Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, Division of Biological Sciences, The University of Chicago, Chicago, IL 60637, USA.
Sleep Med. 2012 Feb;13(2):178-84. doi: 10.1016/j.sleep.2011.10.025. Epub 2011 Dec 15.
Studies ascribe different functions to rapid eye movement (REM) and non-rapid eye movement (NREM) sleep, such that their disruption could result in discrepant clinical outcomes. Although sleep architecture is globally preserved in children with obstructive sleep apnoea (OSA), it is considered to be an REM sleep REMS disorder. Furthermore, body position during sleep affects the occurrence of respiratory events, while the presence of obesity has been claimed to affect sleep-state distribution of respiratory disturbance.
To explore the distribution of respiratory events during REMS and NREM sleep NREMS and its potential predictors, a cross-sectional analysis of 335 overnight sleep studies in snoring children from the community was conducted. The ratio of REMS to NREMS respiratory events was compared, and potential associations were assessed using general linear modelling (GLM).
Children were 7.3±1.2 years old and had a body mass index (BMI) z-score of 1.0±1.3. The obstructive apnoea-hypopnea index (OAHI) was 1.7±3 and 45.8% of children had an apnoea-hypopnea index (AHI) >1h(-1) total sleep time (TST). Obstructive respiratory events were 3.8 times more likely in REMS (2.0 h(-1)) than NREMS (0.5h(-1)), and the GLM revealed distinctive predictive associations for the apnoeic and hypopneic indices separately, and for body position, the latter indicating that the REMS/NREMS distribution of respiratory events depends on body position.
Obstructive respiratory events are predominantly, albeit not exclusively, present in REMS in school-aged children. NREMS respiratory events are more likely in the presence of lower oxyhaemoglobin saturations during event, side body position and in African-American children. However, REMS dominance is not affected by either BMI z-score or obesity. Our findings suggest that incorporating comprehensive respiratory event profiles of children may enhance our understanding of the pathophysiology and adverse outcomes in the context of paediatric OSA.
研究赋予快速眼动 (REM) 和非快速眼动 (NREM) 睡眠不同的功能，因此它们的破坏可能导致不同的临床结果。尽管阻塞性睡眠呼吸暂停 (OSA) 儿童的睡眠结构总体上得到保留，但它被认为是 REM 睡眠 REMS 障碍。此外，睡眠期间的身体姿势会影响呼吸事件的发生，而肥胖的存在据称会影响呼吸障碍的睡眠状态分布。
为了探讨 REM 和 NREM 睡眠 NREMS 期间呼吸事件的分布及其潜在预测因素，对社区中 335 例打鼾儿童的过夜睡眠研究进行了横断面分析。比较了 REM 和 NREMS 呼吸事件的比例，并使用一般线性模型 (GLM) 评估了潜在的关联。
儿童年龄为 7.3±1.2 岁，体重指数 (BMI) z 分数为 1.0±1.3。阻塞性呼吸暂停低通气指数 (OAHI) 为 1.7±3，45.8%的儿童总睡眠时间 (TST) 中呼吸暂停低通气指数 (AHI) >1h(-1)。REM 中阻塞性呼吸事件的可能性是 NREMS（0.5h(-1)）的 3.8 倍（2.0 h(-1)），GLM 分别对呼吸暂停和低通气指数以及身体位置具有独特的预测关联，后者表明呼吸事件的 REM/NREMS 分布取决于身体位置。
在学龄儿童中，阻塞性呼吸事件主要存在于 REM 中，尽管并非排他性存在。在事件期间较低的血氧饱和度、侧卧位和非裔美国儿童中，NREMS 呼吸事件更有可能发生。然而，BMI z 分数或肥胖均不会影响 REM 的优势。我们的研究结果表明，纳入儿童全面的呼吸事件谱可能会增进我们对小儿 OSA 背景下病理生理学和不良结局的理解。
