Huseni Shehlanoor, Gutierrez Maria J, Rodriguez-Martinez Carlos E, Nino Cesar L, Perez Geovanny F, Pancham Krishna, Nino Gustavo
Divivsion of Pediatric Pulmonology and Sleep Medicine, Children's National Medical Center, Washington D.C., USA.
Am J Rhinol Allergy. 2014 Jan-Feb;28(1):e56-61. doi: 10.2500/ajra.2014.28.3994.
Rhinitis and obstructive sleep apnea (OSA) often coexist during childhood. To delineate this clinical association, we examined OSA severity and polysomnogram (PSG) features in children with rhinitis and OSA. Given that rapid-eye-movement (REM) sleep is characterized by nasal congestion, we hypothesized that children with rhinitis have more REM-related breathing abnormalities.
We conducted a retrospective cross-sectional analysis of 145 children with PSG-diagnosed OSA. Outcomes included PSG parameters and obstructive apnea-hypopnea index (OAHI) during REM and non-REM. Linear multivariable models examined the joint effect of rhinitis and OSA parameters with control for potential confounders.
Rhinitis was present in 43% of children with OSA (n = 63) but overall OAHI severity was unaffected by the presence of rhinitis. In contrast, OAHI during REM sleep in children with moderate-severe OSA was significantly increased in subjects with rhinitis and OSA (44.1/hr; SE = 6.4) compared with those with OSA alone (28.2/hr; SE = 3.8).
Rhinitis is highly prevalent in children with OSA. Although OSA is not more severe in children with rhinitis, they do have a distinct OSA phenotype characterized by more REM-related OSA. Further research is needed to delineate the link between REM-sleep and the physiology of the nose during health and disease.
鼻炎与阻塞性睡眠呼吸暂停（OSA）在儿童时期常同时存在。为了阐明这种临床关联，我们研究了患有鼻炎和OSA的儿童的OSA严重程度及多导睡眠图（PSG）特征。鉴于快速眼动（REM）睡眠的特征是鼻充血，我们推测患有鼻炎的儿童有更多与REM相关的呼吸异常。
我们对145例经PSG诊断为OSA的儿童进行了回顾性横断面分析。结果包括REM期和非REM期的PSG参数及阻塞性呼吸暂停低通气指数（OAHI）。线性多变量模型在控制潜在混杂因素的情况下检验了鼻炎和OSA参数的联合效应。
43%的OSA儿童（n = 63）患有鼻炎，但鼻炎的存在并未影响总体OAHI严重程度。相比之下，与单纯患有OSA的儿童（28.2次/小时；标准误 = 3.8）相比，患有鼻炎和OSA的中重度OSA儿童在REM睡眠期的OAHI显著增加（44.1次/小时；标准误 = 6.4）。
鼻炎在患有OSA的儿童中非常普遍。虽然患有鼻炎的儿童的OSA并不更严重，但他们确实有一种独特的OSA表型，其特征是更多与REM相关的OSA。需要进一步研究来阐明健康和疾病状态下REM睡眠与鼻子生理之间的联系。
