）。腺样体扁桃体肥大是OSAS最常见的病因。上呼吸道阻塞导致反复的阻塞性呼吸暂停和呼吸浅慢，伴有氧饱和度下降和睡眠片段化。儿童OSAS与较高的呼吸系统发病率以及严重的临床后果相关，主要是神经认知和行为问题、生长发育受损和心脏功能障碍。本研究的目的是确定2岁以下儿童OSAS的临床和睡眠特征，并评估OSAS婴儿的发病率和医疗保健利用率。这项回顾性研究纳入了35名2岁以下因疑似OSAS而接受多导睡眠图检查的儿童。对照组包括年龄、性别和儿科医生匹配的健康儿童。
共有33名婴儿被诊断为OSAS。平均呼吸暂停/低通气指数（AHI）为18.7±18.1次/小时（范围1.3 - 90.2）。10名婴儿观察到间歇性低氧血症模式。OSAS婴儿的初级保健门诊就诊次数较多（20.8±14次 vs. 12.1±6.6次，P < 0.02）。OSAS儿童到急诊室就诊的比例更高（60.6% vs. 32.2%，P < 0.03），住院比例也更高（36.3% vs. 12.9%，P < 0.03）。OSAS组的住院时间也更长（23.2±14.1天 vs. 3±2.1天，P < 0.05）。研究组的药物处方数量更多（25.9±21.8次 vs. 13.6±10.1次，P < 0.03）。13名患者接受了腺样体切除术，部分患者同时进行了扁桃体切除术，术后AHI得到改善，从术前的26.4±24次/小时降至术后的3.6±4.5次/小时（P < 0.01）。
2岁以下婴儿中可发现OSAS。与健康儿童相比，这个年龄段的OSAS发病率更高。早期诊断和治疗可能预防OSAS幼儿的发病。
