腺样体扁桃体切除术候选患者阻塞性睡眠呼吸暂停严重程度的预测因素。
Predictors of obstructive sleep apnea severity in adenotonsillectomy candidates.
作者信息
Weinstock Tanya G, Rosen Carol L, Marcus Carole L, Garetz Susan, Mitchell Ron B, Amin Raouf, Paruthi Shalini, Katz Eliot, Arens Raanan, Weng Jia, Ross Kristie, Chervin Ronald D, Ellenberg Susan, Wang Rui, Redline Susan
机构信息
Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH.
出版信息
Sleep. 2014 Feb 1;37(2):261-9. doi: 10.5665/sleep.3394.
STUDY OBJECTIVES
There is uncertainty over which characteristics increase obstructive sleep apnea syndrome (OSAS) severity in children. In candidates for adenotonsillectomy (AT), we evaluated the relationship of OSAS severity and age, sex, race, body mass index (BMI), environmental tobacco smoke (ETS), prematurity, socioeconomic variables, and comorbidities.
DESIGN
Cross-sectional screening and baseline data were analyzed from the Childhood Adenotonsillectomy Trial, a randomized, controlled, multicenter study evaluating AT versus medical management. Regression analysis assessed the relationship between the apnea hypopnea index (AHI) and risk factors obtained by direct measurement or questionnaire.
SETTING
Clinical referral setting.
PARTICIPANTS
Children, ages 5 to 9.9 y with OSAS.
MEASUREMENTS AND RESULTS
Of the 1,244 children undergoing screening polysomnography, 464 (37%) were eligible (2 ≤ AHI < 30 or 1 ≤ obstructive apnea index [OAI] < 20 and without severe oxygen desaturation) and randomized; 129 (10%) were eligible but were not randomized; 608 (49%) had AHI/OAI levels below entry criteria; and 43 (3%) had levels of OSAS that exceeded entry criteria. Among the randomized children, univariate analyses showed significant associations of AHI with race, BMI z score, environmental tobacco smoke (ETS), family income, and referral source, but not with other variables. After adjusting for potential confounders, African American race (P = 0.003) and ETS (P = 0.026) were each associated with an approximately 20% increase in AHI. After adjusting for these factors, obesity and other factors were not significant.
CONCLUSIONS
Apnea hypopnea index level was significantly associated with race and environmental tobacco smoke, highlighting the potential effect of environmental factors, and possibly genetic factors, on pediatric obstructive sleep apnea syndrome severity. Efforts to reduce environmental tobacco smoke exposure may help reduce obstructive sleep apnea syndrome severity.
CLINICAL TRIAL REGISTRATION
Clinicaltrials.gov (#NCT00560859).
研究目的
对于哪些特征会增加儿童阻塞性睡眠呼吸暂停综合征（OSAS）的严重程度，目前尚不确定。在接受腺样体扁桃体切除术（AT）的患儿中，我们评估了OSAS严重程度与年龄、性别、种族、体重指数（BMI）、环境烟草烟雾（ETS）、早产、社会经济变量以及合并症之间的关系。
设计
对儿童腺样体扁桃体切除术试验的横断面筛查和基线数据进行分析，该试验是一项评估AT与药物治疗的随机、对照、多中心研究。回归分析评估了呼吸暂停低通气指数（AHI）与通过直接测量或问卷获得的危险因素之间的关系。
地点
临床转诊机构。
参与者
5至9.9岁患有OSAS的儿童。
测量与结果
在1244名接受筛查多导睡眠图检查的儿童中，464名（37%）符合条件（2≤AHI<30或1≤阻塞性呼吸暂停指数[OAI]<20且无严重氧饱和度降低）并被随机分组；129名（10%）符合条件但未被随机分组；608名（49%）的AHI/OAI水平低于入选标准；43名（3%）的OSAS水平超过入选标准。在随机分组的儿童中，单因素分析显示AHI与种族、BMI z评分、环境烟草烟雾（ETS）、家庭收入和转诊来源有显著关联，但与其他变量无关。在对潜在混杂因素进行调整后，非裔美国人种族（P = 0.003）和ETS（P = 0.026）各自与AHI升高约20%相关。在对这些因素进行调整后，肥胖和其他因素并不显著。
结论
呼吸暂停低通气指数水平与种族和环境烟草烟雾显著相关，突出了环境因素以及可能的遗传因素对儿童阻塞性睡眠呼吸暂停综合征严重程度的潜在影响。减少环境烟草烟雾暴露的努力可能有助于降低阻塞性睡眠呼吸暂停综合征的严重程度。
临床试验注册
Clinicaltrials.gov（#NCT00560859）。
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