Yoon Ho-Kyoung, Kang Seung-Gul, Lee Heon-Jeong, Yoo Young, Choung Ji Tae, Seo Won Hee, Kim Leen
Department of Psychiatry, College of Medicine, Korea University, Seoul, South Korea; Sleep-Wake Disorders Center, Korea University Anam Hospital, Seoul, South Korea.
J Sleep Res. 2013 Nov 4. doi: 10.1111/jsr.12103.
It has been reported that sleep problems and neurocognitive deficit in asthmatic children is prevalent. However, systematic studies on these problems in stable asthma using polysomnography have rarely been performed. We therefore investigated sleep and neurocognitive functioning in children with well-controlled asthma. Forty-three children with well-controlled, stable asthma and 31 controls (age range: 6-9 years) were enrolled in the study. Subjects were questioned for daytime sleepiness using the Paediatric Daytime Sleepiness Scale. Complete overnight polysomnography and neurocognitive function tests were performed on all subjects. Children with stable asthma had lower pulmonary function in comparison to their age-matched controls. Asthmatic children had a higher apnea-hypopnea index (P < 0.001) and apnea-hypopnea-related arousal index (P < 0.001) as compared with non-asthmatics. Deep sleep was decreased in asthmatics (P = 0.001). In the vigilance test, the mean number of correct answers was lower (P = 0.005) and the mean reaction time was slower (P = 0.002) in asthmatic children. A hierarchical multiple linear regression showed that deep sleep and apnea-hypopnea-related arousal index were significant predictors of vigilance. The data suggest that the prevalence of paediatric sleep-disordered breathing and sleep fragmentation could be very high among children with well-controlled asthma. Moreover, vigilance, the ability to maintain attention and alertness, was worse in stable asthmatic children when compared with healthy controls. Sleep-disordered breathing should be checked even in stable asthmatic children as they are at risk for developing neurobehavioural deterioration associated with frequent arousals during sleep. Furthermore, early treatment for asthma may be required in order to prevent airway remodelling that could cause sleep problems.
据报道，哮喘儿童中睡眠问题和神经认知缺陷很普遍。然而，使用多导睡眠图对稳定期哮喘患儿的这些问题进行系统研究的却很少。因此，我们调查了哮喘控制良好的儿童的睡眠和神经认知功能。43名哮喘控制良好、病情稳定的儿童和31名对照组儿童（年龄范围：6至9岁）参与了这项研究。使用儿童日间嗜睡量表对受试者进行日间嗜睡情况询问。对所有受试者进行了整夜完整的多导睡眠图检查和神经认知功能测试。与年龄匹配的对照组相比，病情稳定的哮喘儿童肺功能较低。与非哮喘患者相比，哮喘儿童的呼吸暂停低通气指数（P < 0.001）和与呼吸暂停低通气相关的觉醒指数（P < 0.001）更高。哮喘患者的深度睡眠减少（P = 0.001）。在警觉性测试中，哮喘儿童的正确答案平均数较低（P = 0.005），平均反应时间较慢（P = 0.002）。分层多元线性回归显示，深度睡眠和与呼吸暂停低通气相关的觉醒指数是警觉性的重要预测因素。数据表明，在哮喘控制良好的儿童中，小儿睡眠呼吸障碍和睡眠片段化的患病率可能非常高。此外，与健康对照组相比，病情稳定的哮喘儿童的警觉性（即保持注意力和警觉的能力）较差。即使是病情稳定的哮喘儿童也应检查睡眠呼吸障碍，因为他们有发生与睡眠期间频繁觉醒相关的神经行为恶化的风险。此外，可能需要早期治疗哮喘以预防可能导致睡眠问题的气道重塑。
